I'm suppose to be reading up on Sex-Hormone Binding Globulin today (exciting! ) but I'm going to take a nice break to write the definitive guide saturated fat.
It keeps coming up over and over again on the forum so I thought I'd put this thread here so we can refer back to it to stop re-inventing the wheel.
These group of fats are referred to as 'saturated' as every carbon molecule in the 'chain' of fatty acids has an attached hydrogen molecule. This makes for the most 'stable' chemical structure as in the least likely to react with any other chemicals.
This non-reactivity is a good thing as most of the threats that our body uses its resources fighting is created by oxidisation, as in oxygen reacting to another substance. This is why anti-oxidants have such a good reputation. Though it must be said some oxidation is appropriate and contributes to a healthy metabolism, as it promotes an adaptive response such as after exercise. But generally speaking we want to keep oxidisation intermittent and brief.
But, doesn't saturated fat raise LDL or cholesterol, the 'bad' cholesterol? Well that's not actually established, most of the trials are short-term (<12 weeks), low-quality and the results are all over the place, some show slight reductions from reducing saturated fat but they are usually poorly controlled, as in they don't take into account what they are replacing the saturated fat with and how that effected cholesterol level. In the longer term trials the association pretty much disappears when other factors are controlled for (like smoking and obesity.).
Saturated fat does consistently and reliably raise HDL cholesterol however, and unless you're crazily out of range, indicative of a serious infection, the higher the better.
Risk of Heart Disease
But even if saturated fat doesn't adversely affect cholesterol, it's still really associated with getting a heart attack though right? I mean arterycloggingsaturatedfat is almost one word it's been drilled into us so often.
Well, again the science just doesn't back this up. If you look at observational studies you'll find some studies showing that people who go heavy on the butter and bacon tend to die of more heart attacks. But the problem with these kinds of studies is that you cannot infer a causal relationship from an retrospective observational study because the 'experiment' has been tainted.
An example: Lets pretend 20 years ago we decide that people that wear more yellow clothes have less heart disease. All the health-conscious people listen to their doctors and start wearing yellow shirts, along with doing thousands of other things that health-conscious people tend to do either unconsciously or consciously (exercise, no smoking, less fast food) that can't be fully accounted for by mathematically controlling the statistics. Lo and behold a few decades later it's as clear as day that people who wear yellow clothes have less heart attacks!
If you think the above example is completely silly then think how silly it is that even the observational evidence from the last few decades is not consistent the theory. The totality of the studies of this nature don't even support an association with an increase in heart disease even though we've been told to lay off the cream and butter for decades now.
The best version of an observational study is a prospective cohort study, this is where rather than asking people to remember what they were eating ten years ago, you ask them what they eat now and at regular intervals and follow their progress for a number of years. Although still far from perfect, these kind of studies minimise 'recall' bias or the bias we all have in remembering what we eat.
There have been 25 prospective studies done examining the relationship between heart-disease and saturated fat and only four of them managed to find any relationship whatsoever. If there was a real danger from eating saturated fat, we would see a far more consistent relationship, especially considering how healthy people in general tend to avoid it based on public health recommendations.
This recent meta-analysis by Krauss et al. is the most comprehensive review of it's nature:
So according to the balance of evidence saturated fat is at worst benign, but could it actually be beneficial? Well yes, there are trials showing that it:
-Increases testosterone in men
-Reduces Lp(a) (this stuff correlates with heart disease and stroke like no other biomarker out there, it's the most potent risk factor by a mile.)
-Aids the clearance of excess fat from the liver (this is why a lot of people find their cholesterol jumps up on a weight loss diet, that's your body ridding itself of visceral liver fat and it is only temporary)
-Sat fat will also protect your liver from the damage inflicted by alcohol and certain medications.
The tide is turning, albeit at the speed of a fatigued snail. I don't believe most doctors today have taken their own honest appraisal of the literature. If they have and still believe that the same substance that your body will use to store energy is somehow out to get us, then they've seen evidence I don't have access to.
