My colleague Caldwell Esselstyn MD recommends a vegan diet that is virtually fat-free (10% or less) and completely devoid of all fish and animal products of any kind.  He has eaten that way himself for years now, and he has documented the reversal of severe coronary artery disease in a number of patients whom he has taught to eat the same way.  

Then there is Dr. Robert Atkins, of the renowned Atkins Diet, and Dr. Richard Feinman, a biochemist from SUNY Downstate Medical Center who conducted the first serious scientific research on the Atkins Diet.  Feinman observes that "the deleterious effects of fat have been measured in the presence of high carbohydrate.  A high fat diet in the presence of high carbohydrate [think doughnuts] is different than a high fat diet in the presence of low carbohydrate [think steak with buttered broccoli].”

Last week someone showed me a copy of the Mayo Clinic diet their doc had handed them a few weeks earlier. Low-fat chicken.  Grapefruit and tomato juice (They have a lower glycemic index than apple, grape and orange juices.).  Lots of produce.  Anyone can lose weight eating like that.  The question is whether you can eat like that for the next 50 years.  And when you get sick of this restrictive diet, what is the dieter supposed to add back next?  Anyway, that's not what struck me most.  What I noticed first was -- no manufactured calories.  That's key to any successful eating plan.

Michael Pollan says we should "eat food, not too much, mostly plants."  What does Michael Pollan mean when he says to eat "food"?  Well, he's written a whole book about it, and I won't reproduce it here, only to say that he means items that human beings have eaten throughout evolution.  He does NOT mean items that are an invention of the 20th century.  So we're not talking about Crisco, or granola bars, or ho-ho-ding-dongs, or shakin' bakin', or crisps or chips of any kind.  These things aren't food; they're manufactured calories.  Food is things our great-great-great-grandparents ate, and things that we ourselves can prepare in the kitchen with ingredients that are easy enough to grow ourselves or find at the market.

So which diet is the right one?  I believe they all are.  Esselstyn, Atkins, Feinman and Pollan are like the proverbial blind men all touching and describing a different part of the great big elephant in the living room.  

I love mixing metaphors.

Dr. Esselstyn has observed that if he can get people to eat ONLY vegetables, legumes (beans) and whole grains, their cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  He even has data to show that coronary artery disease can be reversed, partial blockages be resorbed, and blood once again flow freely through open vessels.  Dr. Esselstyn reports that the only patients who "fail" the diet are the ones who "cheat" by going back to eating small amounts of processed foods containing very small amounts of processed fats (containing very small amounts of trans fats).    

Back in the 1970's, Dr. Atkins observed that if he could get people to stop eating carbohydrate, their cholesterol improved, their blood sugars improved, their blood pressure improved, and they lost weight, especially around their midsection.  At first, Atkins didn't realize that there was a difference between refined carbs (mainly white flour and sugar) and other carbs, such as produce, dairy, whole grains and legumes.  So he said not to eat any carbohydrate at all.  Later on, he did come to understand that we pay a huge metabolic price for eating refined carbohydrates, and then he created guidelines for incorporating only healthy carbs.

Michael Pollan's approach?  I've been using my own version of it, and guess what?  Patients' cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  The way I see it, Esselstyn, Feinman, Mayo and Pollan are each touching a different part of an elephant called FOOD. 

My take-home message this week is that the ultimate effect of adopting any of these diets is to decrease immediately the amount of manufactured calories you eat, and to replace them with real food.  That real food might be sweet potato, sprinkled with cinnamon, wrapped in kale, and served with brown rice.  It might be lemon-butter sauce on roasted chicken.  It might be fried eggs and carrot soup.  It might be as simple as a spoonful of peanut butter.  What it isn't is deep-fried tater tots and chicken nuggets. 

I'm not saying that all of us can eat any of these diets interchangeably.  We have to experiment and figure out what is right for us.  What I am saying is that, because these approaches are all based on real food, the answer will lie somewhere in and among them.

And the elephant in the living room?  The fact that the standard American diet is causing the obesity and diabetes epidemic.  We are doing this to ourselves, and it will end when we stop eating manufactured calories.  We hold the solution in our own hands.  Now...go make a pot of soup!
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