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Carbs or fats? Good health requires both

You wouldn't know it from watching most television news, but some questions are not as simple as, "Boxers or briefs?" The answer to "Which is worse? Carbs or fats?" is neither yes nor no.

It's not even the right question.

We need them both, in moderation. Certain types of fats and carbohydrates are even good for us. The artificial clarity of either-or is easy to put our arms around, but the downside is we lose our grip on the grays of reality.

The right question is: How can we reach and maintain a healthy and comfortable body weight?

If it means losing weight, there is only one answer. Calorie intake must be less than calories expended.

"When low-carb diets work, they do so because they limit caloric intake," says Richard Cohen, the dietitian who directs Greene Memorial Hospital's HMR Weight Management Program.

Cohen has three criteria for a sensible dietary approach: It must be nutritionally balanced, must be palatable enough to keep following and must enable the person to meet individual goals.

Most people lose weight for health, appearance, comfort and fitness, but in different combinations.

Eating less fat helps anyone lose weight. Dietary fats convert to body fat more completely than carbohydrates or proteins and have nine calories per gram, compared with four each for carbs and protein.

People who eat more fat are more likely to wind up with heart disease or many cancers.

But the laws of thermodynamics still apply, as Cohen puts it. "Calories in" cannot exceed "calories out."

Bagels aren't fatty, but they have 500 calories. Fat-free Snackwell cookies have more calories per ounce than lean steak. It's easy to gain weight on a low-fat diet.

It's also hard to devise a healthy diet without including fats. Monounsaturated fats are good for the heart and appear to have other health benefits. So a sensible diet could even increase the amounts of fat in some fish, vegetables and olive or Canola oil.

The harm comes from saturated fat--largely red meat and dairy products--and trans fatty acids, found in such foods as chips, fries and margarine.

Carbs can be friend or foe, too. Baked goods are high in calories per portion size. Research has shown some carbohydrates not only cause blood sugar to soar but also stimulate appetites.

On the other hand, our bodies are designed to use carbohydrates as their main source of energy, Cohen says. Take them away, and the body breaks down protein and fat for energy instead, just as it would do if a person were starving.

People lose lots of weight quickly on low-carb diets by burning protein and fat. That produces a lot of urine. But the process also strains the kidneys and risks the kind of electrolyte imbalances seen in dehydrated athletes.

The advantage of the Atkins diet and other low-carb approaches is they keep insulin levels in check. Up to one-third of Americans have insulin-resistance syndrome, a risky prediabetic condition of high insulin levels, because their bodies don't process insulin efficiently.

"But I think Atkins throws the baby out with the bathwater," Cohen says. About the same time the New York Times Magazine touted low-carb diets last summer, researchers associated whole-grain foods--fiber-rich bread and bran cereal--with lowered risk of heart disease, diabetes and some cancers. One reason is those foods help make the body more responsive to insulin.

Refined, simple carbohydrates, heavy in white sugar and flour, are high in calories and low in nutrition, and they enter the bloodstream all at once, inducing a surge of insulin.

The complex carbs in whole grains, fruits and vegetables enter the bloodstream gradually and bring nutrients with them.

Three summers ago, a National Nutrition Summit facilitated a debate between leading low-carb proponent Robert Atkins and leading low-fat proponent Dr. Dean Ornish. It was as if, Cohen said, we were "pitting two gladiators against each other," and, of course, it made big news.

Just as the national media generally ignore the middle 90 percent of the country geographically, so do they tend to fixate on the coastal extremes of controversies.

As any Midwesterner knows, the best is somewhere in between.

Kevin Lamb writes for the Dayton Daily News