Low-Fat Eating

A Luscious, Rejuvenating Approach to Food

After a two-year, 24,000-mile voyage aboard a 71-foot sailboat, Graham Kerr was stunned by a mutiny in his own kitchen.

Kerr, who gained fame as television’s "Galloping Gourmet" in the 1960s, his wife, Treena, and their three children had willingly forsaken his delectable but high-fat meals after they discovered that rich foods aggravated seasickness. But they revolted against the famed chef’s improvised low-fat cuisine as soon as they docked for the final time in 1974.

So while Kerr clung to his newly found low-fat lifestyle, his family eagerly returned to typical high-fat favorites like cheese, eggs, and sausages. The result? Seven years later, Treena suffered a stroke and a heart attack.

"When the family rebelled, I think if I had said, ‘Look, we’ll recreate the table so that we eat healthy food but get it in a way that you’ll like it,’ what happened to Treena wouldn’t necessarily have occurred," says Kerr, now in his sixties and the author of Graham Kerr’s Best.

Although she fully recovered, Treena was still at high risk for recurrent strokes and heart attacks because she was overweight and her total cholesterol hovered near 350 milligrams per deciliter (mg/dl). So in 1982, she agreed to change her diet. Since then, the couple has stuck to a low-fat lifestyle that consists mainly of fruits, vegetables, and grains. Treena eats no more than 2 ounces of fish, poultry, or red meat daily. Graham’s diet allows him to have slightly more, but never more than 6 ounces. By 1995, when she was in her early sixties, Treena had lost 15 pounds; dropped her total cholesterol to 220 mg/dl raised her high-density lipoproteins (HDLs), the so-called good cholesterol; and slashed her low-density lipoproteins (LDLs), the "bad cholesterol."

"She’s done very well," Kerr says. "I think there is no question that you can do wonderful things if you adopt low-fat eating."

In fact, more and more doctors are convinced that eating excessive amounts of fat is second only to smoking as a health threat. A growing arsenal of powerful evidence is also proving that cutting way back on dietary fat at any age can prevent or reverse heart disease, short-circuit strokes, and stifle the growth of many cancers, says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California.

How Bad Can Fat Be?

Americans love fat. So much that we eat the fat equivalent of six sticks of butter each week. But doing that month after month, year after year, takes its toll.

Of the estimated 13.5 million Americans alive today with a history of heart attack, angina, or both, about 50 percent are age 60 and older. Overall, heart disease and strokes annually kill more than 40 percent of all people who die in the United States. Of the eight controllable risk factors for those two diseases, five—elevated cholesterol and triglycerides, high blood pressure, diabetes, and excessive weight—have been linked to high-fat eating, says Hans Diehl, Dr.H.Sc., director of the Coronary Health Improvement Project, a lifestyle intervention program based in Loma Linda, California, that has helped more than 15,000 people worldwide reduce their risk of heart disease.

Eighty-three percent of the people who die of heart attack, which can be attributed in part to diet, are age 65 or older.

Heart disease, particularly due to atherosclerosis—hardening of the arteries caused by fatty buildups in the circulatory system—can at least double your risk of stroke, says Ralph L. Sacco, M.D., director of the North Manhattan Stroke Study at Columbia-Presbyterian Medical Center, an ongoing project examining stroke incidence among 260,000 people living in racially diverse neighborhoods in New York City.

The risk of ischemic stroke, the most common type caused by blood clots that block arteries supplying blood to the brain, may be even higher if you also have heart disease. French researchers who examined 250 men and women in their sixties and seventies found that those who had deposits of fatty plaque narrowing their aortic arches, the main artery leading out of the heart, were up to nine times more likely to have ischemic strokes than those who didn’t have such buildups.

"If you have plaque there, more than likely you’re going to have it in the arteries leading to or inside the brain, too," Dr. Sacco says.

. . . And Then There’s Cancer

Dietary fat also may have a role in up to 40 percent of cancers in men and 60 percent of those that affect women, says Moshe Shike, M.D., director of clinical nutrition at Memorial Sloan-Kettering Cancer Center in New York City and co-author of Cancer Free.

