By Steve Blechman

The obesity epidemic is upon us— about four in 10 Americans are obese! The keto diet is the number one Google-searched diet for 2018. The keto craze is on the rise! Many celebrities seem to be on it. Last year I reported why the low-carb Mediterranean diet was the best diet for 2018 and it is still the best diet for 2019 based on the latest scientific research! In 2018, U.S. News & World Report ranked the Mediterranean diet as the best overall diet for healthy eating, tied with the DASH diet. The Mediterranean diet was also ranked number one for the easiest diet to follow; best diet for diabetes; best heart-healthy diet and best plant-based diet too. This year, U.S. News & World Report (January 2nd, 2019) selected the Mediterranean Diet as the best overall diet and healthiest diet for 2019. It was also rated the best diet for preventing heart disease and diabetes. The keto diet was ranked 38 for overall diets! It was tied for first place for fast weight loss but not best in the long run because of the high amount of unhealthy saturated fats, which can raise the risk of cardiovascular disease. These results were based on a panel of 23 experts, and 41 diets based on the scientific literature. The expert panel consisted of the country’s top nutrition experts and physicians specializing in weight loss, diabetes and cardiovascular disease.

The results of a major recent randomized controlled study in young adults, that appeared in the journal Atherosclerosis (October 17, 2018) found a ketogenic high-saturated fat, low-carb diet (less than 20 grams per day) on average increased LDL-C (the bad cholesterol) 44% in healthy adults. The response from this high-saturated fat, low-carb diet averaged 5% to 107% increase of LDL-C. This is very concerning! It is important that LDL-C should be measured in those following a high saturated fat, low-carb diet such as traditional Atkins diet or ketogenic diet. What’s also concerning is there was a significant increase in apolipoprotein B (apoB). High apoB levels are a very high risk for atherosclerosis and cardiovascular disease! Any diet that restricts carbohydrate and calories will result in weight loss, but a high saturated fat diet that raises LDL cholesterol is not healthy, even though you are losing weight!

Several studies have shown that a low-carb, ketogenic Mediterranean diet is a healthier alternative to low-carb, ketogenic high-saturated fat diets for weight loss. It has the favorable effect on non-atherogenic lipid profiles lowering LDL cholesterol, triglycerides, lowering blood pressure and inflammation and improving fasting blood glucose levels, and reduction in waist circumference (Nutrition Journal, October 26, 2008; Nutrition Journal, October 12, 2011; Nutrients, December 18, 2013). A recent study showed that the Mediterranean style diet may also lower women’s stroke risk, which was reported by the American Heart Association’s journal Stroke on October 2018. Another recent Harvard study published in the Journal of the American Medical Association (JAMA) on December 7, 2018, found a 25% reduction in cardiovascular risk on the Mediterranean diet! Finally, a recent study published in the International Journal of Cardiology on November 27, 2018 reported that the cholesterol-lowering statin drugs worked best when combined with a Mediterranean Diet compared to statin drugs alone! Lowering inflammation and LDL (bad cholesterol) seems to be the likely synergistic benefit of combining the Mediterranean diet and statin drugs in people with cardiovascular disease and lowering mortality risk.

People who strictly follow the Mediterranean diet tend to have a lower body mass index (BMI), which is a measure of the proportion of weight to height and waist circumference— according to a large population study led by Simona Bertoli from the Nutritional Research Center in Milan, Italy. The Mediterranean diet is high in fish, seafood, antioxidant-rich vegetables, red wine and berries rich in polyphenols, beans, lentils, nuts, legumes and extra-virgin olive oil (EVOO) that are rich in healthy monounsaturated and polyunsaturated fats and low in saturated fats. Extra-virgin olive oil contains oleic acid, a monounsaturated fatty acid, and a polyphenol called oleuropein that can increase brown fat thermogenesis. Brown fat is a special kind of fat cell that generates heat and helps regulate bodyweight and energy expenditure. The body has two forms of fat— white fat and brown fat. Brown fat burns calories. The more brown fat you have, the more calories you burn. The capability of harnessing one’s one brown fat for fat burning is revolutionary! The ability to get lean by producing extra brown fat and enhancing and activating existing brown fat represents a promising way to burn fat. Several landmark discoveries and approaches to this are being explored at major research centers and universities worldwide with great excitement. Brown fat research is a hot topic today! Studies indicate that the Mediterranean diet promotes metabolic health, boosts fat loss, prevents obesity and may increase longevity. (Clinical Nutrition, 2016; J of Nut Sci and Vitaminology, 2008; J Nutritional Biochemistry, 2017)

As I mentioned in my last article, a breakthrough, long-term diet study was recently published in the American Heart Association journal Circulation on measuring body fat. This diet study used magnetic resonance imaging (MRI) technology for the first time, measuring changes in body and organ fat during 18 months on a Mediterranean/low-carb diet, with and without moderate physical exercise. MRI is a diagnostic technique that produces computerized images of organs and internal body tissues using a magnetic field and radio waves. This is the best approach to date for measuring body fat, compared to weighing people as a result of diet and exercise. The scale, skinfold calipers or underwater weighing aren’t giving you the whole picture.

