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Can Americans trust Dr. Oz for nutrition advice? Only in moderation…

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Let me preface this article by saying this: I used to love Dr. Oz. I’d watch Oprah and hang on his every word, like millions of others watching. I even wrote about some information I learned from him back in my earliest days of blogging in 2006. One post was on the ometum, a visceral fat layer that forms in our abdomen that can grow as thick as 10″. Seen some pregnant men lately? I have! Another was some kind of smoothie recipe that called for soy protein powder– blech! See, we are all on a journey, and it wasn’t that long ago that I, too, was very misled, confused and undereducated. Boy have times changed.

On one of my frequent cross-country trips from San Francisco to New Jersey, I was walking briskly through the airport as usual, but slowed a bit as I passed the bookstore when I noticed a bunch of food on the cover of the latest TIME Magazine. I was reeled in and had to see what the latest “news” was going to teach people about what to eat. Upon closer examination I noticed that now the country is taking this nutritional advice from “America’s Doctor,” Dr. Mehmet Oz.

Just to remind anyone who is unaware, Dr. Oz is a heart surgeon, so I’m unclear as to how this makes him an expert on nutrition since most of the people he sees on a daily basis are way too far gone. That said, we know that nearly anyone who is a thinking person who reads, researches and works with people to see how they respond to different dietary changes can provide sound advice to others on what to eat. Most of us are not, however, being supported financially by Big Food, whose ads are no doubt large contributors to the funding of The Dr. Oz Show. Just watch the show once and note what commercials are shown throughout. They’re not ads for grass-fed beef or even for the Incredible Edible Egg.

Note: Since I started drafting this post, my friend and mentor Robb Wolf published this fantastic piece examining why some mainstream-media doctors (including Dr. Oz) are NOT spreading the real information about food, nutrition and how it impacts health when we take an evolutionary approach to our recommendations.

Time Magazine, September 12, 2001
“The Oz Diet. No more myths. No more fads. What you should eat – and why.” – by Dr. Mehmet Oz

Where Dr. Oz gets it right in his article (well, sort of)…

How people land on his operating table: “The biggest reason was often the simplest one: the food they ate.”

The trifecta represented: oxidized seed oils (fries), gluten (bun), high fructose corn syrup (soda).

Forgive my informality here, but, DUH! I can’t understand how someone would make any assumption otherwise. When you look at what kind of input a person is getting two, three, four, five, six, seven, eight or even more times every day, it’s a no-brainer that it’s going to have an impact on the health of our vascular system. Clearly these inputs can include other environmental factors like toxins (or more positive inputs like exercise) but food is something we put in MANY times a day and we can exact control over much of what we are eating.

“…most of us have almost unrestricted access to food.”

Clearly most of us never want for food that isn’t available. This is not to say that there aren’t plenty going hungry every day in this country and around the world, but to note that the problem facing most Americans with questions surrounding diet is not one of scarcity. When people say they don’t want to give up a certain food, I remind them that it will ALWAYS be there later (though by that point they’re healthier and have usually seen the light). Step away from the bagels.

“The era of myth and marketing is at last giving way to an era of hard fact.” 

Amen to that. If it were really true, that is. The entire foundation upon which a Paleo or primal type of diet  is based is science: evolutionary biology, looking to our ancestors and then to current scientific research on how food works in the body today to reach conclusions about what may promote health for most people. We can’t rely on those selling us the food to educate us on why or how it’s healthy.

Sadly, even Dr. Oz is selling us processed foods, despite his best efforts to say otherwise in this article. Just watch his show for an hour and see which companies are filling his bank account. If he really wanted to take a stand for eating whole foods, he’d make a stand against processed food ads. This may be extreme and nearly impossible given the current markets and power of Big Food to pay for ad space, but I say anything is possible with enough conviction. Clearly Dr. Oz doesn’t have it. Step away from the processed foods.

“Up is down. Want to get healthy? Then forget about diet soda and low-fat foods. Instead, tuck into some eggs, whole milk, fat, salt, nuts, wine, coffee and chocolate.”

