I have to take issue with Dr. Thomas Kottke’s March 4 counterpoint “Eat fat, reverse risks? Only if it’s the right fat,” which responded to Paul John Scott’s Feb. 24 commentary “The risk-reversal diet.”

While Kottke’s premise is correct, the fat advice does not make sense. While avoiding animal fat might appear healthy from a cardiologist’s perspective, it is the worst possible advice, for example, from a gastroenterologist’s or hepatologist’s perspective — those concerned with a healthy liver. By avoiding animal fat, you are avoiding choline, a vitamin-like essential nutrient key in the prevention of nonalcoholic fatty liver disease. As it is, about 90 percent of Americans are deficient in choline. Probably the best source of choline is eggs. Four eggs (high in animal fat) per day is sufficient to meet the daily need. The best plant source is cauliflower, but you would need to eat about 3½ pounds per day.

Also, advising that we limit fat to plant sources will upset the recommended omega-6 to omega 3-ratio, which should ideally be 1:1. Already, the typical American diet provides a ratio way too high in omega-6, yielding an unhealthy (inflammatory) ratio of about 16:1. The only way to counter this is to eat fats either from pastured animals or wild-caught ocean fish. While there are some plants, like flaxseed, that contain omega-3s, these omega-3s are in the form of ALA (alpha-linolenic acid), which needs to be metabolized to the more potent forms DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) to be useful, and this is a very inefficient process, especially when dietary omega-6 is high. The best way to convert ALA to DHA and EPA is to feed the flaxseed to chickens, then eat the eggs. There are many diseases related to omega 3 deficiency, including cancer, Alzheimer’s, diabetes, obesity, multiple sclerosis, breast cancer and ADD/ADHD. Oh, and ironically, also heart disease, stroke and cardiovascular disease.

Finally, any of the animal- or plant-extracted oils, so plentiful on the grocery shelf (or in supplements), including olive oil and canola oil, are micronutrient deficient. Consumption of any quality of these highly processed oils contributes to the vitamin and mineral deficiencies so rampant in our food culture. Animal fats and vegetable oils are best obtained by eating a variety of animal- and plant-sourced whole or real foods, only gently processed to make these all-important micronutrients biologically available.

What is happening too often in our culture is the demonization of some foods and labeling others as “superfoods.” This all-or-nothing thinking causes the underdosing or overdosing of otherwise healthy foods. This isn’t helped by our specialized and disjointed medical care. What one specialty recommends can be the nightmare of another, neither communicating with the other. What we need is a more holistic approach to medical care that looks for root causes, as the form of alternative medicine known as functional medicine proposes.

We also need to be more realistic about what we eat. It is not too hard to argue that a diet based on highly processed sugars, starches and oils, which are inflammatory and mostly devoid of micronutrients, is a bad idea. It is difficult, however, to argue what we should eat.

The best advice that I have heard, however, is from Dr. Catherine Shanahan and her book “Deep Nutrition,” which is to eat “whole” or “real” foods, that somewhat resemble their original source (no nutritional label needed) that are produced locally (assuring freshness), are seasonal (assuring variety) and grown using sustainable/regenerative practices (assuring healthy soil and dense micro-nutrition). All very challenging considering the current marketplace. The diet can be plant-based (but not entirely) or animal-based (but not entirely) or preferably somewhere in between. The foods should be cooked at low temperature and in the presence of water; include odd bits and pieces, like liver and bone broth; grains and legumes should be soaked, sprouted, or fermented; dairy should be raw (if it can be done safely) or cultured; and please increase the spices and herbs as an additional source of nutrients.


Gary L. Engstrom, of Cannon Falls, Minn., is a retired science educator.