The Mediterranean low-carb diet was significantly superior to a low-fat diet in decreasing fat storage, including visceral (deep abdominal) liver and heart fat. High visceral fat has been shown to increase metabolic syndrome, inflammation, cardiovascular disease and diabetes. Losing deep subcutaneous visceral fat, as well as haptic (liver) fat, was associated with improved insulin sensitivity and improved lipid profile.

The low-carb Mediterranean diet was more effective than a low-fat diet in eliminating fat storage. Previous studies have shown that a low-carb Mediterranean diet may be an effective alternative to low-fat diets. It has a more favorable effect on lipids (with low-carb diet) and glycemic control (with Mediterranean diet).

In a groundbreaking, two-year dietary intervention study published in the New England Journal of Medicine, researchers found that the Mediterranean and low-carb diet was beneficial for weight loss. It appears to be just as safe, metabolically healthier and more effective for weight loss/fat loss compared to a low-fat diet. Consumption of monounsaturated fats (extra-virgin olive oil and nuts) is thought to improve insulin sensitivity, which may explain the favorable effect on blood glucose and insulin levels. Research has shown that nut consumption can enhance weight loss and weight gain (N Engl J Med, 2008)

The Mediterranean Diet contains healthy fats from monounsaturated fats and low in bad fats. Twenty-five years ago, nutritionists discouraged nut consumption because of their high fat content. Mountains of evidence show that nuts are a healthy food that reduces the risk of cardiovascular disease, cancer and all-cause mortality. A meta-analysis that combined the results of 20 studies involving more than 819,000 people, led by Dagfinn Aune from the Imperial College London, found that consuming 28 grams of nuts per day was linked to a reduced risk of coronary heart disease (29%), stroke (70%), cardiovascular disease (21%), total cancer risk (15%) and all-cause mortality (22%). Adding nut consumption to your daily diet can have a marked improvement on your health and prevention of disease. (BMC Medicine, 2016.)

A study published in the European Journal of Nutrition cites nuts like walnuts, peanuts, pistachios and almonds help to increase weight loss and prevent obesity. Nuts are low in carbohydrates, are rich in fiber and are a good addition to the low-carb Mediterranean diet. (European Journal of Nutrition, 2017)

Fish consumption, rich in omega-3 fats that are found in oily fish like wild salmon, for instance, is a healthy component of the Mediterranean diet. The omega-3 fats in fish have been shown to activate brown fat thermogenesis and reduce waist circumference (Adipocyte, 2018). Numerous studies have demonstrated that fish oil lowers body fat and prevents fat accumulation in white adipose tissue (WAT) compared to other dietary oils. Fish oil intake can induce mitochondrial uncoupling protein (UCP1) expression in brown and beige adipocytes and thereby attenuate fat accumulation (Scientific Reports, 2015).

A most recent study published in the prestigious Journal of Internal Medicine (July 17, 2018) found that consumption of fish, and long-chain omega-3 fatty acids, was associated with low risk of early death. According to an article in ScienceDaily (July 18, 2018), “…in the study, 240,729 men and 180,580 women were followed for 16 years. 54,230 men and 30,882 women died. Higher fish and long-chain omega-3 fatty acid intakes were significantly associated with lower total mortality. Comparing the highest with lowest quintiles of fish intake, men had 9% lower total mortality, 10% lower cardiovascular disease mortality, while women had 8% lower total mortality, 10% lower cardiovascular disease mortality and 38% lower Alzheimer’s disease mortality.” Consuming salmon twice a week improves the blood fat profile in overweight men and women— according to a study in the journal Nutrition Research (2016). The benefits were dose dependent— eating more fish triggered greater benefits in blood fats. The study found that salmon consumption reduced blood triglyceride (blood fat) and increased HDL cholesterol levels (the good cholesterol) and benefited the size of lipoprotein molecules, which is important for reducing the risk of coronary artery disease.

