Whenever I go out to dinner with my friend, Claudia, she looks on enviously as I pour extra-virgin olive oil over my salad and eat fatty fish, such as wild Alaskan salmon steak. She usually says something like, "You're lucky. I can't eat the way you do because I have a fat gene." She's convinced this is so because she's still got a potbelly after decades of low-fat dieting and exercise.

So she dutifully orders chicken, removing the skin when it arrives at the table, a salad with lemon juice for dressing and a baked potato with a single pat of butter. Not a particularly gourmet experience and certainly not as satisfying as my delicious, fatty dinner.

The bemused Claudia is a victim of conventional wisdom. She doesn't know it, but conventional wisdom, not fatty foods, prevents her from losing excess body fat. We all know what conventional wisdom says about weight loss: To lose weight, eat fewer calories than you burn; the healthiest way to lose weight is to eat a low-fat diet, because fat contains more than twice the calories of Garbs and proteins.

Conventional wisdom pervades nearly all obesity research studies and remains the theoretical foundation of medically approved and scientifically accepted methods of weight loss. But the research data prove otherwise. The data show that you will not get fat eating fatty fish, olive oil and fatty nuts on the MediterrAsian diet. In fact, published research shows that you can get very thin and fit doing so.

Shakespeare Had It Right

Conventional wisdom says that we are helpless, hapless products of our genes. The MediterrAsian diet theory refutes such conventional wisdom about genetics: Our destiny lies not in our stars or genes, but within ourselves– the internal environment to which we expose our genes. The study of epigenetics (broadly, how environment affects genes) has shown that our genes play but a small role in determining how fat we become; what really controls our genes and matters most is the environment. OK, call me the A Gore of nutrition science.

It's true that genetics can determine one's tendency to gain body fat, but "fat genes," to the extent that you possess them, must first be activated by something in the cellular environment. Regardless of your genetics and fat genes notwithstanding, you will not add fat to your body on the MediterrAsian diet because it provides a healthy internal environment for your genes and prevents so-called fat genes from being activated. They remain silent and inactive.

Many people possess a genetic tendency to plump up like a ballpark frank in the same way that feedlot animals possess the tendency to fatten when fed a grain-ba! diet. Hunter-gatherers didn't get fat enjoying the natural game and plant foods in their primitive environment When they moved to industrialized society, they got just as fat as everyo else around them. It's clear their gen ics played no role in protecting then from a new environment consisting "modern" foods and especially grair and cereals. Perhaps they all had my friend Claudia's fat gene.

Only environmental changes can explain why we alone, and no other species of animal, grow chronically obese. If we track the upsurge in obesity during the last 20 years, we can easily see that only environmental causes (i.e., diet and lifestyle) and genetic changes can account for the present obesity epidemic in children and adults.

Why Fatty Fish, Nuts and Extra-Virgin Olive Oil Won't Make You Fat

Under the direction of insulin, a portion of dietary carbohydrate (how arge a portion depends on the type of diet you eat) and all dietary fats are stored first as triglyceride in adipose cells before they can be used for fuel. Since salmon, olive oil and other fatty foods contain negligible amounts of carbohydrate, they will not cause an insulin spike and therefore the fat they contain will supply between 50 and 70 percent of the energy we burn each day. A high-fat diet that is very low in grains, cereals and starches will not add net fat to your body.

The amount of fat released from adipose cells to be burned for energy depends upon the level of blood sugar available for energy needs. The amount of sugar burned depends upon the availability of fatty acids to be burned in sugar's place. This balancing act goes on continuously between dietary fat and carbohydrate to be stored or burned as fuel. Less available sugar means more fat will be released from adipose tissue to be burned for energy.

A special activated molecule called alpha-glycerol phosphate (AGP) is made from glucose whenever glucose is burned for energy and AGP controls how much free fatty acids in the blood will be made into triglyceride (a triglyceride is composed of three fatty acids bonded to one AGP molecule). The more glucose transported into adipose cells and burned for fuel, the more AGP will be produced and thus, more triglyceride.

