Putting Saturated Fat on Trial
David L. Katz, MD, MPH
CMO, Tangelo. Founder: Diet ID; True Health Initiative. Founding Director, Yale-Griffin PRC (1998-2019). Health Journalist. COVID Curmudgeon
As I listen to the seemingly ceaseless, virtual shouting about diet and health these days, much of it self-serving, and little of it genuinely informative or helpful, I am reminded of my now five-year-old wish that we might better separate church and plate. How did what should be a topic based on the aggregation of scientific evidence, time honored good sense, expert consensus, and personal preference- take on the strident passions and dangerous fervor of a Holy War?
Perhaps the conflict- prominently, at present, between advocacy for plant-based eating and advocacy for meat and dairy; and/or between blaming this one, or that one nutrient for all our ills- is genuinely ideological. Maybe it’s mostly about money. Or maybe we’ve simply forgotten how to be civil in this polarized society of ours. Perhaps now no solo note of contention- for example, your favored answer to, “which is worse, sugar or saturated fat?” can be silenced with casual equanimity along the lines of: “who cares; they are both bad!” Perhaps now we have limited our options to choosing a side, and escalating the contention in competing echo chambers into something resembling war.
Personally, I think everyone loses in this scenario, with the obvious exception of nutrition’s answer to arms dealers, those creatures who thrive on mayhem and carnage: propagators of perennial doubt and discord about diet; deniers of the weight of evidence and global consensus; promoters of conspiracy theories; agents of foolishness and fanaticism, fads and false promises.
As the arguments reverberate, and public health (i.e., your family, and mine) pays the costs, my thoughts have turned to the remedy for such insoluble discord: a trial.
Drawing from the most currently salient of the usual suspects, I think there is a case to put both saturated fat and sugar on trial, and surmise our way to likely verdicts.
Accordingly, the trial of sugar is scheduled for this court’s next session. Today, saturated fat is on trial for crimes against humanity, or if you prefer, assault and battery of coronary arteries.
Let’s orient ourselves to the relevant rules at a fundamental level. First, this could be a criminal trial, in which case a verdict requires proof beyond “a reasonable doubt.” Alternatively, it could be a civil trial, in which case the verdict is contingent on “the preponderance of evidence,” a lower bar to clear. My idea is we will empanel two juries, and run both in parallel. (I realize civil trials may not involve a jury, but it suits the thought experiment for there to be one this time.)
Second, in any trial, both sides get to make their full argument- prosecution and defense in a criminal trial, plaintiff and defendant in a civil suit- to inform the verdict.
Complete disclosure about saturated fat by both sides in such a trial would reveal interesting things. A lot of facts would be presented, but there would be quite a bit of spin as well. As the perorations echo in the minds of jurors, and they retire to the jury room to deliberate, let’s consider what they know, and what they don’t.
They know for sure that saturated fat is associated with elevations in LDL cholesterol, and that those in turn are associated with increased heart disease. They know that diets higher in saturated fat sources tend to be associated with more disease and death than diets in which those calories are replaced by unsaturated fats, or whole grains. However, they also know that diets both higher and lower in saturated fat can apparently lead to the same, high rates of heart disease. They know that high saturated fat diets are associated with higher levels of “good” HDL cholesterol. They also know that not all saturated fatty acids are created equal, and that summary judgment against the class may not be unjustified.
Importantly, however certain they may wind up about the harms of diets high in the common sources of saturated fat, they may be left with doubt about exactly what harms are directly attributable to saturated fat. No one, after all, “eats” saturated fat-any more than most people “eat” sugar, although that is more plausible with sugar, as there are some candies made from nothing else. But that’s a fine point. Mostly, people eat foods- some of which contain saturated fat, sugar, or both.
The foods that contain saturated fat contain other nutrients as well, notably animal protein in the most relevant (but obviously not all) cases. There are arguments that the apparent harms of saturated fat are really the harms of animal protein, and in the proceedings of this case, they have heard them. As they deliberate, they agree that the isolated effects of saturated fat on long-term health outcomes like vitality over a lifetime, and overall life expectancy, are practically unknowable. They are left with a reasonable doubt.
However, they are fully persuaded that diets high in the foods that are high in saturated fat are consistently and decisively disadvantageous to human health. They note in passing that they are comparably so, or more so, to the health of the planet- but this particular question was not put on trial. The jury members are unanimous that it should be, before returning to the task of reaching a verdict.