Regular salmon consumption is part of a heart-healthy diet. Ocean and wild fish are preferable over farmed fish. They are richer in omega-3 polyunsaturated fatty acids. For example, farmed tilapia is not a healthy fish because it is very low in omega-3 fatty acids and rich in arachidonic acid, a polyunsaturated fatty acid that can increase inflammation and is linked to a higher risk of cardiovascular disease, cancer, metabolic syndrome and insulin resistance. Other rich food sources of arachidonic acid are found in beef, poultry, pork, butter, cream and egg yolks. Grass-fed beef is lower in arachidonic acid. Arachidonic acid is high in meat and poultry because of the feeding of corn to cattle, hogs and hens.

If you eat a lot of fish, I recommend that you get your mercury levels checked by a physician. I do this on a regular basis and stay under the limit by avoiding tuna, swordfish and other high-mercury fish. Stick with low-mercury fish such as salmon, sardines, fillet of sole, flounder, cod, canned light tuna, shrimp, scallops, crab and lobster. High methyl-mercury-containing fish are swordfish, shark, king mackerel, halibut, grouper, bluefish, Chilean sea bass and tuna. Methyl-mercury is a toxic heavy metal. The main function of methyl-mercury toxicity is oxidative stress. Methyl-mercury induces the production of reactive oxygen species (ROS) causing free radicals and reduction of intracellular glutathione. Studies indicate that daily supplements of selenium and N-acetylcysteine, (NAC) a sulfur-containing amino acid, can protect against methyl-mercury toxicity.

Coconut oil is a popular health trend. I do not recommend its use for weight loss or optimal health. The truth is coconut oil is extremely high in saturated fats. The science does not support coconut oil as a healthy oil! In a study published in the prestigious journal Circulation, Dr. Alice Lichtenstein, one of the lead authors of the study, told FitnessRx/MD Contributing Editor J.A. Giresi via email: “There are no known benefits to using coconut oil in place of vegetable oils such as soybean, canola and corn oils. There is a disadvantage. Whereas most vegetable oils are high in either polyunsaturated or monounsaturated fatty acids, coconut oil, sometimes referred to as a tropical oil, is high in saturated fatty acids. The data consistently demonstrate that replacing sources of dietary saturated fatty acids with sources of unsaturated fatty acids, either polyunsaturated or monounsaturated, improves cardiovascular disease risk factors and is associated with lower cardiovascular disease risk.”

Renowned Harvard Researcher Walter C. Willett, M.D. said this about saturated fats in the Harvard Health Letter: “Too much saturated fat in the diet is unhealthy because it raises “bad” LDL cholesterol levels, which increases the risk of heart disease. So, it would seem that coconut oil would be bad news for our hearts.” Dr. Willett also said, about using coconut oil, “But, for now, I'd use coconut oil sparingly. Most of the research so far has consisted of short-term studies to examine its effect on cholesterol levels. We don't really know how coconut oil affects heart disease. And I don't think coconut oil is as healthful as vegetable oils like olive oil and soybean oil, which are mainly unsaturated fat and therefore both lower LDL and increase HDL.”

A British Medical Journal (BMJ) study published in 2016 examined the association of individual and combined saturated fatty acid intake (lauric, myristic, palmitic and stearic acids) with heart disease risk in more than 73,000 women from the Nurses’ Health Study and 42,000 from the Health Professionals Follow-Up Study (HPFS). The BMJ study concluded: “Lauric, myristic, palmitic and stearic acids are associated with an increased risk of coronary heart disease after multivariate adjustment of covariates. Risk of coronary heart disease is significantly lower when replacing the sum of these four major saturated fatty acids with polyunsaturated fat, whole grain carbohydrates, or plant proteins, with the lowest risk observed when palmitic acid, the most abundant saturated fatty acid, was replaced.”

The research has shown that the saturated fatty acids that also raise LDL (bad) cholesterol are found in coconut oil (lauric, myristic, palmitic acid.) On the chart where coconut oil is listed in the Circulation study, it has about 90% saturated fats. Butter has about 64% saturated fat and beef about 40% saturated fat. Not only is coconut oil the richest source of saturated fat but also a rich source of saturated fatty acids (lauric, myristic and palmitic acids) that raise LDL cholesterol. Palmitic acid is the worst saturated fat when it comes to cardiovascular health and raising LDL cholesterol. Research has shown that palmitic acid is the most atherogenic fatty acid and also enhances inflammation. Animal fats such as meat and butter are rich sources of palmitic acids. Also, a study in the American Journal of Clinical Nutrition found that increasing dietary palmitic acid decreases fat oxidation (fat burning) and daily energy expenditure (thermogenesis). The study found that oleic acid, the most abundant fatty acid in olive oil, had the opposite effect increasing fat oxidation, energy expenditure and thermogenesis. The study said that “increases in dietary palmitic acid may increase the risk of obesity and insulin resistance.” Proliferator-activated receptor c coactivator 1a (Pgc-1a) is a critical regulator of brown fat (BAT) activity in response to environmental stimuli such as cold temperature and diet (Environmental Epigenetics, 2017). Palmitic acid inhibits Pgc-1a while oleic acid increases it; therefore, palmitic acid is not desirable if you want to increase brown fat activity. Monounsaturated fats are preferred along with omega-3 fats from fish if you want to increase brown fat activity, thermogenesis and fat loss. Not all saturated fats have a negative effect on LDL (bad) cholesterol. For instance, stearic acid, a saturated fat found in cocoa butter, does not raise LDL cholesterol, according to recent research.