Therefore, carb-heavy meals, which promote high insulin output, will increase the amount of glucose in fat cells and promote the conversion of free fatty acids into triglyceride. More sugar and starch in the diet means more stored fat without sufficient exercise. When blood sugar decreases, the amount of sugar transported into fat cells declines, which limits AGP and triglyceride synthesis, and more fatty acids can be released into the circulation to be burned as energy.

Homeostasis- Why We Tend To Stay Thin Or Fat

Insulin is the primary controller of fat synthesis and deposition. If you want to mobilize fat from fat cells to be burned for energy (and thus, get thinner), you have to lower insulin and blood sugar levels, which means reducing calorie intake per meal and/or reducing the carbohydrate content of that meal. Another way to achieve this is to replace fat with carbs in the diet, thereby automatically reducing caloric intake and at the same time, increase physical activity to burn off excess carbs. Elite cyclists, such as Lance Armstrong, and marathoners and triathletes do this quite effectively because these sports demand competitors maintain a very low level of body fat.

Insulin controls the entry of glucose into muscle, adipose and liver cells. With the help of other hormones that serve to increase blood glucose levels (epinephrine, glucagon, ACTH, TSH, MSH, vasopressin, GH), insulin — the only hormone that lowers sugar levels in the blood)— controls this balancing act (homeostasis) to provide a flexible source of fuels to our cells: sugar and fat. These facts clearly establish that body-fat loss has little do with how many calories we eat or burn, but rather with which types of calories (fatty acids, glucose and AGP) get in and out of fat cells and which types are preferentially burned for energy, If you learn how to control the flow of calories out of fat cells and into muscle cells to be burned for fuel, you will become thinner. The two master controllers that determine the balance of fat storage and mobilization are dietary carbohydrate and insulin.

Carbs require insulin for entry into cells, which means there is no possibility of getting fat without adequate amounts of insulin. A reduced carbohydrate intake (or reduced total caloric intake, which reduces carb intake) minimizes the storage of food as fat.

Insulin's primary role is actually to turn calories into stored fat (triglyceride) and to reduce the use of fat for fuel by getting sugar out of the blood and into cells. Even low levels of insulin are sufficient to make you fat, so it's vitally important not to consume calorically dense meals at one sitting (in other words, eat normal portions; don't supersize your food order) and to consume most of your carbs as vegetables, not grains, cereals or simple sugars.

Starting a high-cereal/grain/sugar diet will at first increase insulin sensitivity of fat cells (especially the larger ones that are already bloated with fat). In clinical studies, feeding a high-carb diet initially creates the appearance that blood sugar is controlled when in fact, an individual may gradually grow fatter (because carbs are drawn out of circulation and into fat cells) and more insulin resistant, especially without daily commitment to exercise.

Even with significant exercise, the level of fatty acids (triglyceride) in the circulation can increase, thus driving up triglyceride in the circulation. At the outset, eating high-carb diet keeps fat cells sensitive to insulin– blood sugar levels improve and the onset of diabetes is forestalled, at least until one's level of physical activity declines (perhaps due to injury, arthritis, loss of motivation, etc.). Without adequate exercise, muscle cells can eventually become resistant to the carb-lowering effects of insulin. At that point, the person has clinical type 2 diabetes.

Published Studies Tell The Tale 0' the Tape

Consider These Research-Based Facts:

1. Obese people, on average, eat no more than lean people.
   
   
2. A sedentary stay-at-home mom can gain weight on as little as 1,400 calories a day.
   
   
3. Natives of the island of Crete eat a diet that is 40 percent fat (mostly olive oil) that contains fatty fish and other naturally fatty foods, yet they stay thin and healthy. Moreover, these natives are the longest-lived people on planet Earth.
   
   
4. South Africans eat a diet that supplies only 22 percent of its calories as fat, yet they suffer from an epidemic of obesity.