Oh and by the by, I got a cholesterol test done recently for the laugh (I'm a 28 year old woman so barring something genetic my risk of a heart attack is next to zero anyway):
Total: 4.0 (Healthy range 3.0 - 4.0)
LDL: 1.4 (Healthy < 3.0)
HDL: 1.8 (Health > 1.0) My doctor was shocked with how high my HDL was and asked me what my secret was, she almost fell off her chair when I said 'butter'.
Triglycerides: 0.6 (Healthy < 1.0)
I'm not even saying that all of the above is even relevant to my heart disease risk but it goes to show even by conventional measurements a high saturated fat diet has proved beneficial for me.
If I've left anything out please do let me know, I wouldn't want to be accused of cherry-picking anything. There are soooo many crap studies in this area that if I were to name them all I'd be writing a small thesis, and I've already got one of those going on at the moment. But chances are I have come across any study you care to mention in this arena, so don't hold back, come at me bro! I'd love this thread to become a large repository for addressing any concerns in this area.
Hope all the weight watchers crowd read that.
The weston a price guys/gals have been banging on about all of the above for donkeys years
It all makes for interesting reading but what you are saying is really against the conventional wisdom out there! I have recently introduced myself to the world of low fat diets of Esselstyn and Ornish following a recent heart scare. I have also recently discovered this whole world of alternative thinking in relation to saturated fat which some people in here subscribe to. There seems to be a whole debate going on between the low carb Paleo/Atkins eaters and the low fat whole food plant based diets espoused by Dr. Esselstyn, Ornish and Colin Campbell. All very confusing I tell you but I am currently on the whole food plant based diet due to the research I have read in this area.
I would love to know what the experts here make of Esselstyns work in reversing heart disease with a diet extremely low in saturated fat. How does one explain that if its not the saturated fat causing the heart disease! His diet is carbohydrate strong and allows sugars in the diet also.
I'm far from an expert but even just from reading El_dangerosos post I got this
I'm sure someone has a better/more detailed answer
Hi Squeeksoutloud, love the username! There has been on trial one Ornish's approach and it did indeed reduce cardiac events. It's hard to pick apart what actually worked though because the intervention group were also given stress reduction and smoking cessation programs as well as reducing overall processed food. These things we know are good for the heart.
What does the primal crowd and Ornish & co. have in common, and what I suspect is the most potent heart-protective step you can take, especially if you have diagnosed heart-disease is to eliminate as much as possible any trace of omega 6 fatty acids out of your diet. By virtue of being <10% calories in fat, the plant-based approach is automatically very low in n6, usually 3%.
If you're gonna go really low on omega 6 and keep a decent amount fat in the diet you need to be stricter with the type of oils you choose, beef, lamb and dairy fat are naturally very low in omega 6. No plant oils of any sort bar small amounts of EVOO. Moderate bacon, chicken and avocado (no more than twice a week). This is stricter as someone with diagnosed heart disease doesn't have much wiggle room for oxidisation that a healthier person would have.
There is some disadvantages in the Ornish approach and that is it tends to be high in wholegrains which are high in a substance called phytic acid, which binds important minerals. One of the most important minerals for heart health is magnesium and phytic acid depletes magnesium. So if you are continuing on the plant-based path, consider magnesium supplementation, it's one of the few we probably all need a little extra of.
ornish nutrition = shake of head for me
Conventional wwisdom, or marketing?
Seriously, think of the last 5 or 10 times you heard source say, or imply (by saying low in sat fat, or similar). What was the source?
An scientific paper or an ad for a butter substitute
I get a good bit of criticism from work colleagues on my high saturated fat diet. I've simply given up on arguing, my last comment was "I'm not debating nutrition with someone who gets their information from the back of a box of Shredded Wheat"
Well no actually my cardiologist and a surgeon in America called Esselstyn who has actually reversed heart disease in seriously ill people by putting them on a diet low in saturated fat.