Just before asking for conclusions, the dual jury chairs remind their panels that any conviction of saturated fat does nothing to exonerate other nutrient suspects. All are reminded that sugar will be on trial in this same court, and is next on the docket.
In the criminal suit against saturated fat, a mistrial is declared due to a hung jury. The group could not agree that saturated fat, per se, was implicated in chronic disease and premature death beyond any reasonable doubt. In the civil trial, however, the verdict goes to the plaintiff, because the preponderance of evidence inveighs mightily against saturated fat and the company it keeps in diets. The defendant- some medley of bacon, burgers, and pepperoni- goes bankrupt paying damages.
The jury members of these parallel trials get together right after to mingle over their kombuchas, and agree that if the common food sources of saturated fat had been on trial, rather than saturated fat per se, they would have lost both trials. All go home comfortable with their answers.
However, since everyone eats foods rather than nutrients, the jury members all go home wondering: why weren’t they asked better questions?
-fin
Director, Yale University Prevention Research Center; Griffin Hospital
Immediate Past-President, American College of Lifestyle Medicine
Senior Medical Advisor, Verywell.com
Founder, The True Health Initiative
Follow at: LinkedIN; Twitter; Facebook
Read at: INfluencer Blog; Huffington Post; US News & World Report; Verywell; Forbes
Owner-Inventor at Insel-Def.Inc.
7 年Lot of words and sentences,but no substance. This is how I would summarize this article. My question is:" Where is the Beef?". Jeopardy:What is molecular Medicine? Quantum Medicine? What is: Nanoparticle Medicine? "The size(of Molecule)That Matter? What do you know about HDL-2?What is Hypermethylation? What is GIGO?(Garbage In Garbage Mike Out What is Niacin-nicotinic acid? How good and important is Organic Spinach? Avocado Oil? Mono-unsaturated Fat.
In love with life and learning
7 年Well written and there is certainly a religious war. However, the case against saturated fat is 60 years old or more and no evidence against it has materialised. The evidence against sugar has been suppressed by the sugar mafia just as long so this case is quite new. Lets see on an even playing field. Next is the case against grains...
Kommercielle partnerskaber | Finans | Innovation | Strategi | Digitalisering | Forretningsudvikling
7 年First of all - a whole food plant based diet keeps you healthy, and longer alive. But there′s a bigger picture. The animal food industry is the #1 cause of greenhouse gases and rainforest destruction. So, if the environment is a concern of yours, then literally, look no further than your plate. E.g., to produce just 1 kg beef demands 15,500 litres of water. Soon, we very may well have to prioritise who gets the drinking water.
Certified Health Coach, Integrative Esthetician & Cosmetic Laser Practitioner at Cher Clark Coaching and Consulting
7 年I enjoy this discussion and also appreciate looking at all sides and opinions.. such as this article I've read since: The REAL truth about coconut oil – Don’t believe the propaganda 57 by Cat Ebeling co-author of the best-sellers: The Fat Burning Kitchen, The Top 101 Foods that Fight Aging & The Diabetes Fix Just as I thought mainstream medical, the American Medical Association, and the American Heart Association were starting to actually ‘get’ the fact that saturated fats do not cause heart disease and diabetes, and that sugar, processed carbohydrates, and vegetable oils do, they did an about face and the AHA (June, 2017) came out with this information: “This American Heart Association presidential advisory on dietary fats and CVD [Cardiovascular Disease]… concludes strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD…Because coconut oil increases LDL cholesterol, a cause of CVD [cardiovascular disease], and has no known offsetting favorable effects, we advise against the use of coconut oil…” So what the AHA is saying is this: Saturated fats [all kinds] increase LDL cholesterol An increase of LDL causes cardiovascular disease (CVD). Let’s talk about both of these. First, not all LDL cholesterol is ‘bad’, although we have been taught to believe that. In fact, LDL is made up of several different types of particles, not all of which are bad or tied to CVD. Increases in LDL that come from eating more saturated fats in the diet are associated with a healthier version of LDL, the larger, fluffy particles of LDL, which is generally what coconut oil increases. Additionally, LDL has important functions in the body, delivering nutrients to various types of cells, protecting the cell membranes, the building blocks for important hormones (namely, increasing testosterone in men), and strengthening the immune system. Very Small