Fat 101: Part II, February 23rd, 2017

If lipids are so important, then what is up with the fat-phobic mindset that many still posses? To be honest, it is all very weird and political. This is a summary of the story as I see it:

Well it started way back in the 1960s. Thanks to an American physiologist named Ancel Keys and Time magazine, bad science got out that had a huge, nasty domino effect. It was believed and widely publicized during that time that dietary saturated fat and cholesterol raised bodily LDL cholesterol and this in turn caused heart disease (referred to as the “lipid hypothesis”).

In 1977, the first “U.S Dietary Goals” were published that recommended the following:

  1.  Increase carbohydrate consumption to account for 50 to 60 percent of the energy (caloric) intake.
  2.  Reduce overall fat consumption to 30 percent energy intake.
  3. Reduce saturated fat consumption to account for about 10 percent of total energy intake; and balance that with poly-unsaturated and mono-unsaturated fats, which should account for 10 percent of energy intake each.
  4. Reduce cholesterol consumption to about 300 mg a day. (Meg note: 1 egg has 187 mg cholesterol… So I go WAY over this every day. Lolz. )
  5. Reduce sugar consumption by about 40 percent to account for 15 percent of total energy intake.
  6. Reduce salt consumption to 3 grams a day

These “ dietary goals” came with these recommendations:

  1. Increased consumption of fruits and veggies
  2. Decrease consumption of meat and increase consumption of poultry and fish.
  3. Decrease consumption of foods high in fat and partially substitute poly-unsaturated fat for saturated fat.
  4. Substitute non-fat milk for whole milk.
  5. Decrease consumption of butterfat, eggs, and other high cholesterol sources.

(Dang! That’s a lot of harping on one nutrient. Lots of villainizing, huh? Seems like they want us to stay the freak away from saturated fat… lest we die).

The American Heart Association got on board with the lipid hypothesis and the subsequent recommendations at this time and asserted that limiting total fat and saturated fat was prudent and wise to prevent heart disease. The first Dietary Guidelines for Americans where created in 1980 (differing slightly but based off the 1977 Dietary Goals). Still, they recommended “Avoiding too much fat, saturated fat, and cholesterol”. In the actual literature that comes along-side the guidelines, they admit: “There is controversy about what recommendations are appropriate for healthy Americans”. (They are referring to fat, saturated fat, and cholesterol.) Still, they made the recommendations.

In the 1990 Dietary Guidelines, they recommend the same “fat caps”  as the 1977 Dietary Goals:

-       limit overall dietary fat to 30% of total calories

-       limit saturated fat to 10%.

Unfortunately, most of the rest of the world followed suit. Moreover, the 1990 Dietary Guidelines began the recommendation of “choose liquid vegetable oils most often because they are lower in saturated fat”. The guidelines and accompanying literature also recommend limiting things such as egg yolks, butter, lard, organ meats, whole milk etc. Over the past few decades, to challenge this dietary paradigm has been highly frowned upon and discouraged... But that’s another story for another time.

There are a lot of theories out there and assertions that the Dietary Guidelines and thus, the government are to blame for making everyone sick and obese. And they are quite convincing. And probably at least partially true. The obesity epidemic started in 1980- the year the first Dietary Guidelines were published. (From 1970- 2000, the prevalence of obesity in the US increased from 14.5% to 30.9%. Today over one-third (34.9% or 78.6 million) of U.S. adults are obese. While I believe the Guidelines to be contributing factors to the epidemic, I do not think the USDA and the HHS actually intentionally caused all the harm that they did…. They just did? (Hah) The 1980 Guidelines told us to “avoid” too much added sugar. Not just avoid added sugar… Avoid TOO MUCH. Does this imply that a certain amount of added sugar is okay? They told people to limit added sugars to make up for 15% of total energy intake…. Okay. So that means people should eat more sugar than saturated fat?! WHAT?! Sugar is highly inflammatory, leads to insulin resistance, hormone dis-regulation, fat storage, and is void of any nutrition. (This is what they define as sugar: brown sugar, raw sugar, honey, syrups, candy, soft drinks, ice cream, cakes, cookies.) Their recommendation means that on a 2000 kcalorie diet, one would be permitted 200 kcalories of added sugar. That’s a lot of permitted sugar. (Conveniently food companies such as Coca-Cola benefit from this recommendation. Go figure.)