I'm not saying its the only option but I have yet to see a study that has reversed heart disease with a diet high in saturated fat and low in carbohydrates.
I do find the whole theory that saturated fat is not responsible for heart disease interesting and am reading up about it as much as I can as I am certainly no expert...this is all new to me! I have read Gary Taubes articles and have even found some of the blogs on the internet by Mark Sisson and others.
I note that Ornish/Esselstyn etc. are of the opinion that (taken from internet!):
And the HPLC diet doubles the nonesterified fatty acids (NEFAs) which promote inflammation & atherosclerosis
This was looked at in the study 'Vascular effects of a low-carbohydrate high-protein diet':
I know its only mice so take from it what you want I guess.
Also to quote from the following:
'CSU scientist and author of The Paleo Diet, Loren Cordain responds to U-C Davis Scientist and co-author of the New Atkins, Steve Phinney’s discussion on Pemmican. This interview includes Loren’s opinion that saturated fats DO increase plaque in the arteries. However, Loren says, this only becomes very hazardous when saturated fats are eaten in combination with grains, beans, dairy, high-sugar foods or other foods that tend to increase inflammation. Cordain says the combination of saturated fats and inflammatory foods such as grains is a deadly formula for a heart attack'
'I’m not saying that pemmican isn’t a healthy food. It’s probably an expedient way to provide calories over a North American winter. It’s a very great way to store these things. An all pemmican diet, I don’t think is a healthy diet for a number of reasons. If you only eat pemmican, I think you’ll become osteoporotic. You won’t get any vitamin A. If you eat only pemmican, you will promote atherosclerosis. So I just bring to you one paper that I’d like you to distribute. That paper is published in an obscure journal, the Texas Heart Institute Journal in 1993. So nobody’s read it, because you can’t get it on Medline. What this guy did, he was a physician, an MD PhD by the name of Zimmerman. Zimmerman was a pathologist, and he was lucky enough to be in Alaska when a 400 AD, so we’re talking 1600 year old, frozen Inuit mummy was recovered. He did an autopsy on this, and he sectioned the coronary arteries. So this is 400 AD. These people had never seen white people. They had only eaten what Steve Phinney had suggested people eat–fat and protein–and significant atherosclerosis in a 53 year old Inuit woman, on pathology. That wasn’t just the only case. He then was privy to another group of frozen Eskimo bodies that were recovered in Barrow, Alaska, and these people date to about 1520 AD, so just slightly after the time Columbus had discovered America. Once again, no influence of Western civilization. So presumably, they were living at Barrow, 60 degrees north, they were eating meat and fat their entire life. They might get a little bit of berries sometime in the summer. Extensive atherosclerosis was in the older woman, who was 30. All three of them were osteoporotic. They were severely osteoporotic on that type of diet. So you can give this to people who claim that all we need to eat is meat and fat.'
I completely understand your concern, it's all nice to get theoretical but when it's your life on the line then it's a whole other thing and you WANT to be sure.
Esselstyn has not reversed heart disease by putting people on a low saturated fat diet, if he has reversed it (I remember subsequent trials were not as successful as the first) then it was down to the low omega 6, low processed junk, low stress and giving up smoking. How do I know? Because when you just change saturated fat content and nothing else, you get either no change in heart disease risk or your heart disease risk goes up! That's what good science does, isolates the variable of interest while controlling for everything else. Not throwing a bunch of changes at someone and then deciding which one made the difference.
Re: Endothelial progenitor cells, there's no evidence in humans that happens, in fact, bone marrow (incredibly high in sat fat) is an excellent promoter of EPC's. Collagen is fantastic too. Ornish and co. are incredibly fond of mice studies, they don't really like human ones because they rarely tell them what they want to hear.