Particle LDL is the harmful type. So, increasing LDL is only bad when it is directly tied to Very Small Particle LDL or VSLDL. But, of course, the AHA left that vital information out of their report. VSLDL is increased by eating high sugar, high starch diets often accompanied by high triglycerides. More than 17 studies and analyses have been unable to establish a clear link between saturated fats and CVD. And the American Heart Association cherry-picked their studies–some of them as old as 50-60 years old to use for their latest report. Tell me, does that make ANY sense? Well, do you know anything about the American Heart Association? This organization is a non-profit organization made up of cardiologists and other medical professionals. The American Heart Association (AHA) is an organization with a mission to “build healthier lives free of cardiovascular disease and stroke.” In their 2011-2012 financial statement, the AHA noted $521 million in donations from non-government and non-membership sources and many well-known large drug companies, including those who make and market statins, contribute amounts in the $1 million range. A quick look at some of their funding sources includes: Amarin (Pharmaceutical Company) Amgen (Pharmaceutical Company) AstraZeneca (Pharmaceutical Company) Eli Lilly (Pharmaceutical Company) Glaxo-Smith Kline (Pharmaceutical Company) Merck (Pharmaceutical Company) Pfizer (Pharmaceutical Company) Regeneron/Sanofi (Pharmaceutical Company) Takeda (Pharmaceutical Company) California Walnut Commission (incentivized to undermine saturated fats) Ag Canada and Canola Oil Council (incentivized to undermine saturated fats and promote vegetable oils). (More funding sources here) In addition, the AHA takes in millions from big food companies, who—besides their donations– also pay $5-7,000 per product to gain the ‘heart-check mark’ that goes on the labels for advertising. These foods merely have to be low in fat and saturated fat and cholesterol. Doesn’t really matter how refined or how much sugar is added. Take a look at some high sugar cereals in the supermarket and you will see that they have the ‘heart-check’ mark, in spite of the fact they are one of the biggest causes of obesity, heart disease and diabetes. Hmmm. It doesn’t take a genius to see that there may be a (not-so-hidden) agenda, as in: …take statin drugs, eat more vegetable oil like canola oil, and only eat the AHA ‘approved products’. Isn’t that the advice that increased heart disease and created a country of overweight, unhealthy adults? Gary Taubes, noted science writer and author of several books, including “The Case Against Sugar”, says this: “[T] he AHA concludes that only four clinical trials have ever been done with sufficiently reliable methodology to allow them to assess the value of replacing SFAs with PUFAs (in practice replacing animal fats [with] vegetable oils) and concludes that this replacement will reduce heart attacks by 30 percent … These four trials are the ones…the AHA experts have systematically picked through…and found reasons to reject all that didn’t find such a large positive effect, including a significant number that happened to suggest the opposite…including among the rejections the largest trials ever done: the Minnesota Coronary Survey, the Sydney Heart Study and, most notably, the Women’s Health Initiative, which was the single largest and most expensive clinical trial ever done. All of these were…rejected from their analysis.” But wait! This is 2017, and we have already discovered that Ancel Keys’ study on cholesterol and diet in the 50’s and 60’s was extremely flawed, and the results were ‘cherry picked’ to show what his head researcher wanted to show. Keys tried to show that dietary saturated fats contributed to heart disease, ignoring the fact that processed carbs and sugar were major contributors to heart disease. When researchers have gone back in and looked at the data from all of the countries, there actually was no link between fat consumption and heart disease deaths, and there was no consideration of other factors such as smoking rates, stress factors, sugar intake, exercise frequency, or other lifestyle factors. So his conclusions were not actually even valid! Unfortunately, Keys’ faulty study has been followed for the last 5 decades to the major detriment of modern society. After the world replaced meat, butter and eggs (which were staples of the American diet back when heart disease wasn’t even on the map yet back in the early 1900’s) with processed margarine, grains, and vegetable oils, we watched as populations grew obese, heart disease increased, and diabetes and other inflammatory diseases increased dramatically over the last 50 years. Instead of improved health, Americans have just gotten fatter and sicker. Heart disease rates increased, even though people have