Enjoy whole foods like butter and eggs. (Yes, the yolk, too.)

THANK YOU. Oz even goes so far as to say that “Despite conventional wisdom all of those foods and many more can be beneficial to your body.” He explains how some commonly demonized nutrients and foods have been shunned unnecessarily including salt, red wine, chocolate and full fat milk. Then he goes on to tell the reader that “the key, for all of these foods, is moderation.”

Yawn, we’ve heard all that before.

Oz begins to vindicate fat in our diet, but steers a bit off-course when he lumps canola oil in with olive oil for its health-promoting properties. If you’re simply talking about the molecular structure of the fats, perhaps this would be true, and it’s likely why Loren Cordain even included canola oil as part of a healthy Paleo diet in his original book (though I think he sees the problems with it currently).

But this doesn’t take food quality or production methods into account. It also doesn’t recognize that the polyunsaturated fatty acids (PUFAs) that are touted for health benefits in these plant oils are often oxidized (damaged) by not only the production methods to get them from seed/plant to bottle, but then from the bottle to your plate via refining, heating, light and air interactions with these delicate fatty acids. Step away from the seed oils.

“As a heart surgeon, I am continually struck by the variability in how people process dietary cholesterol.”

Clearly Dr. Oz hasn’t read any of the work by Dr. Uffe Ravnskov or other leaders in the field of cholesterol research or he’d have learned that dietary cholesterol is not to blame for heart disease. [1],[2]  Hey, doc, here’s another HUGE point you’re missing with regards to cholesterol in the bloodstream: cholesterol itself not the problem. Perhaps high levels of cholesterol are a sign that something else is wrong and the body is responding with protective factors, OR perhaps a person just needs to operate at some higher levels of cholesterol in their body.

Does high cholesterol mean a person is less healthy or more prone to heart disease or death? I don’t think so. Neither does Chris Masterjohn. And in this report, we can see how Ravnskov shows that cholesterol can even be protective against such ails.[3]

“Most people have little issue with their blood-cholesterol levels after eating foods that are relatively high in cholesterol.”

This is another “DUH” point for me while reading the article as I answer questions about this topic often at my seminars and have researched it based on what Dr. Uffe Ravnskov writes about this in his books “The Cholesterol Myth,” “Ignore the Awkward: How the Cholesterol Myths are Kept Alive,” and “Fat and Cholesterol are Good for You. Ravnskov explains that serum cholesterol levels are only minimally affected by dietary cholesterol as exemplified by trials he’s conducted.

In his article, Dr. Oz points to the fact that a few people may struggle with even small amounts of dietary cholesterol. Perhaps Oz is referring to those who are genetically predisposed to poor LDL receptor function as in the case of Familial Hypercholesterolemia, according to Chris Masterjohn [listen here at 1 hour 15 min], though he doesn’t mention this genetic disorder in the article, which leaves the reader wondering who “most people” might be and whether or not they are part of that group. Unless you’re allergic, go out and buy some more eggs. And for the love of all that is holy, eat MORE THAN ONE OF THEM AT A TIME.

Where Dr. Oz gets it wrong in his article…

Dr. Oz aligns diets I think most would consider to be actual “fads” together with general lifestyle changes/choices that many of us maintain for years or even our entire lifetime when explaining diet confusion. He puts Atkins, South Beach and the Mediterranean diet along side the cabbage soup diet and the grapefruit diet claiming that they ALL dramatically limit our food choices and are therefore unsustainable in the long-term. Come on, Dr. Oz, some of those are legitimately going to help people to improve health, while others are pretty darn silly.[4] Dr. Oz even goes so far as to say that those who faithfully follow the Atkins diet begin “to suffer the bad breath of ketoacidosis, which occurs when glycogen stores are too low.”

At this point in the article, I actually BACKTRACKED and had to remind myself of who wrote it. I asked myself, “what BS nutritionist wrote this not knowing the difference between keTOSIS and ketoACIDOSIS?!” I was so appalled that I though, “surely Dr. Oz didn’t write this.”

