Dr Aidin Rawshani

Carbohydrates, our downfall?


New focus: fast carbohydrates, starch, sugar

Every year 30,000 Swedes suffer an acute heart attack. Despite huge success in heart care in Sweden, cardiovascular disease is still the single most common cause of death in Sweden. Here at diabeteson.com, we have several times discussed the cause of a heart attack, namely varicose fattening (atherosclerosis) of the heart’s own vessels. Vascular fat, atherosclerosis and atherosclerosis are the same and mean that fat and inflammatory cells accumulate inside the walls of the vessels. High blood lipids, smoking, high blood lipids and diabetes are the main causes of atherosclerosis.

For several decades, doctors, nutritionists and nurses have recommended low-fat diets to reduce the risk of atherosclerosis of the heart and other vessels of the body. The focus has always been on saturated fats and animal fats, which were considered to be particularly harmful. During the same period, cereals were considered to be healthy, among other things because cereals would lower blood fats (cholesterol). Cereals and other carbohydrates were considered the key to better health.

Unfortunately, it seems that this theory has been somewhat wrong. We have not yet found any evidence that fatty foods cause cardiovascular disease, but we have many evidence that carbohydrates can increase the risk of cardiovascular disease. Some doctors and scientists are willing to stretch this argument so far that they claim that carbohydrates cause heart disease.

Here at diabeteson.com, we have previously discussed the international PURE study, which clearly demonstrated that fatty foods were not associated with either increased mortality or with an increased risk of cardiovascular disease. In the same study, however, it was clear that a high intake of carbohydrates was associated with an increased risk of cardiovascular disease and death. The fact is that in the PURE study, people who ate a lot of saturated fats actually had the lowest risk of stroke, which is a remarkable finding.

Today, therefore, more and more doctors and scientists believe that it is the carbohydrates that are the culprit of the drama. The British Journal of Nutrition recently published a study combining the results of a dozen previous studies, noting that people who ate low carbohydrate diet weighed less and had a more favorable risk factor profile (their risk factors for cardiovascular disease were more favorable) .

Eric Thorn, a cardiologist in Virginia, is now writing in the Washington Post how he started treating low-carbohydrate patients. He tells about the patient Marj, 71 years old, who lost 45 kilos in a year by stopping eating sugar and starch, and by focusing on healthier food. Patient Denise had a very difficult to control diabetes and started with a low-carbohydrate diet, as a result of which she could stop her insulin.

There are currently no good randomized controlled trials that tested the hypothesis that saturated fat is dangerous. The scientific evidence we have today is based on epidemiological studies, which, however, suggest that fat, as well as saturated fat, is not dangerous. Eric Thorn writes in his article in the Washington Post that there have been researchers reluctant to publish studies that said that saturated fat would be dangerous.

The fear of eating fat has in recent decades caused people in the West, including Sweden, eating more and more carbs and fewer fats. This, in turn, can be a contributor to the increased incidence of obesity and diabetes worldwide. See the following graphs, which show how the change in the intake of fats, carbohydrates and protein correlates with the weight of the American population (data from NHANES).

For those who have diabetes, low-carbohydrate diets seem particularly beneficial, as we have explained in the chapter: The science of low-carbohydrate diets.

Confuse and do not confuse

The effect that fatty foods have on blood fats appears to be positive. Fatty foods also do not appear to be harmful, on the contrary, many studies argue that fatty foods are beneficial compared to foods rich in carbohydrates.

The fact that a lot of fat in the food is harmless does not mean that high blood lipids are harmless. High blood lipids are harmful, especially if you have high levels of LDL cholesterol. High blood lipids increase the risk of a heart attack. There is no doubt about this at present. This means that you who eat statins can continue to do so. Statins reduce the risk of having a heart attack. How big the effect of statins depends on how high your risk is; if you have a very high risk, you will benefit a lot from eating statins, while if you are at low risk, you will benefit less from eating statins.

Not all carbohydrates are bad. Fibers and carbohydrates in fruits are healthy. Examples of bad carbohydrates are sugar and starch (potatoes, rice, pasta, etc.).

There are few studies that investigated low-carbohydrate diets in the Swedish sense, namely LCHF. The Swedish variant of LCHF means that 70% or more of the energy intake is derived from fat. Such high levels have not actually been investigated in any major studies. The PURE study investigated effects of up to 50% of energy intake from fat (the more fat you ate, within that range, the lower the risk of death and cardiovascular disease).

It is important to find a balance in the diet. Extreme positions are never good and rarely durable in the long run. Completely stopping carbohydrates can be harmful to some people with type 2 diabetes, as recently reported in the Journal of Medicine. Therefore, it is important to be balanced and ensure that dietary changes occur gradually, and not to the extreme.

It should also be borne in mind that mortality from cardiovascular disease has actually decreased during the same period as the intake of carbohydrates has increased. However, it has been estimated what led to this improvement and it seems to be mainly that we smoke less, have lower blood pressure, lower blood lipids (e.g. by means of statins) and better treatments for people with cardiovascular disease.2

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