Here is a laugh-worthy verbatim clip from the 1980 Guidelines: “Contrary to widespread opinion, too much sugar in your diet does not seem to cause diabetes. The most common type of diabetes is seen in obese adults and avoiding sugar, without correcting the overweight, will not solve the problem. There is also no convincing evidence that sugar causes heart attacks or blood vessel disease.” WHAT? While yes, obese people are more prone to insulin resistance due to their weight… telling them to not avoid sugar is crazy! Can’t we kill two birds with one stone here? (Just realized how gruesome that phrase is….) Avoiding sugar can help a person loose weight and reduce insulin resistance! I mean, my word. Blood sugar control is CRUCIAL for any individual pursing good health- ESPECIALLY overweight, diabetic ones. Blood sugar spikes are inflammatory. Inflammation promotes aggravation in the blood vessels and arteries… ultimately causing cholesterol to be deposited to help repair said arteries… ultimately leading to atherosclerosis and heart disease. At least, that’s how I see it. Take it or leave it. Also, telling everyone to avoid fat and also “avoid too much added sugars” (at least past 15% total energy intake) is a catch 22. If you remove the fat- you have to replace it with something. Nine times out of ten that is additional carbohydrates/sugar. Also, encouraging people to avoid fat encourages them towards processed, packaged, refined foods. Because real foods, found in nature…. Have fat. I don’t know why we humans think we are so smart that we can manipulate the way things have evolved. Nature is the way it is for a reason.

According to the NHANES study- the average kcalorie intake has increased from 2,450 kcals to 2,618 kcals for men and 1,542 kcalories to 1,877 kcalories for women from 1970-2000. Know this: while fat does have more actual kcalories per gram than protein and carbohydrate, fat is also SATIATING. It is satisfying and appetite suppressing. Without fat, you will CRAVE CRAVE CRAVE, eat, eat, eat, and not feel satisfied. Ever had non-fat ice-cream? Its not very satisfying is it? You virtually have to eat a whole tub in order to feel somewhat fulfilled. I believe this to be a contributor to the increase in kcal consumption. Furthermore, processed foods that have become infinitely more popular since the 1970s are hyper-palatable. They are addictive and they make you want to eat more and more. Whole foods are nourishing and fulfilling, and non-addictive. You can eat, know when you are satisfied, and stop.

All of the various editions of the Dietary Guidelines have been based on a hypothesis- the lipid hypotheses, which has been subject to a lot of controversy and questioning today. Dietary cholesterol and saturated fat does not necessarily increase bodily LDL cholesterol. The guidelines propose that a diet high in saturated fat and cholesterol can cause cancer, obesity, and heart disease. (But sugar does not? Jokes.) But at the same time, the 1980 Dietary Guidelines fairly say: “The way diet affects blood cholesterol varies among individuals.” This is true… Nutrition is different for everyone. Yet they still recommend a blanket low fat diet for everyone. They even say in the supporting 1980 literature that foods high in cholesterol such as eggs and organ meats contain essential vitamin and minerals and protein and can be consumed in moderation. Still, high cholesterol foods were wrongfully demonized.

Everyone took the low fat diet recommendations and ran with them. The entire US including government agencies, food companies, organizations, associations, and the rest of the world got on board. We exported our dietary policy to WHO and other government and health organizations. Food companies jumped on the bandwagon and were able to make huge profit off “low fat foods”. (And they still are. They will milk that for as long as they can.) This marketing strategy has exacerbated the problem. Catch phrases such as “saturated fat free”, “cholesterol free” and “low fat” further engrained the low fat dogma into the American mindset and the notion that a healthy diet meant a low fat diet.

We all abandon the natural way of things- we all abandon real, unadulterated food as it should be and opted out for margarines, vegetable oils, and “low fat” processed food like substances. The guidelines put the living fear of God in everyone about fat- either completely intentionally or not. Everyone translated: Fat= heart attack, fat = obese, fat = cancer.

The food companies and Big Ag both benefited from this: with the dietary guidelines, everyone got caught up in calories and macronutrients and forgot about INGREDIENTS and SOURCING. A true shame I tell you. Decades later in 2017, the real food movement is finally coming back around.

Over the years, the Dietary Guidelines have evolved a little… but have remained largely the same. Even today, the updated version of the My Pyramid- the My Plate, has no mention or place for fats/oils. NONE. The supplemental guidelines still recommend limiting saturated fat with the following foods: “Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages.” Bllehhhh!!!

And guess what? Yet, Americans are sicker than ever. And they can’t tell us it’s because we have not followed the guidelines. According to the NHANES study, we have increased carbohydrate consumption and decreased total fat and saturated fat consumption.  We have replaced solid, natural fats for vegetables oils and trans fats. We have cut whole milk consumption and red meat consumption.  Yet obesity rates are still rising and cardiovascular disease is still the leading cause of death world-wide.

The American Heart Association (AHA) is slowly tiptoeing away from their recommendations from a low fat diet. The AHA removed their total fat cap intake in 2013- meaning they no longer recommend a low fat diet. Did you know this? Probably not. Their abandonment of the low fat diet recommendation has gone largely unnoticed. Not surprising. How embarrassing for them?

Anyho, this is their current AHA fat recommendation:

“Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.” (LOLZ I had 13 grams in my bulletproof coffee alone this morning… and I feel greeeaaatttt!)