been eating what the AHA suggests is a heart-healthy diet. So if the AHA’s advice didn’t work 65 years ago, WHY would it start working now? The REAL causes of heart disease are these: Trans fats (artificially hydrogenated oils) proven to be major contributors to heart disease Heavily refined inflammatory vegetable oils such as soy, canola, cottonseed, corn oil, etc. Read more about healthy cooking oils vs unhealthy cooking oil here Too much refined sugar, especially high fructose corn syrup High intake of carbohydrates such as ‘whole grain’ bread, packaged cereals, snacks, crackers, etc Smoking Stressful lifestyle Lack of exercise Clearly we are not headed in the right direction—at least if we let the AMA and the AHA (mis)guide us. The point is, saturated fat CAN good for us, or at worst, it’s just neutral. Many primitive tribes in Africa have subsisted on high saturated fat diets with almost no heart disease. The Masai, and the Samburu, and Fulani tribes ate mostly raw whole milk, red meat, and cows’ blood. And the Kitavans and The Tokelau people really did show zero signs of heart disease despite eating a diet high in coconut fat. They actually started getting fat, heart diseased, and diabetic after they started eating a more modern diet full of wheat, sugar, and vegetable oils. Not only were these primitive tribes extremely healthy, they were lean and had very little disease or health issues. So, yes, American Heart Association and USA Today and everyone else–coconut oil is STILL HEALTHY for you! Coconut oil has been a dietary staple of many civilizations for years and years, and it provides healthy, high quality fat that benefits your health. It helps support healthy thyroid function, boosts your metabolism, balances blood sugar, and is an excellent low glycemic, ketogenic fuel to use for energy. The ketones that coconut oil stimulates your body to make are actually the preferred and more efficient type of fuel for your body to use, especially healthy for blood sugar, and also prevention of Alzheimer’s, and heart disease. The medium chain triglycerides (MCT’s) in coconut oil are very easy for your body to metabolize, and utilize immediately as fuel, making it an effective ‘fat-burning’ fuel, that doesn’t raise blood sugar or insulin or stimulate fat storage. MCT’s from coconut oil do not have to be broken down or semi-digested in order to be utilized by the body, unlike most other fats (Long Chain Fatty Acids) that do. Coconut oil also contains lauric acid that helps to increase your healthy HDL cholesterol, and boost the immune system. Palmitic acid is another component of saturated fat and increases HDL as well. Higher HDL is linked to protection from heart disease. A higher HDL to cholesterol ratio is also one of the best protective factors against heart disease. Coconut oil is also scientifically proven to not only increase cardioprotective HDL, but it decreases waist circumference (a risk factor in heart disease) and decreases body mass in patients with coronary artery disease. Coconut oil is also very beneficial to the hair and skin for a healthy scalp and to ease skin irritations, as well as being an excellent moisturizer. Coconut oil reduces cavities when used as a tooth brushing aid, and the lauric acid it contains has powerful antimicrobial effects, even on toenail fungus. So, in the long run, coconut oil is GOOD for you, and will not kill you or cause heart disease. Yes, it does raise LDL cholesterol and can raise overall cholesterol (many studies show higher total cholesterol leads to longer lives in elderly, and lower cholesterol leads to increased death), but don’t believe the AHA when they say that you will have a heart attack from coconut oil. Heart disease is caused primarily by inflammation in the blood vessels, brought on by inflammatory, highly processed (that’s most all of them) vegetable oils, sugars, and starchy refined processed carbohydrates. So keep doing what you’re doing: eat healthy saturated fats from coconut oil, grass fed butter and grass fed meats. Slather on the extra virgin olive oil, eat nuts and avocados. Enjoy your free-range, pasture-raised eggs cooked in butter, and savor that raw, unpasteurized cheese. Hey, the French enjoy lots of butter, cheese, and eggs and have much lower heart disease rates than Americans! Avoid the sugar, avoid the refined grains, and avoid the processed foods and vegetable oils. Your body will thank you!
Head of AI | Deep Tech & AI Investor | 2x Founder | Published Author
7 年Not a fan of the Ketogenic diet then? Many would look at the same research linking saturated fats to higher cholesterol, YET FIND NO increased heart disease and mortality. On the contrary there is research to show "healthy" monounsaturated fats lead directly to heart disease and increased mortality. Would pick grass fed butter over vegetable oil any day.