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CHAPTER ONE

The Perils of Low-Fat Eating

Discovery consists in seeing what everybody else has seen and thinking what nobody else has thought.

—ALBERT SZENT-GYORGI

Susan is 38 years old and she is dieting—again. She couldn’t count the number of diets she has been on since she first tried to lose her “baby fat” at age 13. A half grapefruit for breakfast, a salad with diet dressing for lunch, and broiled fish for dinner will help her reach her goal, she hopes. It seems to get harder and harder each time. It takes less time to regain the weight and more time to lose it, especially from around her waist. Desserts are her downfall—she rewards her daytime watchfulness with a “little treat” at night, Häagen-Dazs rum raisin ice cream. Susan is a chronic dieter.

Twenty-eight-year-old Pat works at maintaining nutrition despite a hectic lifestyle. She often reads articles on the latest food trends and is quick to incorporate them into her diet. Concerned about fat and cholesterol, she avoids oils, butter, red meats, and eggs. She eats shredded wheat with skim milk and bananas for breakfast, stir-fried brown rice with vegetables and soy sauce for lunch, and pasta with meatless tomato sauce for dinner. Her one food vice is chocolate, which she craves, especially just before her period. Some of her friends call her a “nutrition buff.”

At 18, Maryann is just beginning an independent life. One of the things she brought with her into her new apartment is her style of eating. Maryann is a “grabber”—a snacker who subsists on mini-meals as she rushes from one appointment to another. There are simply not enough hours in the day for her to sit down to three basic meals. Breakfast is a croissant and a cup of coffee, followed within a couple of hours by a diet cola and chips at her desk. Lunch with her coworkers is usually a hamburger, french fries, and a shake at a nearby fast-food chain. Dinner (if it’s not pizza) has more variety thanks to the frozen-food section. Fruit-flavored yogurts are her favorite snack.

These three women have different eating habits but share some common complaints. They feel tired much of the time; they are irritable and often feel cold; they seldom sleep soundly through the night; they have various aches and pains that seem to have no cause; they are the first to get the season’s colds; and vaginal infections, menstrual cramps, and bloating plague them every month. A visit to the doctor rules out a medical problem, so they think it must be “stress,” “that time of life,” “getting old,” or “hormonal readjustment”—in any case, just something to live with. The longer they maintain their diet styles, the greater the likelihood that they will develop anemia, heart disease, cancer, osteoporosis, premenstrual syndrome, and arthritis.

Susan, Pat, and Maryann are fictionalized women, but they rep- resent the three basic female eating patterns I have observed while counseling thousands of clients both in person and on the Internet. I spotted these eating patterns repeatedly when I served as the nutrition director at the Pritikin Longevity Center in Santa Monica, California, and while working as a consultant to medical doctors, corporations, and environmental health clinics. By authoring twenty books on nutrition, I have worked to steer women away from these destructive patterns. In the last few years, it has been gratifying to help millions of women worldwide over the Internet via my interactive message board and my Web site, www.annlouise.com.

The chronic dieter, nutrition buff, and grabber are three basic female eating types I have noted over the past decades all over the country. These eating types have also been the focus of attention for USDA nutrition educators and other researchers throughout the country for decades, and they seem to cross economic and age categories. They can be identified in the diet histories of patients I counseled as far back as the early 1990s, spanning from Santa Fe to Washington, D.C., New York, Chicago, and San Francisco.

Whether in private practice, at hospitals, or in public health clinics, I have always required that my clients keep a food diary, recording what, when, and where they eat and drink, as well as their emotions at the time. By reviewing this record of total food intake over a period of three to seven days, I have been able to gauge their current eating habits.

Through my counseling I have evaluated the health impact of these eating styles and the concerns that have motivated women to adopt them in the first place. I have identified the potential health hazards of such eating patterns, and I have found food solutions that are nutritious, delicious, and convenient, whether at home or on the go.

CHRONIC DIETER

Let’s begin with a little background on the chronic dieter who is dieting (again) for weight loss. A National Health Interview Survey found that almost half of American adult women were dieting at any one time.

In my own counseling experience, the majority of clients who have come to see me over the years have wanted to lose weight. Many had already tried the most popular diets of the day, including Weight Watchers, Slim•Fast, Atkins, and Eat 4 Your Type. Were these women on the right track? The answer is yes and no. Based on conventional wisdom, there are basically only two ways to lose weight: burn more calories with exercise, or take in fewer calories with diet. Most women choose this second way.

Most of my clients tried to speed up the weight loss process by skipping meals, believing that by eating even less they would lose more weight faster.