So, what about medium-chain-triglycerides (MCTs), a form of saturated fat that has shorter chains of fatty acids? Claims that the majority of fat in coconut oil are MCTs is untrue. The thermogenic/weight-loss research has been done on pure MCT oil, not coconut oil. It’s inaccurate to apply the research on pure 100% MCT oil to coconut oil, which only has 13% of MCTs

In February 2017, 52-year-old Bob Harper, celebrity fitness trainer on the hit TV show “The Biggest Loser,” suffered a heart attack at a New York City gym and went into cardiac arrest. He was lucky to survive! The culprit turned out to be fatty particle in the blood called lipoprotein(a) or Lp(a), which is a risk factor for heart disease. Research has shown that it can be lowered by monounsaturated fats as shown by a study that reported significant decrease in lipoprotein(a) levels in people whose diet was supplemented by almonds. Also, the B vitamin niacin has been shown to lower lipoprotein(a) levels.

Bulletproof Coffee is a trendy product. Bob Harper was on the “Rachael Ray Show” in April 2017 demonstrating his “morning coffee” which consisted of 8 ounces of strong coffee, coconut oil and clarified butter (ghee). He said that this was his “fuel” before he “heads to the gym every morning on an empty stomach.” After his heart attack, I’m sure he discontinued this pre-workout ritual! In fact, he now follows a Mediterranean-style diet, which is rich in monounsaturated and omega-3 fats.

At this time, I do not recommend coconut oil’s use for weight loss or optimal health. The truth is coconut oil is extremely high in saturated fats that can raise LDL (bad) cholesterol, a high-risk factor for cardiovascular disease.

The book entitled The Thermo Heat® Weight Loss Revolution by Michael Rudolph, Ph.D. provides a calorie-controlled, low-carb Mediterranean diet, 30-day meal plan and exercise program. It says that you should limit yourself to 100 grams of carbohydrates per day, or less. If you want to follow the ketogenic diet, carbohydrates should be kept at less than 50 grams per day. Processed food and sugar is off the table! The Thermo Heat® Weight Loss Revolution stresses foods high in monounsaturated and omega-3 polyunsaturated fatty acids. It also recommends thermogenic brown fat-activating herbs and spices instead of salt to flavor food— such as garlic, onion, mustard and chili pepper (capsaicin) to name a few. Monounsaturated fats are more thermogenic than saturated fats found in high-fat dairy and red meat. Because of ease of compliance, The Thermo Heat® Weight Loss Revolution Mediterranean diet makes it easy to follow even when dining out. One or two glasses of polyphenol-rich red wine (not white wine, or any other alcoholic beverages) per day can have positive health benefits on the Mediterranean diet. Studies show that olive oil and certain spices can enhance brown fat and increase thermogenesis. A number of studies have shown that healthy fats from nuts, olive oil and fish, found predominantly in Italian, Greek and Turkish cuisine, have health benefits in the prevention of heart disease, type 2 diabetes and obesity. Fish oil and omega-3 fats can decrease bodyweight gain and fat accumulation by increasing thermogenesis and energy expenditure. (Clinical Nutrition, 2009; Metabolism: Clinical and Experimental, 2008; International Journal of Obesity, 2002; Nutrition Journal, 2015).

