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The Emphasis on Low Fat
26 Nov 2020
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What fat percentage do various Whole Food Plant-Based doctors recommend?
Dr T Colin Campbell

Dr T Colin Campbell coined the term Whole Food Plant-Based in 1982. In his book Whole: Rethinking the Science of Nutrition (352 pages, 2014), Dr T Colin Campbell says (page 17):

"The ideal human diet looks like this: Consume plant-based foods in forms as close to their natural state as possible ("whole foods") Eat a variety of vegetables, fruits, raw nuts and seeds, beans and legumes, and whole grains. Avoid heavily processed foods and animal products. Stay away from added salt, oil, and sugar. Aim to get 80 percent of your calories from carbohydrates, 10 percent from fat, and 10 percent from protein."

In the article Fat and Plant-Based Diets (2009, updated 2018), Dr T Colin Campbell says,

I don’t argue for a 10% fat diet as the main starting point. Rather, I begin with the view that a plant-based diet is optimal and it just so happens that this diet, when done right (good quality WHOLE vegetables, legumes, fruits and cereals), is low in fat as well as in protein. It is a diet that, for most people, is 10-15% fat, and 8-12% protein. For those who demonstrate vulnerability to health disorders, the fat intake should favor the lower side. Dr. Esselstyn (in his heart disease reversal study) and Dr. John McDougall (thousands of patients) have demonstrated this very clearly. The difficulty that we, as individuals, all face is really how vulnerable are we.

(4 mins, 2013) T. Colin Campbell Promoting The 80/10/10 Diet

This short video features Dr Douglas Graham, author of THe 80/10/10 Diet (348 pages, 2006), a raw, Low Fat Whole Food Plant-Based system.

ACLM Dietary Guidelines

What does American College of Lifestyle Medicine (ACLM) say about fats?

ACLM Lifestyle Medicine Standards (2012) has a summary in Table 2:

Fats: ACLM recommends "Total fat < 15%, whenever possible from whole unprocessed plant sources." In nutrition circles, this would be called a 'low fat diet'.

Omega-3 and Omega-6: ACLM recommends "from whole unprocessed plant sources whenever possible". Quite often, dietary guidelines by different organizations encourage us to get Omeg-3 and Omega-6 from fish. ACLM encourages plant sources.

Mastering Diabetes Guidelines

Mastering Diabetes program by Dr Cyrus Khambatta and Robby Barbaro is targeted at tackling diabetes via Whole Food Plant-Based guidelines. How much fat intake do they recommend? This article by Mastering Diabetes explains:

In reality, what we do recommend for improved diabetes health, for improved insulin action, for improved glucose tolerance is to reduce your fat intake to between about approximately 10% and 15% of your total calories.

The book Mastering Diabetes (400 pages, 2020) has Take Home Messages at the end of Chapters 3 to 8. Chapter 4 is titled 'All Fat Is Not Created Equal'. Take Home Messages from Chapter 4:

The most important things to understand when it comes to dietary fat are:

  1. The most effective way to increase your insulin sensitivity through diet is to reduce your total fat intake to a maximum of 15 percent of total calories.
  2. The second most effective way to increase your insulin sensitivity is to replace foods that are rich in saturated fat and trans fat (including meat, poultry, fish, dairy, eggs, oils, and processed foods) with carbohydrate-rich whole foods that are low in saturated fat and trans fat.
  3. High-fat plants like nuts, seeds, avocados, coconut, and olives are nutrient-dense foods rich in PUFAs, but will contribute to increasing insulin resistance if your total fat intake exceeds approximately 15 percent. Feel free to eat these foods, but be aware that a little bit goes a long way.
  4. All whole foods contain fat, even if they have a sweet flavor. To calculate your total fat consumption from whole foods, add up the total fat from each food you've eaten throughout the day using diet-logging software that we describe in Chapter 8.

Dr McDougall

In this article: Making the change to a healthy lifestyle work in your life (2005) by Dr McDougall, the guidelines are:

The ideal starch-based diet is:

  5 to 10% fat
  8 to 15% protein
  75 to 87% carbohydrate

Dr McDougall: Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort by John McDougall et al, Nutrition Journal, 2014, 13:99. PDF Copy. Another copy: here. Excerpt:

[Patients received] dietary counseling and were fed a low-fat (≤ 10% of calories) diet based on minimally refined plant foods ad libitum to satiety.

The macronutrient profile was roughly 7% fat, 12% protein, and 81% carbohydrate by calorie. Meals were served buffet-style, and participants were encouraged to eat to the full satisfaction of their appetite.

