Somewhere around the mid 1950's, the diet theory of heart disease was born out of The Seven Countries study. This study look at modifiable reasons for the surge in heart disease in the Western World post WW II. One of the contributing factors was thought to be fats in the diet. Even at the time the methodology of the study was criticized, but cholesterol and saturated fats became the poster child of causing coronary artery disease, or "clogged arteries". My father, an internist, whose family history was rife with early death to due heart attacks and strokes, adopted the theory almost as a religion. He shunned cholesterol laden foods and fats in favor of chicken, fish, and vegetables. Growing up my mother often made two dinners since we detested the frozen fish fillets she bought at the time. Our whole house smelled when they were defrosted. To my dad eggs were evil and bacon verboten.
Later in life, after living in San Diego, I discovered the fresh fish did not "smell like fish," and the fillets that caused olfactory ruination in our home, were most likely frozen long after they should have been tossed. However, that voice in my head kept telling me that cholesterol was bad, and unsaturated fats were good. I never ate butter and always had skim milk. As a cardiologist my father's voice was re-enforced by the American Heart Association and national dietary guidelines and food pyramids.
As is often the case in medicine, the resulting "cure" was worse than the original disease. Margarine and other "fat-altered" foodstuffs became touted as "healthy" and flooded the grocery shelves fueled by national public health hysteria. Only decades later did we find out that the most popular modified fat: trans-fats, were even more injurious to our blood vessels than saturated fats. The trans-fats were everywhere, from cookies to crackers to cereals. As on cardiologist put it, "they extended the shelf life of the products they entered, but not the person consuming them."
Next came the Adkins, Zone, South Beach, Fat for Fuel, Keto, Paleo, and hundreds of other high fat low carb diets. These are the antithesis of the low fat, high carb diet, but neither is particularly healthy or easy to maintain. I think if the ideal diet was discovered, that people could enjoy eating, there would no longer be a need for diet books of which literally millions have been written. I believe that the Mediterranean diet comes closest to the most healthy and most palatable when all is said and done.
So many people ask me, "As a cardiologist what do you eat?" I try to be honest but my diet has evolved with my health and new scientific information. I try to adhere to a med diet, but confess to eating bacon and eggs a couple of times week. The former is always nitrate free. Since learning I had Crohn's disease last year, I try to eat less red meat and more fresh fruits and vegetables. I eat lots of chicken and fresh fish, that I usually catch. Salmon is always Wild Alaskan, and never farmed. In fact I never eat any farm-raised fish. My occasional "go-to" cheating meal is pizza. I believe that diet and exercise are important but genetics is also a strong risk factor as to who gets heart disease and who doesn't. Also smoking is more negatively powerful than any diet, exercise, medication, or genes.
If I am hungry in between meals, I will snack on yogurt, nuts, cheese or peanut butter. I enjoy chocolate but it must always be dark. I try to eat ice cream and or gelato infrequently. I think the gluten-free graze, unless you are TRULY allergic and have celiac spruce disease, is not beneficial for most people's health. I also think that grains should be whole and not white or "enriched flour." Finally, since I live in Florida where it is usually hot, I will share with you one of my favorite healthy salads that is tasty and filling. The proportions are irrelevant-add as much or as little as you like:
Around 2-3 cups of watermelon cubes- (I prefer the seedless variety)
Half of an English (seedless) cucumber in large dices or small chunks
1/2-3/4 cup of GOOD quality feta cheese. ( I use the full fat kind from my local Greek market)
About 1/3 cup or more of roughly chopped fresh mint
Toss all together and enjoy. Cover and refrigerate any left-it is even better few hours cold or in fridge overnight.
Like the Buddhists say, "moderation in life is best."