I hope to be discussing and critiquing the research on coconut oil, rice (as opposed to gluten containing grains), a higher protein diet in those with chronic kidney disease (decreased GFR and/or significant proteinuria), and other topics which are poorly understood by patients and physicians.
I am a bit of a novice at the moment in my development of my own diet and dietary recommendations for my patients, but I certainly believe in the power of major dietary changes of our ratios of fat, protein and carbohydrates in those with susceptible metabolisms. I personally have a family history of very early onset of type II diabetes, gout, and severely high triglycerides. My current dietary approach is low carbohydrate with no avoidance of saturated fat, but I am open to the evidence.
I have been shocked in the last few months from successes by several patients who have been on Medifast and I have been always mystified by my patients who have lost (and later regained) weight on lower carbohydrate diets which they went on furtively prior to seeing me, without any physician approval. It seems half of my obese or metabolic syndrome (or worse, diabetic) patients have been on low carb diets and are ashamed of this admission. I think they quit the diet which made them feel better and they could follow because they had no support and felt that they were doing something wrong. This all goes back to the fat-cholesterol hypothesis which has become dogma secondary to many factors but not actual good evidence.
So, I feel despite my reservations from years of hearing about fat, that if my overweight, obese, diabetic, and/or dyslipidemic patients have not improved their diet by now on a low fat, calorie restricted diet they are unlikely too. I have reviewed the literature and looked at my own labs and feel it is reasonable to recommend a much lower carb and much higher fat diet. I hope I am right, but I do not find any evidence that contradicts this approach and find beneficial changes in short term studies (up to 2 years in duration though now). I am disappointed that a study powered to find mortality differences between a low carb diet versus a conventional or a low fat diet. Unfortunately this study will be unlikely to be funded since dietary recommendations are not a profit making venture for any pharmaceutical company. The government and institutional consensus, per the food pyramid and official recommendations from the American Heart Association, seems to have already decided in 1984 with very little evidence that a low fat diet will decrease deaths and disease, despite contradictory or lack of evidence.
So, this is my initial musing (rant???).