Practicality and Safety

Presentation given on September 5, 1997, to 500 physicians
and healthcare providers at the Disney Institute in Orlando, Florida.

Charles R. Attwood, MD, FAAP

Crowley, Louisiana


At the end of this presentation participant will be able to:

  1. Understand that the beginnings of coronary disease begin very early, during childhood.
  2. Appreciate the practically and safety of a low-fat, plant-based diet for children.
  3. Dispel the 12 common myths of low-fat diets in childhood.

Twelve Common Myths
About Low-Fat Diets for Children

Myth Number One: Controlling Cholesterol Can Wait. There are presently 50 million children in the United States with abnormally elevated cholesterol levels. As a result, 70 percent of children have fatty deposits in their coronary arteries by junior high school. According to the Bogalusa Heart Study, these are related to a high-fat diet, primarily from animal sources.

Throughout the world, wherever we find a high incidence of elevated cholesterol levels in children, that nation’s adult death rate from coronary heart disease is high. The only real risk factor of major significance for coronary artery disease is a sustained cholesterol level over 150 mg.\dl.

Since we now know that coronary heart disease has early childhood beginnings, we have an opportunity to prevent it by establishing a sensible low-fat diet early in life.

A proper diet for children, as well as adults, should be primarily vegetables, fruits, whole grains, and legumes.

Myth Number Two: Controlling Obesity Can Wait. An obese adolescent picks up a health risk of dying prematurely before age 70 of heart disease two times that of his non-obese peers. This risk isn’t lost later, even though the child looses the weight!

Obesity is family-related, but not necessarily genetic. If the father is obese, the child has a 40 percent change of becoming an obese adult. If the mother is also obese, the chance increases to 80 percent. Is this genetic or does the family tend to eat alike? Often the father, mother, child, and family dog are all obese. It’s the earliest visible physical sign of poor health habit trends.

A low-saturated fat diet may control cholesterol levels, but controlling obesity usually requires increasing physical activity as well.

Myth Number Three: The Fat-Taste is Natural and Inborn: This learned taste requires repeated exposure to fat. It’s highly addicting, but unknown in much of the world. Like all addictions, it can be diminished, or even abolished by abstinence.

Here, I usually recommend my "Four Stages to an Ideal Diet."

Four Stages to an Ideal Diet

Stage 1

* Limit meat, including poultry and fish, to 3 ounces (cooked) per day.
*Low-fat (1%) milk and low-fat dairy products if desired.
No foods fried in oil.
*One dessert and 1 snack daily.
*Unlimited vegetables, fruits, grains, and legumes.

Stage 2

*Limit trimmed meat, including skinless poultry and fish, to 3 ounces
(cooked) no more than 3 times per week.
*Skim milk and nonfat dairy foods, if desired.
*No foods fried in oil.
*One low-fat dessert and 1 low-fat snack daily.
*Unlimited vegetables, fruits, grains, and legumes.

Stage 3

*Trimmed meat, including skinless poultry and fish, no more than 3
ounces (cooked) once a week, or used sparingly as a condiment
to vegetable dishes.
*Nonsoy fat-free meat substitutes.
*Skim milk and nonfat dairy foods, if desired.
*No foods fried in oil.
*One fat-free dessert and 1 fat-free snack daily.
*Unlimited vegetables, fruits, grains, and legumes.

Stage 4

*No meat, poultry, or fish.
*Unlimited vegetables, fruits, grains, and legumes.
*Nonsoy fat-free meat substitutes.
*Skim milk and nonfat dairy foods, discouraged but optional.
*Egg whites, optional.
*One fat-free dessert and 1 fat-free snack daily.
*Vitamin B12 sources or supplements.

(Four Stages from Dr. Attwood’s Low-Fat Prescription For Kids, page 130)

Myth Number Four: Small Reductions in Fat Will Do: Based on adult studies, atherogenesis, it appears, proceeds when fat consumption remains as high as 30 percent of calories. Larger reductions haven’t been recommended for fear of "discouraging" the public. Our job is to tell the truth, and let the public decide.

Myth Number Five: Children’s Diets Are Getting Better. A fat rampage has existed since the late 1980s. This has been encouraged by fast food restaurants and the snack food industry. Serving sizes are increasing. Example: McDonald’s created larger burgers with more beef, and the relatively lower-fat McLean burger was discontinued in 1996. This is an industry-wide trend, justified by the fast food restaurants as only a response to what the public wants: more fat, bigger burgers with more beef.

Myth Number Six: Meat Is Needed for Protein and Iron. Proper amounts and quality of protein are easily obtained from a variety of vegetables. When enough calories are consumed, enough protein is consumed. Iron deficiency has not been seen clinically among healthy vegetarians who consume adequate calories. The American diet depends on animal sources for 75 percent of its protein. Nutrient per calorie sorting of food shows that vegetable sources of protein are superior to animal sources. (See slide)

The necessity of careful vegetable-combining to insure quality proteins is yet another myth.