Now to the mice study, that diet was 45% protein, which is a ridiculous amount, even a whey-chugging elite body builder would have trouble getting close to that amount, that's the equivalent of 30 eggs worth of protein for a 2,000 calorie diet. Believe it or not, low carb diets (and I'm saying that all saturated fat is harmless regardless of whether the diet is low or high carb) are moderate, not high protein. The low fat promoters like to call them high protein as it sets up a nice straw man argument and mice are not adapted to great amounts of protein like humans are.
Secondly apoE-/- knockout mice (the kind used in the study) are touted as the best model of heart-disease in mice as they are engineered to do badly on a high-fat diet. Sounds like a bit of a tautology doesn't it? I'll bet you still have your ApoE gene intact, otherwise you'd probably know about it.
On the NEFA front, blaming fat for pathologically high NEFA is the same as blaming eating potatoes for hyperinsulemia. Both are blaming a normal physiological response for a pathological state.
Who eats only pemmican and nothing else? Who says all you need to do is eat meat and fat? Strawman says what..
Once again we have massive extrapolation, medical staff who have examined the traditional Inuit have seen vastly lower levels of heart attacks (atherosclerosis is not a heart attack) than in western populations. They do have higher rates of osteoporosis but they also suffer from various deficiencies along with living in an extreme environment. They are not a great example of anything. I suspect too much omega 3 PUFA is a negative factor in their diet too.
All you need to do is look at the pacific island populations eating 50% of their calories as saturated fat or look at Europe and see the French or the Swiss who consume lots of dairy fat and have low levels of heart disease to know that saturated fat has been incorrectly blamed.
If saturated fat was an issue, there would be evidence for it being bad independent of any other factor. That evidence doesn't exist.
This coming from a supporter of the WAPF.
Dr. Esselstyn tells his patients to not eat meat, fish, eggs, dairy, nuts, avocado, or oil. His clinical research shows that if you take the overt fats out of the diet (and limit highly refined carbs) the disease stops and/or reverses. High amounts of animal products make the disease worse.
Their clinical evidence speaks for itself. There is no documented treatment that is more successful at reversing Heart Disease than a low-fat plant based diet (70%+ reversal rate in Dr. Esselstyn's patients, 80%+ in Dr. Ornish's).
You can't have a heart attack without all the gunk in your arteries and the main atherosclerotic risk factor is hypercholesterolemia.
The diet of the Maasai of Kenya consists of very high quantities of animal products. All that saturated fat in their diet gives the men as much atherosclerotic plaque lining their arteries as seniors on the Standard American Diet but they don't get heart attacks because a) high levels of physical activity are thought to widen their blood vessels and b) they don't live long enough to die of heart attack, their life expectancy is below 50 yrs.
Thats because it's a combination of things. Not one thing on it's own.
Yay, Ice, wondering how long you'd take to show up.
70% reversal of heart disease? Put your (Peer-reviewed paper) money where your mouth is.
Are you familiar with the hierarchy of evidence of medical science?
From the HSE.ie website:
So the evidence you've provided is on the lowest level of the hierarchy. Ornish and Esseltyn's diets promote smoking cessation, exercise, stress reduction, omega 6 reduction and less refined foods.
Tell me again how you know it's the saturated fat?
Nope, unless we can tell all those people suffering a heart attack from arteriosclerosis that they were just imagining things. Also atherosclerosis is not sufficient to cause a heart attack, you need ruptured lesions caused by oxidisation. (Omega 6 again!)
OMG! People with no access to modern medicine in the third world don't live very long shocker!!
What about those pesky Swiss people living longer than the Japanese despite eating some of the highest levels of saturated fat anywhere in Europe!
Look at all those countries eating the most saturated fat, it's almost like there's no pattern at all!
What? No, when we isolate cigarettes, obesity, exercise and transfats we see a measurable effect. So you're saying saturated fat is magically exempt from this? Seriously, you make this too easy sometimes.
Some more fun:
Look at these papers showing Red Palm oil (a very saturated oil) reversing atherosclerosis:
Oh and guys, forget coconut oil, red palm oil is the next trendy sat fat. You heard it hear first.