+91 9930 085 000

Looking Back Detail Page

The Kinetics of Dietetics

Altaf Patel Campionite class of 64

There are several prospective and retrospective trials on diets and diseases that are used to make recommendations to the general public. The conundrum however that troubles me is whether dietary restrictions and changes affect various parameters in every human the same way. I know for a fact that alcohol, although defined in its limits, affects different individuals differently. I remember during my resident days, a ward boy who cleaned our resident quarters, would perpetually ask me for money, presumably to fuel his drinking habits. One day, I decided that he needed to be examined, since he told me that he drank almost a litre of moonshine every day and had been doing it for the last 30 years or so. I took him to the ward, collected his blood and ordered the necessary tests. The consultant asked me about the boy and the tests. I told him the story and he told me that 20 years ago, when he was a resident, he too had similarly checked the ward boy and surprisingly found nothing wrong in his body. True to that, his liver function and other tests came out normal. I was quite surprised, shocked in fact, after having seen a lot of other patients suffering from alcoholic liver disease who drank 10 per cent of what this gentleman did. So this had me puzzled. Do dietetic changes bring about similar changes in all humans or does it vary. By and large this may be correct but I am certain it is not absolutely so. The other question is does consuming food in its natural form, or taking it in a pharmaceutical form have any bearing on its effects on our diets? For example, will consuming fish have the same effect as a fish oil capsule? Dieticians often recommend two servings of fish every week, now whether it is due to the presence of omega fatty acids in the fish or simply replacing the red meat with it seems not entirely clear. Recommendations suggests that fish benefits people who have had a recent heart-attack scare or are known to have a history of heart disease.
It is not likely to change anything in normal human beings, but most are quick to draw this parallel. The American Dietary Guidelines suggested that saturated fats are not risk factors, and implied that the effect was at least minimal. I think the rational medical explanation is that the miniscule change in cholesterol increase is offset by the salubrious effects fats have on particle size. Fats seem to change particle size from small and dense to large and buoyant, and at this point of time though not absolutely certain, this may be as or even more important than the marginal increase in cholesterol from a fatty diet. I had previously written about this on Feb 28, stating that this was my own impression. Most cholesterol was made in the liver and if diet was the bigger player, then in vegetarians cholesterol would have been very low. The American Heart Association in its June issue, issued a presidential advisory on saturated fats that they most definitely cause heart diseases. These two diametrically opposite opinions are surprising in the very least, if not downright confusing. The AHA has been recommending this since 1961. An extremely well written article on the topic by Nina Teicholz and Dr Eric Thorn is noteworthy. She says, and correctly so, that this diet hypothesis connecting it heart disease was utopia-based that left a panicked public grappling with a sudden increase in heart disease. The National Institute of Health held trials on about 50,000 individuals, replacing saturated fats by vegetable oils but could not convincingly link saturated fat with heart disease. Similarly, studies such as the Minnesota coronary survey on dietetic changes in institutionalised patients found no difference in the health of the hearts of those that consumed saturated fat and those that consumed unsaturated vegetable oil. The study was not published for 16 years because the authors were disappointed that they could not incriminate saturated fats!!! The AHA's presidential advisory suggests that replacing saturated fats with vegetable oils reduces the risk of heart disease by almost 30 per cent, which is the equivalent of administering a statin drug. None of the other studies back this claim. such drastic reduction.
In fact according to the Minnesota survey, the more you reduce your total cholesterol intake, the more likely you were to suffer from heart diseases. What compounds the dilemma further, is the fact that these very vegetable oil companies had pledged support of 5,00,000 US dollars to the AHA, and the review paper that favoured such vegetable oils was written by a researcher serving on the scientific advisory board of a vegetable oil manufacturing company. In conclusion, I have always said that databases of experience are perhaps as good as databases of evidence. In fact most databases of evidence essentially take their first steps from databases of experience. With such conflicting views, I am not surprised that the vox populi now treats many of these suggestions with a jaundiced eye.