THE NURSES’ HEALTH Study II revealed that other lifestyle variables were also important.
Maintaining a normal weight, getting regular physical exercise, not smoking, and eating a
healthy diet could prevent a stunning 91 percent of type 2 diabetes. But the million-dollar
question is: What is a “healthy” diet? Dr. Willett’s healthy diet was defined as high in cereal
fiber, high in polyunsaturated fats, low in trans fat, and low in glycemic load.
When digested, carbohydrates break down into glucose. The glycemic index measures
the rise in blood glucose after ingesting 50 grams of carbohydrate-containing foods.
However, the amount of carbohydrates contained in a standard serving varies enormously.
For example, a standard serving of fruit may contain less than 50 grams of carbohydrates
whereas a single pastry may contain far more. The glycemic load refines this measure by
multiplying the glycemic index of a food by the grams of carbohydrate in a standard serving
of that food.
Generally, foods high in sugar and refined carbohydrates are high in glycemic load.
Dietary fats and proteins, since they raise blood glucose very little, have minimal glycemic
loads. Contrary to the low-fat diet recommended by all the medical associations around the
world, Dr. Willett’s healthy diet was high in dietary fat and protein. His diet was about
reducing sugar and refined carbohydrates, not reducing dietary fat.
In 1990, the widespread belief was that dietary fat was evil, that dietary fat was a mass
murderer, that dietary fat was vile. The term healthy fats did not exist. It was an oxymoron,
like a jumbo shrimp. Fat-laden avocados? A heart attack in a fruit. Fat-laden nuts? A heart
attack in a snack. Olive oil? Liquid heart attacks. Most people fervently believed fats were
going to clog our arteries, but it was only an illusion.
Dr. Zoë Harcombe, a Cambridge University–trained obesity researcher, reviewed all the
data that had been available in the early 1980s, when low-fat guidelines were introduced in
the U.S. and U.K. No proof had ever existed that natural dietary fats worsened
cardiovascular disease. The evidence for the low-fat guidelines was simply a great work of
 The science was far from settled at the time the government decided to weigh in and make the final decision to vilify dietary fat. Yet this belief had become so entrenched both in the medical establishment and among the general public that it had become heretical
to suggest refined grains and sugars were the problem rather than dietary fat.
In the midst of our frenzied low-fat obsession, Dr. Willett’s assertion was considered
high treason. But the truth could not be concealed forever. Today, we understand clearly
that obesity is the main underlying issue behind type 2 diabetes. But the problem isn’t
simply obesity. Rather, it is abdominal obesity.


IN 2012, Dr. Michael Mosley was a TOFI. A what? Not tofu, the delicious Asian soy delicacy.
The acronym TOFI stands for “thin on the outside, fat on the inside.” Dr. Mosley is a medical
doctor, British Broadcasting Corporation (BBC) journalist, documentary filmmaker, and international bestselling author. And, in his mid-50s, he was also a ticking time bomb.
He was not particularly overweight, weighing 187 pounds, standing 5 feet 11 inches, with a waist of 36 inches. This equals a body mass index of 26.1, just barely in the overweight range. By standard measurements, he was considered just fine. He felt fine, perhaps
carrying a little bit of weight around the mid-section from being middle-aged. Just a little
pudge, that’s all.

However, body mass index is not the best indicator of type 2 diabetes risk. The waist circumference, a measure of body fat distribution around the trunk, is a far superior predictor of type 2 diabetes.
7 Filming a health segment for the BBC, Mosley underwent a magnetic resonance imaging (MRI) body scan. To his shock and consternation, his organs were literally swimming in fat. To look at him, you would not have guessed it because most of the fat was hidden inside his abdomen.
Eighteen months later, during a visit to his own physician, routine screening blood tests
revealed type 2 diabetes. Devastated, Dr. Mosley says, “I had assumed I was healthy and
suddenly I was discovering I wasn’t, and had to take this visceral fat situation seriously.”

Visceral fat accumulates inside and around the intra-abdominal organs such as the liver,
kidneys, and intestines, and can be detected by an increased waist circumference. This
pattern of obesity, where most of the fat is carried around the abdomen, is also known as
central obesity, or central adiposity. In contrast, subcutaneous fat is the fat deposited
directly under the skin.

The different health risks associated with the different fat distributions explain how
roughly 30 percent of obese adults are metabolically normal.
 These healthy-fat people
carry more subcutaneous fat rather than the more dangerous visceral fat. On the other
hand, some normal-weight people show the same metabolic abnormalities as in obesity.

No comments

{ "gcm_sender_id": "376695005133" }