Myth Number Seven: Milk Is Needed for Calcium and Protein. Plant sources of calcium have the advantage of not adding excessive protein to the diet, thereby avoiding the calcium-loosing effect. Again, the nutrient per calorie sorting, shows that calcium is more available from vegetables than from milk and cheese. (See slide)

Myth Number Eight: Low-Fat Diets Lack Vitamins and Minerals. A vegetarian diet with adequate calories contains adequate vitamins and minerals. Vitamin B-12 may be obtained by a multi-vitamin, fortified cereal or by consuming fortified soy milk and meat substitutes. Vitamin B-12 stores may last 5-10 years. Questions still remain about self-synthesis of the vitamin after ingesting "unclean" food and the recent reports of B-12 in spinach grown and fertilized with cow manure.

Myth Number Nine: A Low-Fat Diet Means Limited Choices. Of the more than 80,000 edible plants, about 300 are available in stores. The variety is seemingly endless (see slide which compares the nutrient density of vegetables with those most commonly eaten). A healthy diet is limited in only two kinds of food -- meat and dairy products.

Myth Number Ten: Low-Fat Diets Retard Growth. Again, with adequate calories growth is normal with a low-fat, plant-based diet. In 1992, at the University of California, San Diego, after reviewing all available scientific evidence, the Department of Community and Family Medicine concluded that the studies reporting growth retardation of children on low-fat diets were seriously flawed. Subsequent studies are consistently showing normal growth among vegetarian children.

Evidence from the China Study suggest that the dramatic increased adult height of Chinese between 1953-1982 was not related to animal fat or protein increases, but actually seemed related to the control and prevention of infectious diseases during youth.

Myth Number Eleven: It’s Obvious Which Foods Are High in Fat. The obvious sources are the first three letters of my acronym, M-E-D-I-C-S. Meat, Eggs, and Dairy products, which I have labeled The Kevorkian Three.

The letter "I" refers to Invisible fat. Examples: "Sweets," such as candy, cookies, and pastries. Avocados, olives, and nuts, including coconuts. Some names are often misleading, such as granola and bran muffins, which may contain as much as 5 grams of fat per serving. "C" is for Condiments, such as sour cream, mayonnaise, salad dressings, butter, gravies, and sauces. "S" is for Snacks, even so-called low-fat snacks. Many of these contain hydrogenated oils. Also, watch serving sizes of "low-fat" snacks.

Myth Number Twelve: Children Won’t Eat A Plant-Based Diet. Dr. Antonia Demas, proved in her Trumansburg, N.Y. studies that they will. They simply need more information about this kind of food. I suggest to my patients that they take their children grocery shopping, at least occasionally. Spend 75 percent of time in the produce department. Explain what various vegetables are, that their deep colors usually mean more nutrients, where they come from, and how they are prepared. Go to the grain aisles, and explain the value of whole grains. Explain that the darker pastas, rices, and breads, contain more whole grains and fiber. Explain why they need fiber. And finally, let them see that these are the only foods that you are going to take home.

One Final Myth: No One Knows What’s Really Best for My Child. They’re talking about us, you know. Those of us who have the answers are no more believable than the other "experts." The reason: regular appearance of conflicting media reports. Why should one believe Dr. Attwood, when New York Times best-selling authors Atkins and Sears say just the opposite.

This conference, ladies and gentlemen, is our answer. We must speak out strongly and present a united front. Our evidence for the truth has come from dozens of viewpoints, including clinical studies, laboratory studies, epidemiological studies, and all have led us to the same conclusion. A low-fat, high-fiber diet of vegetables, fruits, whole grains, and legumes is the natural and healthy diet for the human race. I have called it The Gold Standard Diet, by which all others must be measured.

Thank you for coming. I hope you will return to your patients, families, and friends with this important message.


Charles Attwood, M.D. Dr. Attwood’s Low-Fat Prescription For Kids (Viking, 1995)
W. C. Roberts, "Atherosclerotic Risk Factors--Are There Ten or is There Only One?" American Journal of Cardiology, vol. 64 (1989), pp. 552-54.
A. Must et al., "Long-term Morbidity and Mortality of Overweight Adolescents: A Follow-up of the Harvard Growth Study of 1922-1935," New England Journal of Medicine, vol. 327 (1992), pp. 1350-55.
R. Kaplan and M.Toshima, "Does a Reduced Fat Diet Cause Retardation in Child Growth?" Preventive Medicine, vol. 21 (1992), pp. 33-52

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