Research shows that men in their sixties and seventies who continue to eat lots of red meat are at 2 to 3 times greater risk for colon cancer. They also are more likely to develop rectal cancer and 2.6 times more likely to have prostate cancer than men who limit dietary animal fats. Women older than age 60 who load up on red meat are 2.5 times more likely to develop colon cancer.

Scientists also are learning more about the role of fat in the development of breast cancer. Researchers at the University of Hawaii, for instance, compared the eating habits of 272 postmenopausal women who were being treated for breast cancer with 296 women who lived in the same area but who were cancer-free. They found that overweight women who ate a lot of foods high in saturated fat like sausage, processed cold cuts, beef, lamb, and whole-milk dairy food were at greater risk for breast cancer.

"We know that saturated fats have an impact on hormone levels in the body, and we think that has a role in promoting breast cancer," says Cheryl Ritenbaugh, Ph.D., head of nutrition research at the Arizona Cancer Center in Tucson.

Eating fat also might increase your risk of lung cancer even if you don’t smoke, says Michael Alavanja, Ph.D., senior scientist at the National Cancer Institute in Rockville, Maryland. In his study of 429 female nonsmokers ranging up to age 84, Dr. Alavanja concluded that those who ate the most saturated fat were six times more likely to have lung cancer than those who consumed the least amount of that fat.

"At least seven studies worldwide have shown an effect of saturated fat on lung cancer," Dr. Alavanja says. "It’s not conclusive, but the evidence is pointing toward the fact that fat increases the risk of lung cancer among smokers and nonsmokers."

But the truth is that none of these things need to happen to you. You could help prevent and possibly subdue almost every one of these diseases if you did just one thing: Slash the fat.

"It’s very clear that our diet is totally devastating us," Dr. Diehl says. "We know that if we cut the fat content and ate a more plant food-centered diet, we could drastically cut our risk for most cancers, heart disease, and stroke."

So Why Do We Still Eat It?

A surprising number of people—particularly among those of us over age 60—haven’t gotten the word yet.

In fact, one-third of 4,480 people who cook household meals told University of Nebraska researchers that they had never heard that fat was a problem.

"I was very surprised by that finding. The information about fat has been around for a long time. You’d think that by the 1990s everyone would be aware of it, especially the people who are taking care of food preparation for an entire household," says Nancy Betts, R.D., Ph.D., associate professor of nutritional science at the university in Lincoln, who conducted the survey.

Why are we so perplexed?

Well, you probably can guess that fat exists for a reason. Eating it provides us with essential fatty acids that we need to regulate body temperature, maintain healthy skin and hair, and insulate and protect nerves and vital organs like the heart and kidneys.

The problem is that all fats are not created equal. Monounsaturated fats like olive and canola oils and polyunsaturated fats, like corn and safflower oils are considered healthier than saturated fats, which are found mainly in meats, eggs, and dairy products. Trans-fatty acids, another type of harmful fat, are unsaturated fats that have been artificially solidified by food manufacturers to make products like margarines and vegetable shortenings.

Unfortunately, many foods aren’t purely unsaturated or saturated. So when you eat a typical American meal, you’re likely consuming a mixture of these good and bad fats. Therefore, it is possible to unwittingly load up on bad fats even if you chop obvious fats like butter out of your life.

Why Cut Back Now?

The average American eats about 34 percent of calories from fat—down from 43 percent just a few years ago. But many people in their sixties, seventies, and eighties continue to consume 40 to 50 percent of their calories from fat, says Cheryl Pingleton, R.D., a dietitian at the Grand Court Lifestyles, a retirement community in Phoenix.

"Many of the people I see are eating a lot of fried foods, creamy salad dressings, and rich desserts," Pingleton says. "They feel as if they’ve worked their whole lives and now literally want to enjoy the fat of the land."

But as we have seen, enjoying fat too much can lead to serious health problems. If, however, you switch to a low-fat lifestyle, you may quickly feel rejuvenated, particularly if you have a chronic ailment.

"You can lose weight, feel more energetic, have fewer digestive problems, and just feel better about yourself," Pingleton says. "No matter what your age or medical condition—diabetes, gout, high cholesterol, heart disease—low-fat eating is the way to go."

The American Heart Association (AHA) and the National Cancer Institute recommend that no more than 30 percent of total calories come from fat. The AHA says that less than 10 percent of calories should come from saturated fat. Many researchers believe that fat should have an even smaller role on our dinner plates—down to 20 percent or possibly as low as 10 percent of total calories.