(6 mins, 2022) Is there such a thing as "Healthy" Fats?
Dr Caldwell Esselstyn

In the article In Cholesterol Lowering, Moderation Kills (Cleve Clin J Med 2000 Aug;67(8):560-4, also available at Dr Esselstyn's website), he says,

The high fat American diet is responsible for an epidemic of coronary artery disease. A plant-based diet with less than 10% fat will prevent coronary disease from developing, halt the progress of existing disease, and even reverse the disease in many patients. Given proper support and education, motivated patients with a history of coronary disease can follow this diet and prevent future cardiac events.

Table W3 of A way to reverse CAD? by Esselstyn et al, J Family Practice, Vol 63, No 7, 2014 (available at Dr Esselstyn's website) on pages 364a-364b summarizes trials by both Dr Ornish and Dr Esselstyn; the target fat percentage in all of them was 10%.

Dr Dean Ornish

Nutrition Guidelines at Ornish Lifestyle Medicine explains:

"No more than 10% of calories are from fat. This is achieved by not adding any fats, oils, avocados, coconut and olives to a mostly plant-based diet. The 10% of calories from fat comes from fat that occurs naturally in grains, vegetables, fruit, beans, legumes, soy foods — and small amounts of nuts & seeds."

How many nuts and seeds?

"Three or less servings from low-fat foods or nuts can be included per day."

How much is 1 low fat serving? Surprisingly small! The article explaine:

1 low-fat food serving (≤ 3 gm fat) equals:
  5 almonds
  9 pistachios
  1 whole walnut
  3 pecan halves
  2 cashews
  6 peanuts (no shell)
  2.5 tsp flax seeds, ground
  2 tsp chia seeds or sunflower seeds, shelled
  1.5 tsp pumpkin seeds

Why does Ornish Lifestyle Program emphasize 10% total fat intake? Pages 2-3 of Ornish Guidelines in Detail (PDF) explain their rationale.

… should we consider dropping our fat percentage to 7% or 5%? Their writeup explains:

"The human body needs about 5% of calories from fat to obtain the essential fats for good health. Plus, there are no research studies that have evaluated or supported a fat intake below 10% fat."

In other words, we need about 5% total fat intake for EFAs (Essential Fatty Acids). But we don't have research studies to assess whether 5% is better or worse than 10% total fat intake.

Why 10% Fat? Pg 2
Why 10% Fat? Pg 3
Dr Neal Barnard

In 2006, Dr Barnard published this study: A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes by Barnard et al, Diabetes Care 2006;29(8):1777-1783. This study became the foundation of his book: Dr. Neal Barnard's Program for Reversing Diabetes (288 pages, 2018). Excerpts from the 2006 paper:

"The vegan diet (∼10% of energy from fat, 15% protein, and 75% carbohydrate) consisted of vegetables, fruits, grains, and legumes. Participants were asked to avoid animal products and added fats and to favor low-glycemic index foods, such as beans and green vegetables. Portion sizes, energy intake, and carbohydrate intake were unrestricted."

Nowadays, when PCRM (headed by Dr Barnard) conducts a study like this one: Fat Quantity and Quality, as Part of a Low-Fat, Vegan Diet, Are Associated with Changes in Body Composition, Insulin Resistance, and Insulin Secretion. A 16-Week Randomized Controlled Trial by Kahleova et al, Nutrients. 2019 Mar; 11(3): 615, what do they recommend?

"The daily allowance for fat intake was set between 20 and 30 g. This level of intake ensured that participants were able to consume adequate amounts of the essential fatty acids."

"They were also asked to avoid added oils."

On a 2,000 calorie diet, 20 to 30 grams of fats are 180 to 270 calories, which is 9% to 13.5% of total calorie intake.

Dr Greger

Dr Greger's has 2-pronged guidelines for nuts and seeds (and thereby on total fat intake). For prevention, Dr Greger doesn't insist on a low fat diet. He doesn't prescribe a target fat percentage. Many of his recipes have extra nuts and seeds, so they are not low fat. At the same time, he says that if we do have a chronic condition like heart disease, then we should switch gears and adopt a low fat Whole Food Plant-Based guidelines by Dr Esselstyn.

See How Many Nuts & Seeds To Eat Daily?

Very Low Fat: Dr Peter Rogers, Dr Rick Dina

When it comes to dietary fat intake, Dr Esselstyn's food guidelines are arguably the strictest. But some WFPB doctors argue for even stricter guidelines! They explain that we don't even have to consume nuts, seeds, peanuts or avocados for Essential Fatty Acids (EFAs), and that it's possible to derive these EFAs from fruits and vegetables alone, if we chose them carefully and consume them in sufficient quantities! See Essential Fatty Acids for a discussion.

Kempner's Rice Diet

Dr Kempner's Rice Diet from 1940s and 1950s is an example of early attempts at carving out a plant-based diet for severe chronic illnesses which was very low fat. And it was surprisingly successful too! For details, se Kempner's Rice Diet.

How Many Nuts & Seeds To Eat Daily?

See How Many Nuts & Seeds To Eat Daily? for an interesting discussion.

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