Focus on what you eat more than what you don't

Over the years there has been constantly changing opinions on what is the healthiest diet plan. When I was in medical school, it was simply “eat three square meals per day” without defining a “square” meal.

In the mid-1980s, the low-fat diet was all the rage. Later it was discovered that a low-fat diet did not really improve health. Low-carb diets have been around since the 1960s but did not become popular until the 1990s when Robert Atkins published “Dr. Atkins New Diet Revolution,” a diet based almost entirely on animal protein and fat. It seemed that overnight it became gospel that a diet low in carbohydrates was the way to go.

Some 40 years later, medical publications may offer insight — or the “skinny” — on low-fat and low-carb diets.

Medical research has shown, in general, that low-fat and low-carbohydrate diets both result in weight loss and improvement in other parameters, such as inflammatory markers. In contrast, other medical studies have shown no, or a weak, association between low-carb and low-fat diets and health outcomes including heart disease and mortality. Recent studies suggest the quality of the food is the reason for the disparity in results.

For low-fat diets it seems the type of fat is associated with health benefits rather than the total intake of fat. Saturated fat was associated with higher mortality compared to a diet rich in unsaturated fats. In addition, in a recent meta-analysis study (a study that combines the results of several clinical trials) on low-carb diets, animal-derived fat was associated with higher mortality compared to plant-derived fat intake. These findings were implied by the Women's Health Initiative Dietary Modification Trial, which demonstrated that simply reducing overall fat did not reduce the risk of heart disease and mortality.

A recent study in the Journal of American Medical Association suggests any health benefits of either a low-fat or low-carb diet are the result of the quality rather than the amount of the fat or carbohydrate in the diet. Corroborating this finding is that unhealthy fats in a low-carb diet increases total mortality. Unhealthy fats are primarily animal fats.

Unhealthy carbohydrates also showed no health benefits. Unhealthy carbohydrates are commonly found in processed foods, such as refined grains and added sugars.

Whether someone decides on a low-fat or a low-carb diet, the focus should be on the quality of the food rather than the absolute amount. Food sources that contain of high-quality carbohydrates including whole grains, non-starchy vegetables, whole fruits (not juices) and nuts (in moderation) are best choices for a low-fat diet. A low-carb diet should contain robust amounts of unsaturated plant fats and protein, plus nuts and seeds. The vitamins, minerals and fiber in these foods may be the true source of all of the health benefits.

These studies suggest any health benefits depend on the quality of the food rather than the quantity.

• Dr. Patrick Massey is president of ALT-MED Medical and Physical Therapy, 1544 Nerge Road, Elk Grove Village.