For more authoritative information, see The Thermo Heat® Weight Loss Revolution by Michael J. Rudolph, Ph.D., including the foreword by Daniel L. Friedman, MD and Eugene B. Friedman, MD. You can click the link to order on Amazon here. The Thermo Heat® Weight Loss Revolution is a groundbreaking scientific plan based on research involving brown fat (BAT) and offers its readers a brown fat, thermogenic and brown-fat-activating-diet, nutrition, supplement(s) and exercise program. You can also get a free PDF version here

References:

U.S. News & World Report; Jan 2nd, 2019

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Mediterranean Diet Reduces Risk of Incident Stroke in a Population With Varying Cardiovascular Disease Risk Profiles. Paterson, K. E., Myint, P. K., Jennings, A., Bain, L., Lentjes, M., Khaw, K. T., & Welch, A. A. (Oct 2018). Stroke, 49 (10), 2415-2420. Advance online publication. doi:10.1161/STROKEAHA.117.020258

Ahmad S, Moorthy MV, Demler OV, et al. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Netw Open. Dec. 7, 2018;1(8):e185708. doi:10.1001/jamanetworkopen.2018.5708

Marialaura Bonaccio, Augusto Di Castelnuovo, Simona Costanzo, Mariarosaria Persichillo, Amalia De Curtis, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello. Interaction between Mediterranean diet and statins on mortality risk in patients with cardiovascular disease: Findings from the Moli-sani Study. International Journal of Cardiology, 2018; DOI: 10.1016/j.ijcard.2018.11.117

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The effect of dietary oleic, linoleic, and linolenic acids on fat oxidation and energy expenditure in healthy men. Jones, Peter J.H. et al. Metabolism: Clinical and Experimental, Volume 57, Issue 9, 1198-1203

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Oleuropein, a Phenolic Compound in Extra Virgin Olive Oil, Increases Uncoupling Protein 1 Content in Brown Adipose Tissue and Enhances Noradrenaline and Adrenaline Secretions in Rats. Journal of Nutritional Science and Vitaminology, Released November 11, 2008. Yuriko Oi-Kano, Teruo Kawada, Tatsuo Watanabe, Fumihiro Koyama, Kenichi Watanabe, Reijirou Senbongi, Kazuo Iwai.

Effect of Distinct Lifestyle Interventions on Mobilization of Fat Storage Pools: The CENTRAL MRI Randomized Controlled Trial. Yftach Gepner, Ilan Shelef, Dan Schwarzfuchs, Hila Zelicha, Lilac Tene, Anat Yaskolka Meir, Gal Tsaban, Noa Cohen, Nitzan Bril, Michal Rein, Dana Serfaty, Shira Kenigsbuch, Oded Komy, Arik Wolak, Yoash Chassidim, Rachel Golan, Hilla Avni-Hassid, Avital Bilitzky, Benjamin Sarusi, Eyal Goshen, Elad Shemesh, Yaakov Henkin, Michael Stumvoll, Matthias Blüher, Joachim Thiery, Uta Ceglarek, Assaf Rudich, Meir J. Stampfer and Iris Shai. Circulation 2017;CIRCULATION AHA.117.030501, 2017.

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., et al., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group. July 17, 2008. N Engl J Med 2008; 359:229-241
DOI: 10.1056/NEJMoa0708681

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Mensink, R.P., Zock P.L., Kester, A.D., Katan, M.B. 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. Am J Clin Nutr. 2003;77:1146-55.

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Acute effects of three high-fat meals with different fat saturations on energy expenditure, substrate oxidation and satiety. Casas-Agustench, P. et al. Clinical Nutrition, Volume 28, Issue 1, 39-45 2009

Fish oil intake induces UCP1 upregulation in brown and white adipose tissue via the sympathetic nervous system. Minji Kim, Tsuyoshi Goto, Rina Yu, Kunitoshi Uchida, Makoto Tominaga, Yuriko Kano, Nobuyuki Takahashi & Teruo Kawada. Scientific Reports volume 5, Article number: 18013 (2015)

Jens Lund, Lesli Hingstrup Larsen & Lotte Lauritzen (2018) Fish oil as a potential activator of brown and beige fat thermogenesis, Adipocyte, DOI: 10.1080/21623945.2018.1442980

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Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association Frank M. Sacks, MD, FAHA, Chair, Alice H. Lichtenstein, DSc, FAHA, Jason H.Y. Wu, PhD, MSc, Lawrence J. Appel, MD, MPH, FAHA, Mark A. Creager, MD, FAHA, Penny M. Kris-Etherton, PhD, RD, FAHA, Michael Miller, MD, FAHA, Eric B. Rimm, ScD, FAHA, Lawrence L. Rudel, PhD, FAHA, Jennifer G. Robinson, MD, MPH, FAHA, Vice Chair, Neil J. Stone, MD, FAHA, and Linda V. Van Horn, PhD, RD, FAHA, Vice Chair On behalf of the American Heart Association.

The Coconut Oil Health Craze: Is It a Big Fat Lie? FitnessRx for Women, By J.A. Giresi 15 January 2018

The Rachael Ray Show, April 2017

The Thermo Heat® Weight Loss Revolution, by Michael J. Rudolph, Ph.D.