Ketosis is a natural state for the body to be in where it can utilize ketone bodies versus glucose as a fuel source. Dr. Mike Eades explains this utilization very well in his post on “Metabolism and ketosis“:

As the liver breaks down the fat to release its energy to power gluconeogenesis, the conversion of protein to sugar, it produces ketones as a byproduct. And what a byproduct they are. Ketones are basically water soluble (meaning they dissolve in blood) fats that are a source of energy for many tissues including the muscles, brain and heart. In fact, ketones act as a stand in for sugar in the brain. Although ketones can’t totally replace all the sugar required by the brain, they can replace a pretty good chunk of it. By reducing the body’s need for sugar, less protein is required, allowing the muscle mass (the protein reservoir) to last a lot longer before it is depleted. And ketones are the preferred fuel for the heart, making that organ operate at about 28 percent greater efficiency.

Reality check: This is a low-carb meal.

Ketoacidosis is when the naturally occurring metabolic state of ketosis described above goes awry and our liver begins to break down “fat and proteins in response to a perceived need for respiratory substrate to maintain it.” Sound scary? Perhaps, but it’s most common in uncontrolled Type 1 Diabetics.

Are you an uncontrolled Type 1 Diabetic? No? Then chill out and learn the difference between these two metabolic states.

Spending some time in ketosis may prove to be a great way for your body to naturally and easily burn your own fat stores for energy. Imagine that? Burning your body’s stored fat for energy… sounds like what most people are TRYING to accomplish when they eat-less and move-more… no?

I can see how calling the cabbage soup or grapefruit diet dramatically limiting, but if you take an honest look at what’s being consumed on an Atkins, Mediterranean, South Beach or Paleo type of diet, the food choices are pretty endless. They are limiting in terms of what’s available in the American food landscape, but that doesn’t mean they’re limiting, nor that the easily available “food” served in this country (yes, I’m focusing on the US since that’s who Dr. Oz mainly is addressing) is even what people SHOULD be eating for the most part. This is why a legitimately different way of eating (grain-free, perhaps?) gets viewed as a “diet” by mainstream media, and those of us who educate on the topic are sort of forced to label it for any gravity in the realm of the health-conscious general public. Talk to anyone who eats “this way,” and most of us would never, ever call it a diet.

“Bad fats generally include saturated fats (found in animal products), trans fats (found in hydrogenated and partially hydrogenated oils) and their cousin cholesterol (found in egg yolks, meat and dairy products).”

Dr. Oz lumps naturally occurring fats from animal products with man-made hydrogenated, refined, industrialized seed oils. Well, clearly that’s how Americans already think, so he’s not helping anyone to uncover the truth about natural fats versus man-made fats. Oz goes on to exonerate the saturated fat in coconut oil explaining that “new research” says it may actually be good for you.

I’m not sure what he considers to be new research, but we’ve seen this information in studies for some time now.[5] I’m happy to see when people reverse their stance on something in light of new information (as Cordain has also done regarding saturated fat to an extent in his new version of The Paleo Diet as well as in his presentation at the Ancestral Health Symposium this past August). I will remind people, however, that it was just under two years ago when I read a question answered by Dr. Oz and Dr. Roizen about coconut oil stating quite adamantely that it was unhealthy. Argh. This one deserves a big, FAT: “WE TOLD YOU SO!”

Oz also states that monounsaturated fatty acids (MUFAs) have been found to lower LDL and raise HDL. Okay, this may be true, but we’ve also seen that saturated fatty acids (SFAs) like those from coconut oil can raise HDL.[6] Interesting, no?  Oz also states that simply lowering LDL and raising HDL will lower the risk of atherosclerosis and heart disease.

I think Chris Masterjohn, someone many consider to be a leading expert on cholesterol and its role in the health of humans,would beg to differ that simply manipulating the numbers on our blood tests will be the answer to a positive effect on our long-term health. (Listen to both of his recent podcast interviews with Chris Kresser here and here.) Rather, changing our diet and lifestyle to then, in turn, allow our cholesterol levels to reach a healthy place for what our bodies need, should be the approach we take. People want to think their health is easy to measure in numbers. Sadly, it’s not quite that simple.