"Cutting back on fat will help, and the more drastically you can cut back, the better off you’ll be, with the lower limit being around 7 percent of calories from fat for nutritional adequacy. If you have angina, you’ll certainly have less angina. You’ll also have less risk of stroke, heart attack, and cancer. And every study that I’ve ever looked at says it’s never too late to make these important changes in your diet," says Lee Lipsenthal, M.D., medical director of Preventive Medicine Research Institute in Sausalito, California, where Dean Ornish, M.D., is conducting his pioneering research on reversing heart disease.

In fact, according to Dr. Diehl, switching to a low-fat lifestyle even in your later years can help quash the big three killers—heart disease, stroke, and cancer. Here’s a look at how dietary fat does its harm and how you can stop or even reverse some of this damage.

The Heart of the Matter

Within five hours of eating a fatty meal like a slice of pepperoni pizza or a bologna sandwich, which are loaded with saturated fat, radical and dangerous changes occur in your body’s chemistry, Dr. Klaper says.

First, a tide of fat oozes into the bloodstream and coats red blood cells with a sticky film. "Under normal conditions, blood serum is clear. But after you eat a fatty meal, it is thick, white, and greasy. It looks like household glue," Dr. Klaper says.

Because they’re more sticky, these cells begin to clump together. It is this clumping that eventually forms the blood clots in the arteries, which lead to stroke or heart attack. At the same time, saturated fat raises the harmful LDL cholesterol levels in the blood by suppressing the production of enzymes in the liver that would normally help destroy these compounds. Adding to your woes, as the body processes the fat, it produces free radicals, the same oxidizing molecules that cause metal to rust and food to spoil. Inside your body, these free radicals cause cholesterol to cling to artery walls and clog them up. Years of eating like that virtually guarantees that a person age 60-plus will have at least some atherosclerosis, the underlying disease that can lead to stroke and heart attack.

In addition, this arterial rust makes it more difficult to deliver oxygenated blood, says Dr. Diehl. This starves the tissues and leads to degenerative changes that can cause impotence, hearing loss, degenerative disk disease, memory loss, and vision problems, Dr. Diehl says.

But remember, it doesn’t have to happen.

"Atherosclerosis is totally unnecessary. But it is reversible, even after age 60. All you have to do is take better care of yourself, particularly how you eat. The simpler your diet, the better your chances of reversing these narrowed arteries and increasing blood flow to more adequate levels once again," Dr. Diehl says. "In as little as three weeks, most people can eat themselves out of angina symptoms just by switching to a simpler diet that includes very low fat foods."

Going into Reverse

Several exciting studies have shown that eating a very low fat and low cholesterol diet in conjunction with other lifestyle changes like exercise, smoking cessation, and stress reduction can, as Dr. Diehl says, actually reverse heart disease.

"Our experience has shown that within days of starting a low-fat diet, patients with angina can show an immediate and dramatic decrease in their symptoms," says Monroe Rosenthal, M.D., medical director of the Pritikin Longevity Center in Santa Monica, California. In addition, studies have shown that coronary artery blockages can actually be reversed over a one- to two-year period, he says.

Pritikin researchers, for example, studied a group of 4,587 men and women that included people in their eighties and nineties. After three weeks, those who ate a diet that was less than 10 percent of calories from fat and consisted mostly of fruits, vegetables, and whole grains lowered their total cholesterol levels by 23 percent. This reduction sliced their heart attack risk in half.

"There was little difference in drop in cholesterol levels between the young people and the older people. This is clear proof that it’s never too late to change your lifestyle and improve your health," says R. James Barnard, Ph.D., author of the study and professor of physiology in the Department of Physiological Science at the University of California, Los Angeles.

The Ornish Way Works

Even more dramatic results come from Dr. Ornish’s landmark work. Dr. Ornish divided 43 men and 5 women—many in their fifties, sixties and seventies who had severe atherosclerosis—into two groups. The "treatment" group was instructed to go on a strict vegetarian diet deriving fewer than 10 percent of calories from fat. No meat, poultry, fish, or cheese. No nuts or seeds. No chocolate, no coffee, no cooking oils. In addition, they walked for at least 1 hour, three times a week; practiced meditation and yoga daily; and if they smoked, they quit.