As you read this, an estimated 124 million Americans are deliberately starving themselves in an effort to conform to society’s and their own ideal body image. A large-scale survey in a popular women’s magazine concluded that 75 percent of young women considered themselves too fat, even though 45 percent of them were actually underweight.1 Twice as many women diet as men—and they are happier about losing weight than about any other success in their work or home lives. Even women who are underweight are trying to eat less. In fact, some health authorities believe only 20 percent of women eat normally, without dieting.

Yet the National Center for Health Statistics estimates that 47 percent of women over age 18 are overweight, with 20 percent being obese. A study by the Centers for Disease Control found that nearly 8 percent of women put on more than 30 pounds between the ages of 25 and 35. Over the past five decades, fatness has been increasing steadily in the United States. We spend a staggering $30 billion to $50 billion annually on diet books, pills, foods, and gimmicks, but at the same time we are consuming candy in record amounts. In the last 25 years, our consumption of soft drinks has increased by more than 114 percent, but we’re eating only 10 percent more fruits and have upped our intake of vegetables by a scant 2 percent. Overall, Americans eat 15 percent less fat than they did a decade ago, but weigh 30 percent more.

I’ve often speculated that fatness is on the increase because of our preoccupation with dieting. Eating, not skipping meals, elevates the body’s metabolic rate. In fact, as my former chronic dieters can testify, simply eating three meals a day can burn up to 10 percent more calories. This translates into 200 more burned calories for most women on a daily basis.

Taking in fewer calories usually means taking in fewer nutrients as well. A 1995 USDA study of food consumption found that women got significantly less than the recommended dietary reference intakes (DRIs) of seven nutrients: vitamins B6 and E, calcium, magnesium, iron, folic acid, and zinc.

YO-YO DIETING RISKS

The effects of these schizophrenic eating habits have recently become the subject of serious research. At the University of Pennsylvania and elsewhere, scientists have studied what has become known as the yo-yo syndrome. Their conclusion—dieting can make you fat!

The yo-yo syndrome refers to cycles of weight gain and loss from dieting. Unable to distinguish between famine and dieting, the body reacts to fewer calories with inherent defenses, biological mechanisms designed to withstand starvation and protect the species. Your basal metabolic rate actually slows down. Since this rate accounts for 60 to 75 percent of the energy used by the body—for routine functions like breathing and cell repair—its slowdown calls a halt to weight loss.

In addition, the body becomes more efficient in storing fat. Enzymes are complex proteins that regulate the body’s chemical processes. One of them, called lipase, predigests dietary fat before it enters the intestine and thus makes the fat easier to digest and store. In yo-yo dieters, this enzyme becomes more active in preparing fat to be stored in fat cells.

These metabolic changes also cause a woman’s body to gain weight faster and hold on to it once calorie intake returns to normal.

Kelly Brownell, Ph.D., and the researchers of the Weight Cycling Project have seen other hazards in yo-yo dieting in their preliminary data:

•Women who yo-yo diet may redistribute their body fat from the thighs and hips (the predominant location on the female body) to the abdomen. The fatter a person is from the waist up, the greater the risk for diabetes and heart disease.

•Yo-yo dieting may increase the body’s ratio of fat to lean tissue. Women may lose considerable muscle tissue while dieting, but tend to regain it as fat.

•Yo-yo dieters may find their desire for fatty foods, many of which are unhealthful, increases.

•Additional risk from heart disease may come from the cycling of weight up and down. The long-term Framingham Heart Study, which has monitored more than 5,000 people for over 50 years, has found that people who raised their body weight by 10 percent increased their risk of coronary artery disease by 30 percent. On the other hand, if they lost 10 percent of body weight, they decreased their risk by only 20 percent, for a net increase of 10 percent in risk every loss-gain cycle.

Now you can understand why every time you diet, it gets harder and harder to lose weight. It is not just common sense, but biochemical fact, that changing eating habits gradually (combined with exercise) is the only effective way to lose weight.

THE CHRONIC DIETER AND ENERGY-SAPPING DIETS

In addition to metabolic slowdown, diets that reduce calories also often exclude entire categories of foods. This sets women up for nutritional deficiencies. Red meat is a good case in point. A diet of fruits, vegetables, grains, and fish and poultry may be high in vitamins A and C and protein, but significantly deficient in blood-building iron, vitamin B12, and the trace mineral zinc. These deficiencies can bring on anemia, asthma, hair loss, and psoriasis.