“Most physicians are now comfortably recommending one egg with the yolk per day as an inexpensive source of high-quality protein, even though a few patients do need to be pulled off the program pending blood-cholesterol levels.”

Who is this person? Is it a 105lb female? Is it a 195lb male? Is the person active or sedentary? How much food is this person eating over the course of the day? If the person is eating ONE EGG, say, for breakfast, what else is the person supposed to eat to gain satiety? I’d argue that most Americans then fill their breakfasts up with oatmeal, other cereal, fruit or yogurts that contain sweeteners. Sugar, sugar and more sugar. Ugh.

Beyond that, since the original scares around dietary cholesterol raising serum cholesterol, there have been multiple studies that say just the opposite, that the need to limit egg consumption is unfounded and that cholesterol level markers, in isolation (out of context, without knowing about the person’s entire lifestyle) are not significant markers for developing heart disease. [7] Additionally, “Several recent studies have shed additional light on the specific interplay between dietary cholesterol and cardiovascular health risk. It is evident that the dynamics of cholesterol homeostasis, and of development of CHD, are extremely complex and multifactorial.

In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated.” [8] This recommendation REEKS of the whole “everything in moderation” approach. Which I pretty much loathe. Why don’t we EVER hear that people should moderate their intake of grains from anyone but Paleo or primal advocates?

“The only fat that is universally accepted as bad is trans fat, and that’s now been stripped out of most foods.”

Flow chart for seed oil refining. (Source: westonaprice.org)

Something Dr. Oz NEVER addresses is that the real issue we’re still facing today regarding the consumption of “bad fats” is that, even with the supposed limitation of trans-fats in processed foods currently, the food supply is still LOADED with industrial, highly refined seed oils. Seed oils, as discussed earlier are not, for the most part natural and healthy foods for us to eat.

The oils to which I’m referring include everything from canola oil, corn oil, soybean oil and cottonseed oil (all refined by expeller and with a lengthy process, see the graphic to the right) to even grapeseed oil and some sesame and peanut oils (look for cold-pressed vs expeller pressed varieties for safer versions, though cooking with them is not recommended).

The refining process alone damages many of the delicate PUFAs within the seed oils, which is one of the reasons for the added step of deodorization in the process.

Furthermore, according to Sally Fallon and Mary Enig, “certain types of trans fatty acids could probably be formed from a highly polyunsaturated oil during deep fat frying in one of the new pressure cooker fryers, but these types of trans fats would be like those formed in high pressure deodorization.” [8] So we’re damaging these oils by simply refining them, before they even get into our cupboards or into the processed foods that contain them, of which there are MANY. Even Muscle Milk contains canola oil. Yes, really. Step away from the Muscle Milk.

Furthermore, when we heat these oils we are risking damaging them since they are largely unsatuarted (mono or poly) and their chemical structures are weak relative to that of their sister fatty acids, saturated fats. When we consume damaged oils, we are exposing our bodies to oxidative damage and inflammation that we work so hard chugging blueberries to defend against! [9]

It’s frustrating that Dr. Oz is talking out of both sides of his mouth in this article.

I understand that he’s trying to dispel myths, but the problem is that he’s not explaining what the problems in the diet ARE as much as he’s trying to explain why some things we’ve thought were problematic may not be. This leaves the reader to believe that much of the Conventional Wisdom around what is a balanced and healthy diet is likely what they thought before: eat everything in moderation, though I propose that even the term moderation VARIES GREATLY from person to person. What does moderation even mean? And it seems that when people DO try to take the “everything in moderation” approach, they’re left hungry, nervous, and unsure of what exactly they should be eating. I’ve seen this time and time again with my clients who are scared of fat and eating high-carb/low-fat diets only leading to anxiety around food choices because they just “don’t know what’s right.”

Dr. Oz, you haven’t helped to clarify much of that at all for them with this article.