Meanwhile, the other group was advised to follow the standard American Heart Association lifestyle program. That is, reduce their fat intake to less than 30 percent of calories, stop smoking, and exercise moderately.

After one year, 82 percent of those in the treatment group had shown reversal of coronary blockage. The average amount of reduction was about 5 percent. But even that modest regression can mean a 100 percent improvement in blood flow, says Dr. Lipsenthal. Those on the AHA diet didn’t experience these striking results. At best, their disease appeared to progress at a slower rate.

"It’s a world of difference. I’m doing things that I never imagined I could do again," says Victor Karpenko, in his seventies and a retired nuclear engineer in Danville, California. When he began the Ornish program in 1987, he had one artery almost completely blocked, had suffered from persistent angina, and could walk less than a block.

Since then, his total cholesterol has dropped from 290 to 150 milligrams per deciliter, he has lost 30 pounds, his angina is gone, and he regularly hikes in the hills surrounding his home. He also climbs the equivalent of 130 floors on his stair-climber in a half-hour and backpacked in the High Sierras at 8,000 feet with 40 pounds on his back.

"The diet is really the foundation of the whole program," Karpenko says. "I feel so much better now physically and mentally because of it. And it’s a diet that really isn’t hard to stick to when you consider the benefits."

Little Trims Add Up, Too

But even if you can’t see yourself curbing your fat consumption as much as Dr. Ornish suggests, just shaving a modest amount of fat from the obvious sources might have some positive effects.

In the St. Thomas’ Atherosclerosis Regression Study in London, for instance, 26 men up to age 66 were put on a diet that limited fat intake to 27 percent of calories and lowered saturated fat to 8 percent of calories. In a similar group, 24 men were allowed to eat their usual English diets, which typically consist of about 40 percent of calories from fat. Three years later, researchers found that 10 men in the dietary group (compared to 1 man in the usual-care group) had small regressions of artery blockages. As a result, the dietary group reported better control of angina and had three times fewer deaths and coronary surgeries and two times fewer heart attacks.

"Anything that you can do to lower your fat is better than doing nothing at all," Dr. Barnard says. "It’s like a game of Russian roulette. It just depends on how many bullets you want to stick in that revolver. If it holds six bullets and you eat the typical American diet, then you have five bullets in it. If you want to eat 20 percent, you’re down to four. If you go to 15 percent, you’re down to three. And if you can manage to get down to less than 10 percent, you may only have one bullet in that pistol, and your risk of these diseases is dramatically reduced."

The Cancer Link: Another Reason to Lower Fat Now

Fat doesn’t directly cause cancer. Instead, it promotes it—much like ice on a porch step increases the chances that you’ll slip and fall, Dr. Klaper says. Although researchers aren’t certain how this happens, they do have plenty of theories. Some suspect that free radicals, produced as the body metabolizes fat, damage a cell’s genetic codes and spark cancers. Others believe that fat may interfere with the body’s ability to shut down cell growth or that it disrupts the immune system, which may have a protective role against cancer.

High-fat meals also may stimulate production of sexual hormones like estrogen and testosterone that can promote cancer, particularly in the breast and prostate, Dr. Klaper says.

But whatever the reason, it is becoming increasingly clear that the longer you stick to a high-fat lifestyle, the less likely it is that you will remain cancer-free in what should be the best years of your life.

"Eating high-fat foods is like throwing gasoline on a fire," Dr. Klaper says. "You’re just fanning the flames of the cancer and helping it spread."

But as with heart disease and stroke, this doesn’t have to be your future. In fact, slashing dietary fat might help many of us in our sixties, seventies, and eighties halt the progression of certain tumors before they become cancerous and prevent recurrences, Dr. Ritenbaugh says.

It may be too late, for instance, for dietary changes to stop a tumor from developing in the next couple of years, but "tumors that would have gotten you 4, 5, or 10 years from now, you can still do something about," Dr. Ritenbaugh says.

Derailing Tumors

Cutting back to 20 percent of calories from fat, for example, may reduce your risk of precancerous skin growths and prevent skin cancer in your sixties and beyond, according to researchers at Baylor College of Medicin