Women who feel deprived by low-calorie diets are more likely to cheat by devouring high-calorie, vitamin-deficient treats like gourmet cookies and rich desserts. How many times have I noted a coconut chocolate chip cookie, butternut ice cream, or a raspberry tart on the food diary of a chronic dieter who has sworn off red meat but treats herself to a fattening reward? These high-sugar foods may lead to anemia, osteoporosis, menstrual problems, and dry skin and hair by displacing more substantial foods in the diet.

THE NUTRITION BUFF

What about nutrition-conscious women like Pat? I have worked with hundreds of Pats, who make up the second largest group of patients consulting me for health problems. They think they are keeping fit and healthy by their watchfulness. Unfortunately, this is not the case for many of them.

Magazines and Internet sites that regularly poll their readers find that women say they are eating more poultry and fish, reading labels for nutrition information, and snacking on fruit.

Yet industry sales figures and national food consumption studies give a different view. Sadly, the 1995 USDA survey found no significant increase since 1977 in the percentage of women serving fish or fruits on a given survey day. As I pointed out earlier, the same study found women getting less than recommended amounts of vitamins B6 and E, calcium, magnesium, iron, folic acid, and zinc, all critical to a woman’s good health and optimum reproductive function.

FAT DECEPTION

For years, American women have been concerned about fats and, in particular, cholesterol. The late nutrition pioneer Nathan Pritikin, the American Heart Association, the Surgeon General, food editors all over the country, and even many food manufacturers urged a significant reduction of dietary fat as the way to health—to 30 percent of calories, down from the 40-plus percent most Americans consume. The Pritikin diet, with its emphasis on only 5 to 10 percent of calories from fats, convinced millions that fats were bad and linked with various degenerative diseases, particularly heart disease, America’s number one killer.

The American public has been brainwashed with a great big fat lie—a lie that has been told, retold, and told again over the past fifteen years. This lie—that fats are the ultimate dietary killers—has been extended to cover all fats, not just a few harmful ones. In my opinion, this lie has resulted in widespread harm to the overall health of our nation.

For so long, marketing by the nation’s food companies has included phrases like “slash the fat,” “reduced fat,” and “fat free.” The idea was that we could eat whatever we wanted, whenever we wanted, as long as the foods we ate were fat free. And many people, especially women, bought into this myth.

Women like Pat are so anti-fat that they have not only sworn off every nut, seed, and avocado on the planet, but they’d rather be caught dead than use a drop of oil on their foods. Some of these women have become too lean from their obsessive dieting.

One of my clients, 33-year-old Gina, was a strong advocate of the low-fat, high-complex-carbohydrate diet because she believed it was the ideal diet for athletes. She ran almost five miles a day. When she consulted me because her periods had stopped, I explained that in addition to her extremely low-fat diet (fat makes hormones, as you will read later), her excessive exercise may have further reduced her body’s fat stores and disrupted hormonal function, which ultimately reduced the circulating estrogen levels in her body. Overexercise causes the body to stop making estrogen and utilize calcium, which is estrogen dependent! I suggested that she decrease her running by one-half, to two and one-half miles a day, and that she gain at least five pounds. I also told her to add one or two tablespoons of flax oil or olive oil to her daily diet. As it turned out, her period returned when she had regained only three pounds.

What advocates of the low-fat, high-carbohydrate diet overlooked was the evidence about the crucial—and positive—role some fats play in the diet. Women like Gina and others, who want to be thin but fertile, suffer the most from this nutritional one-sidedness.

But now other experts are beginning to agree with me about the importance of fats. As Gary Taubes reported in the New York Times in July 2002, “The dietary recommendations—eat less fat and more carbohydrates—may be the cause of the ram- paging epidemic of obesity in America.” Research points out “that there are plenty of reasons to suggest that the low-fat-is-good hypothesis has now effectively failed the test of time.”2

As I will describe more fully in Chapter Three, certain vitamins must have fat present in order to be dissolved and absorbed into the body. Essential fatty acids (EFAs) play a positive role in a myriad of female reproductive disorders like premenstrual syndrome, viral and yeast infections, and infertility, as well as food allergy and immune disorders. EFAs strengthen cell membranes, which are our bodies’ first defense against infections. Essential fats are also vital to healthy skin, hair, and nails (they are often added to hair and skin care products for topical application). Most important, essential fats are needed to form the hormonelike substances prostaglandins, which control the body’s immune, cardiovascular, reproductive, and central nervous systems. Without prostaglandins (and the essential fats necessary for their production), our blood does not clot, tumors grow unchecked, cells become inflamed, and allergies rage out of control.