A number of recent published studies from around the world reveal why naturally occurring fatty foods that are part of a reduced-carb diet like the MediterrAsian diet, can lead to slenderness:

A 2007 Japanese study found that on a calorie-reduced diet, low-carb intake was much more effective than highcarb intake in improving insulin sensitivity.

A 2007 Italian study revealed that weight maintenance with an olive-oil-rich diet improves fasting insulin levels in insulin-resistant people. Ingestion of extra-virgin olive decreased post-meal glucose and insulin levels and increased HDL-cholesterol as compared with carbohydrate- rich diet.

A 2007 Spanish study found that an isocaloric olive-oil-rich diet prevents abdominal fat redistribution and the post-meal decrease in peripheral adiponectin (hormone that regulated the metabolism of fat and glucose) gene expression and insulin resistance induced by a carbohydrate-rich diet in insulin-resistant subjects.

These facts are at odds with conventional wisdom about fat loss, calories and low-fat diets. In order for conventional wisdom to be true (low-fat, high-carb diets are best), these facts must be false. But they are quite true. The truth is simple: Elevated insulin + blood sugar levels lead to a predominance of fat deposition over fat burning and we gain weight because our blood levels of insulin remain elevated far longer than nature (evolution) intended.

All things being equal, if two sedentary women eat the same number of calories, but one eats a low-fat, high-carb diet and the other eats a high-fat, low-carb diet, the first will store more body fat and burn a higher ratio of carbs-to-fat than the second. The first woman's fat stores will be less available to be burned for energy, and so her body will preferentially burn more carbs than fats.

The Glycemic Index-More Conventional Wisdom That Doesn't Add Up

Conventional wisdom tells us such foods such as carrots and watermelon, which raise blood glucose levels as much as pure table sugar, are unhealthy. You've already learned that conventional wisdom is often wrong and in this case, it's downright silly. The glycemic index, the current darling of conventional wisdom, is no exception.

The glycemic index (GI) is a list of foods ranked according to the extent to which they raise blood glucose levels after eating. Individual foods are graded on a scale from zero to 100 (relative to a reference food, such as white bread or glucose). Conventional wisdom says we should construct meals based on the GI of foods. Why? Because a few recent studies have suggested that the risks of type 2 diabetes and coronary heart disease are related to the GI of the overall diet– lower being healthier than higher. In 1999, the World Health Organization (WHO) and Food and Agriculture Organization (FAO) recommended that people in industrialized countries base their diets on low-GI foods.

We can do better than using this questionable and misleading index to plan our diets. Here's why: Foods with a high and thus, a presumably "unhealthy" GI rating, are rapidly digested and absorbed, causing elevated blood glucose levels. Low-GI foods, by virtue of their slower digestion and absorption, produce a gradual rise in blood sugar and insulin levels. But the GI is biased against such healthy foods as very low-calorie vegetables. For example, a medium-sized raw carrot weighs 78g and contains 8g of carbohydrate and 35 calories. The GI implies that carrots are unhealthy and fattening. Oh, really?

The GI treats ice cream more favorably than carrots and watermelon. Ice cream has a relatively low GI because of its high fat content and high osmolarity (which means it's slowly released from the stomach). But ice cream's high-fat content amplifies the insulin response to its high-sugar content, so it causes a surge of insulin release, which helps turn the sugar it contains directly into stored fat. You can get slender on a high-fat/low-carb diet or a high-carb/low-fat diet, but your chances of doing so while eating low-GI foods like ice cream are slim.

That's because the combination of high fat and high sugar in one food or meal is the WORST combination you can eat for losing body fat. The I I" Commandment should be: "Thou shalt not mix Mr. Fat with Mr. Sugar." High-protein meat and seafood also promote insulin release, but since they contain negligible Garbs, they will have little effect on blood sugar and therefore, not add net fat to your body when consumed in reasonable amounts.