The apparent take-away from Dr. Oz’s advice in this article: Eat unprocessed foods primarily. GREAT. From there, moderate everything that mother nature provides that seems possibly like it might somehow have a negative effect on some people’s health. It’s wishy-washy, nebulous and “conventional wisdom in a new outfit” advice if I’ve ever heard it. I wish he’d just be a bit more vocal on his TV show about how healthy a grain-free diet can be. Perhaps he needs to learn more about it and will come around. I’m trying to have faith that this doctor will learn and change his stance and it appears that he’s more open to it then we may have thought…

Dr. Oz fields a question on his show about The Paleo Diet.

Interestingly, his advice on it is mostly accurate, but he’s ignoring what we know about modern grain products and their effect on human health. Not to mention he is not well-versed in the diet or the facts on Paleo man, considering average life expectancy then includes higher infant mortality rates without modern medical interventions. Alas… watch the clip. He can’t tell the viewers not to eat grain products at all or this show would be off the air due to lack of commercial funding.

Ask Dr. Oz Season 2: Post Op #21: MyFoxCHICAGO.com

And apparently just today Dr. Oz says that a ‘pre-historic diet’ is the best way to decrease hypertension at ~19:30. “We are not designed to eat the modern food diet.”

Sources:

[1] Ravnskov, Uffe. A hypothesis out-of-date: The diet–heart idea. Journal of Clinical Epidemiology, Volume 55, Issue 11, November 2002, Pages 1057-1063.

[2] McNamara, Donald J. Dietary cholesterol and atherosclerosis. Biochimica et Biophysica Acta (BBA) – Molecular and Cell Biology of Lipids, Volume 1529, Issues 1-3, 15 December 2000, Pages 310-320.

[3] Ravnskov, Uffe. High cholesterol may protect against infections and atherosclerosis. QJM: An International Journal of Medicine, Volume 96, Issue12, 2003, Pages 927-934.

[4] Frassetto, L A, et al. Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. European Journal of Clinical Nutrition (2009) 63, 947–955; doi:10.1038/ejcn.2009.4; published online 11 February 2009

[5] Mensink, Ronald P., Peter L Zock, Arnold DM Kester and Martijn B Katan. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. American Journal of Clinical Nutrition, Vol. 77, No. 5, 1146-1155, May 2003

[6] Hayek, Y Ito, N Azrolan, R B Verdery, K Aalto-Setälä, A Walsh, and J L Breslow. Dietary fat increases high density lipoprotein (HDL) levels both by increasing the transport rates and decreasing the fractional catabolic rates of HDL cholesterol ester and apolipoprotein (Apo) A-I. Presentation of a new animal model and mechanistic studies in human Apo A-I transgenic and control mice. Laboratory of Biochemical Genetics and Metabolism, Rockefeller University, New York 10021-6399. J Clin Invest. 1993 April; 91(4): 1665–1671.

[7] Constance, C. The good and the bad: what researchers have learned about dietary cholesterol, lipid management and cardiovascular disease risk since the Harvard Egg Study. International Journal of Clinical Practice, Special Issue: A Review of the Harvard Egg Study, Volume 63, Issue Supplement s163, pages 9–14, October 2009

[8] Jones, PJ. Dietary cholesterol and the risk of cardiovascular disease in patients: a review of the Harvard Egg Study and other data. Int J Clin Pract Suppl. 2009 Oct;(163):1-8, 28-36.

[9] Enig, Mary. “Trans Fatty Acids Are Not Formed by Heating Vegetable Oils.” February 24 2004.

[10] Masterjohn, Chris. “Corn Oil, Not “High-Fat,” Causes Inflammation.” January 13, 2010.

More sources if you’re interested:

Kritchevsky, Stephen B. PhD. A Review of Scientific Research and Recommendations Regarding EggsJ Am Coll Nutr December 2004 vol. 23 no. suppl 6596S-600S.

McNamara, Donald J. The Impact of Egg Limitations on Coronary Heart Disease Risk: Do the Numbers Add Up? J Am Coll Nutr October 2000 vol. 19 no. suppl 5540S-548S.