FAT AND CALCIUM

The right kind of fat is necessary for calcium availability in the soft tissues and to promote calcium elevation in the bloodstream so that muscles contract properly and maintain their tone, nerves function smoothly, blood clots when needed, and bones and teeth remain strong and healthy. Women who believe they are getting enough calcium through diet and supplements may be sabotaging themselves if they do not include enough of the right oils in their diets.

THE GRABBER VERSUS THE GRAZER

Eating a number of small meals each day can be an effective way to maintain a healthy weight and a stable blood sugar. This eating pattern is often called “grazing.” However, Maryann, our mini-meal “grabber” and constant snacker, is fast becoming the norm in women’s eating habits. Visit almost any major American shopping mall—shops selling chocolate chip cookies, European chocolates, croissants, and gourmet ice cream have joined the dress, shoe, and department stores as mall staples.

For many teenagers like Maryann, junk-food snacks and fast-food meals form a habit that is carried into adulthood. Fast-food restaurants make up almost 50 percent of all eating places in the United States, with more than 215,000 in operation. In fact, Americans spend more money on fast food than on movies, books, magazines, newspapers, videos, and music combined! Sadly, in the United States, more money is spent on calorie-laden fast food than on higher education.

Unlike sugar-laden junk food, which by definition has almost no food value, fast food does have some nutritional value. But it lacks several key vitamins and minerals—vitamins A, B1, and C, and calcium, in particular—and a steady diet of fast food can be hazardous. The excesses of saturated fat, sodium, calories, and even sugar add to the problem.

The typical meal of hamburger, fries, and shake (not a milk shake, since it contains almost no milk) weighs in at almost 1,000 calories. Individuals who select the fish sandwich thinking it’s healthier are in for a surprise—processing, breading, and deep-fat frying turn the wholesome fish into a high- calorie food filled with the wrong kind of fat.

COMPARISON OF TWO FAST-FOOD STAPLES Burger King WhopperBurger King Big Fish

Calories640700 Protein27 grams26 grams Carbohydrates45 grams56 grams Fats39 grams41 grams Sodium870 milligrams980 milligrams

Source: Adapted from Fast Food Facts by the Minnesota Attorney General’s Office.

Women who eat on the run have created a booming market for convenience foods as well. Retail sales of frozen dinners and entrees were over $5.3 billion in 2000. Joining the three-course dinners are single-serving vegetable side dishes, gourmet entrees from around the world, and single-serving desserts.

Undeniably convenient and appealing, today’s frozen foods achieve much of their appeal at the cost of healthfulness—the average frozen entree is over 50 percent nonessential fat, and some may contain over half of a woman’s recommended daily sodium intake (1,100–3,300 milligrams), as this chart of just a few products highlights.

FROZEN DINNERS AND ENTREES (AVERAGE OVER PRODUCT LINE)

FatSodium Brand (serving size)(percent of cals)Calories(mg)

La Choy Dinners (12 oz)102431,822 Light & Elegant (9 oz)19259880 Lean Cuisine (10 oz)28260978 Weight Watchers (10 oz)352771,051 Armour Dinner Classics (11 oz)393911,339 Swanson 4-part Dinners (12 oz)404831,154 Le Menu (11 oz)423981,001 Budget Gourmet (10 oz)43373849 Stouffer’s Entrees (9 oz)463431,130 Old El Paso (na)55359623

Source: © 1989 CSPI. Reprinted from Nutrition Action Healthletter (1875 Connecticut Ave., N.W., Suite 300, Washington, D.C. 20009-5728. $24.95 for 10 issues).

Maryann’s problem as a grabber is related less to her pattern of eating than to what she eats. It is not necessary to eat three square meals a day to get the healthy balance of nutrients and calories you need. Mini-meal eaters, or grazers, who select wisely benefit not only in good health but also in weight control. In fact, a study reported in the Journal of the American Medical Association found that women who ate one large meal a day instead of several small ones were 25 times more likely to store fat. The constant nibbling of the women who ate several small meals stimulated their bodies’ brown fat, a special fat-burning tissue that produces body heat by burning calories rather than storing the calories as fat cells. This meant that the women’s bodies stored less fat, their metabolism rose as their food intake rose, and they lost weight.

I was first introduced to the concept of grazing (as opposed to grabbing) while working as the Director of Nutrition at the Pritikin Longevity Center. In the early 1980s, the Center served six mini-meals a day. This concept of constant feeding was so integral to the program, but avant-garde at the time, that the meals and food timings were printed on T-shirts, which all the participants wore.