Making Sense Of It All

The GI index does not take into account that very low-calorie food be digested and absorbed quickly, but their impact on blood sugar is so small that it simply doesn't matter. Comparing carrots to glucose or white bread (both are used as reference foods for the GI) is nonsensical. Just look at the differences in caloric density: One pound of carrots contains only 195 calories, while a pound of table sugar contains 1,725 calories. A person would have to consume more than eight pounds of carrots to equal the caloriE density of pure sugar. One would have to drastically increase the volume of a very low-calorie food to achieve the same caloric and carbohydrate level as sugar. No one eats eight pounds of carrots in a meal.

Another factor the GI creators failed to account for is that sugar has a higher osmolarity than carrots, which delays stomach emptying time, lowers the GI rating and creates a bias against low-calorie/low-osmolarity foods like carrots. Bottom line: A normal serving of carrots or other low-calorie, high-carb foods has too few calories to matter. Interestingly, insulin output in response to a meal correlates best to total calories consumed and not to the GI of individual foods in that meal.

The MediterrAsian Diet: One Flexible Plan For Everyone

Moderation and "mixed" diets are making us fat and unhealthy. When it comes to diet and health, extreme diets are best: high-fat/reduced-carb or high-carb/reduced-fat. Fortunately, the MediterrAsian diet allows you to follow either within the framework of one dietary approach. Why? The MediterrAsian diet is based on the world's two healthiest diets – the Mediterranean and Asian diets. As you know, the Mediterranean diet (the native diet as eaten in Crete before "modernization" hit the country in the 1960s) is a high fat (40 percent fat) diet based on extra-virgin olive oil, fatty fish, shellfish, nuts, cocoa, vegetables, fruits and wine.

The traditional Asian diet (as eaten by native Okinawan fisherman) is a very low-fat diet (10 percent-15 percent fat) based on rice and noodles, vegetables, soy, green tea, seafood and saki. You can grow very slender and healthy on a high-carb, Asian-type diet if you eat modestly and exercise daily to burn off the Garbs. But you can also do the same on a high-fat/low-carb Mediterranean-type diet that includes omega-3-rich seafood, extra-virgin olive oil, vegetables, fruits and nuts without exercise, although for health purposes, I strongly recommend that you do a slow-andsteady daily exercise (e.g., walking, cycling, swimming) combined with two or three days of light strength training for a well-rounded, healthy lifestyle.

Both dietary approaches work for different reasons. The scientific literature supports this conclusion. On my flexible MediterrAsian diet, you can choose the dietary approach that best fits your palate and lifestyle. That's why I say the MediterrAsian diet is a diet that fits all sizes.   

References:

1. Koide, N, Oyama, T, Miyashita, Y and Shirai, K. Effects of calorie-restricted low-carbohydrate diet on glucose and lipid metabolism in Otsuka Long Evans Tokushima Fatty rats. Atheroscler Thromb 14:5, 253-60 (2007).
2. Paniagua, JA, de la Sacristana, et. Al. A MUFA-rich diet improves posprandial glucose, lipid and GLP-1 responses it insulin-resistant subjects. I Am Coll Nutr 26:5, 434-44 (2007).
3. Paniagua, JA, Gallego de la Sacristana, A, Romero, I, Vidal-Puig, A, Latre, JM, Sanchez, E, Perez-Martinez, P, Lopez-Miranda, J and Perez-Jimenez, F. Monounsaturated fat-rich diet prevents central body fat distribution and decreases postprandial adiponectin expression induced by carbohydrate-rich diet in insulin-resistant subjects. Diabetes Care 30:7, 1717-23 (2007).
4. Miyashita, Y, Koide, N, Ohtsuka, M, Ozaki, H, Itoh, Y, Oyama, T, Uetake, T, Ariga, K and Shirai, K. Beneficial effec of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract 65:3, 235-41 (2004)
5. Piatti, PM, Monti, F, Fermo, I, Baruffaldi, L, Nasser, R, Santambrogio, G, Librenti, MC, Galli-Kienle, M, Pontiroli, AE and Pozza, G.Metabolism Hypocaloric high-protein diet improves glucose oxidation and spares lean body mass: comparison to hypocaloric high-carbohydrate diet. Metabolism 43:12, 1481-7 (1994)

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