These mini-meals included many healthy foods, but they lacked one key element—fat. Like the others on the program, I was constantly grazing because I was always hungry. The fat-free meals never left me satisfied. I can remember downing bowl after bowl of oatmeal, wheat berries, or steamed barley before my morning lectures in order to feel full. In fact, the Pritikin fat-free regimen kept me from using even a bit of butter on my grains, so I was always hungry. (Fat slows down digestion; it takes at least two more hours for food to digest with fat than without it. Hunger is therefore retarded when a small amount of fat is added to the meals.) Thus, for fat-free eaters, grazing was a necessity, almost an obsession.

Grazing is no longer considered avant-garde; it has become part of the current nutritional prescription of sound dietary practice. If grazers choose wisely and include fats, carbohydrates, and protein in balanced mini-meals, they can avoid the trap of becoming either a grabber or a Pritikin-style grazer.

THE SOUR SIDE OF SUGAR

All three eating styles share one potential pitfall—the lure of sugar in its many forms.

Desserts and sugar-laden snacks tempt a woman to choose happiness over health. Women who carefully monitor their food intake all day might indulge in a rich dessert reward at night—what one observer has termed the “Lean Cuisine/ Dove Bar mentality.” Restaurants report an ever-increasing demand for the richest desserts they can produce. Nearly 40 percent of Americans eat ice cream often. In fact, Americans average 16 quarts per person per year. Gourmet brands, which are growing in popularity, get their richness from a recipe that is more than double the fat content of less expensive brands (a half cup of Häagen-Dazs vanilla ice cream contains 270 calories and 18 grams of fat; Breyers has 150 calories and 8 grams of fat).

These cravings are a complex mix of physiological and psychological factors, not yet fully understood. We know that fat in the diet gives a sense of fullness, so when the body is fat-starved, it sends insistent hunger messages. Good-tasting foods, including sweets, stimulate the palate and bring pleasure. There is a chemical basis for this in the mood-altering brain chemicals that are triggered by eating carbohydrates (cookies, cakes, muffins). In addition, many of us carry from childhood the “knowledge” that the reward for good behavior is a cookie, not a carrot.

Our sweet tooth contributes directly and indirectly to osteoporosis, premenstrual syndrome, excess weight, coronary artery disease, and cancer. Excess sugar is converted in the body to nonessential fatty acids (such as saturated fats) and cholesterol. One study by the USDA found that individu- als who consumed 30 percent of their calories from sugar (slightly more than the typical American diet) developed significantly higher levels of cholesterol and triglycerides (fats) in their blood than did control subjects who had wheat starch substituted for the sugar.

Sugar consumption adversely affects the calcium- phosphorus balance so crucial to effective calcium absorption. If calcium levels in the blood are inadequate, calcium is drawn from bones and teeth, contributing to the development of osteoporosis and dental disease. Furthermore, calcium is essential for proper muscle function; deficiencies lead to muscle cramps, including those associated with menstruation. A recent American study has found that calcium also helps neutralize bile acids and fatty acids, which can irritate the bowel and contribute to the development of colon cancer.

Eating sugar with fat, as in ice cream, doughnuts and other baked goods, and butter-rich chocolates, causes the body to store fat more readily, rather than burning it for energy (see Chapter Four).

IS THERE A SOLUTION?

Many women are becoming more aware of how diet affects their bodies. They are making the connection between what they eat and how they feel. Many of my clients are eating some red meat, and more fish and vegetables. They’re eating less salt and cutting back on their sugar habit. But this is only the beginning for the food-wise woman. We need to truly support female health. We need to know how chemical imbalances create a climate for disease and unhealthfulness. We must learn to protect the crucial “female minerals” from inhibitors—sugar, caffeine, soft drinks, and saturated fats—and to return valuable food staples to our diet, including lean red meat and eggs. We need to know the good side of cholesterol and dietary fats and learn to incorporate them into a balanced diet.

All of this can be done without exotic foods, chemistry books, obsessive concern for food, or, in most cases, nutritional supplements.

The suggestions I give in this book have worked for the thousands of women I have advised; they can work for you to restore the health and vitality you may have lost from chronic dieting, following the once popular low-fat and high-complex-carbohydrate diets, and eating fast food. I offer a nutritionally sound program to put the right fats, red meat, eggs, whole grains, and even fast foods in their proper place in your diet, to eliminate mineral inhibitors such as sugar and caffeine, and to banish the fear of fat—forever. It is my hope that this book will help you learn by firsthand experience that health is not a matter of chance, but a matter of choice.