This being said, the AHA still recommends what they consider to be “healthy fats” such as vegetable oils, fish, nuts/seeds, olive oil etc and only lean animal proteins. So again, no fat cap, but still missing the point. Unfortunately, they are still based on the lipid hypothesis: Still demonizing cholesterol and saturated fat while praising polyunsaturated fat… never mind the inflammatory properties of these oils. (Read about that here- in case you missed Part I).

Is serum cholesterol still regarded as a major risk factor for cardiovascular disease? Honestly, this is dependent on numerous other factors. Many lifestyle factors are taken into consideration such as age, standing blood pressure, HDL / LDL ratio, medical history, race, sex… all of these are taken into consideration in the medical setting to develop an accurate risk factor for cardiovascular disease. Cholesterol levels alone actually means very little. If your cholesterol is high, I would submit first removing all inflammatory foods from your diet. Cholesterol is essentially the body’s Band-Aid. It is often deposited in the arteries as a result of INFLAMMATION. In fact, in February of 2015, the Dietary Guidelines Advisory Committee board submitted its annual Scientific Report to the USDA. Within the report, they retracted their previous assertions that dietary cholesterol contributed to cardiovascular disease and concluded, "Cholesterol is not a nutrient of concern for overconsumption.” They now assert that the evidence does not support the need for cholesterol restriction.

So foods like shrimp and eggs are back on the menu… but what about foods high in saturated fat? Well, for the most part, they are still demonized. Honestly, I believe it is only a matter of time before saturated fat is no longer a nutrient of concern either as there is an overwhelming amount of new research implying that reducing red meat consumption does not have a positive affect on human health.

Side note: your body actually MAKES, cholesterol. Yes, we actually REQUIRE it. Our bodies will make cholesterol whether we eat it or not.  If we eat less, our bodies will simply increase production. If we eat more, our bodies will simply make less.

So, why are so many of our dietitians and other professionals still preaching a low fat diet? Here are the primary arguments against saturated fat and red meat:

1.     It will cause cancer

2.    It causes heart disease – The one we will address today.

I guess old habits die hard. (Especially when there are politics and money involved.) Also, the actual execution of new research takes about 10 years.

Ahhhh nutritional science… it really is so complicated and ever evolving. I LOVE IT! But it is also so frustrating. A big problem with nutritional studies is…well, you ate red meat… but what other food items did you eat with it? Was it a processed CAFO burger from fast food joint with a processed white bread bun, a side of canola oil fried fries and a large chocolate malt? There are other confounding variables and it really is so hard to pin point one cause of an effect. Was it red meat that caused cancer or heart disease? Or was it the carcinogens and inflammatory foods you ate with it? Red meat has been regarded as a “unhealthy” food since the 70s. That means those who consume red meat are more likely to engage in other less than healthy lifestyle choices. Thus, affecting nutritional studies. (This is referred to as the “healthy user bias”. On the other hand, looking at food from a minimalistic point of view is also problematic as food is a WHOLE science that needs to be contextualized. Every whole food is the sum of its parts. Every single nutrient in an unprocessed food has a role and influences the effects of the other nutrients in our bodies. (Are you still with me!?)

Often the villainification of one category of food (such as red meat) is based off observational studies. These can show correlation, but unfortunately, correlation doesn’t necessarily mean causation. Americans are sicker and more obese than they have ever been. What’s true: we are eating more poultry/pork than in previous eras. However, we’ve actually been reducing our red meat consumption over the past few decades. Shocking, I know. Because everyone is assuming that our intake of red meat is killing us. Beef consumption saw a 0% growth over the past 50 years, while chicken and poor saw nearly a 400% growth. The rise in obesity and ailments along with the fact that we have NOT increased our consumption of red meat with that seems to be proof enough that saturated fat may not be the culprit. (What is disturbing is the incredible increase in poultry and pork. These animals are raised primarily indoors, subject to harsh living conditions, antibiotics, and fed mono-crop, GMO grain.) But again, these foods in and of themselves are not BAD, but what is the quality of these foods? And what foods are you eating alongside them? What other lifestyle choices are you engaging in? These are the real questions.

There has been an increase in our consumption of vegetable oils, grains and sweeteners since the 70s. Why are these things not addressed since there is a correlation here as well? On the contrary, these food items are ENCOURAGED.

I believe there is a massive difference between processed meat and quality raised processed red meat. They are not even in the same ballpark. Processed meats have been treated or preserved by smoking, salting or the addition of nitrates and other chemicals. Processed meats do in fact, have a strong and notable correlation between heart disease, colon cancer, and type 2 diabetes.

As I have mentioned— I believe there is a lot to be said about the quality of animal proteins we are eating. There has been a huge shift in agriculture from small local farms to large CAFOs where animals are subject to medications, chemicals, GMO feed, food that is not of their natural diet, no access to outdoors, etc. Whatever toxins and medications an animal consumes, we subsequently get when we eat them. Even the type of food an animal is given will change the omega 3:6 ration in their meat (to favor more omega 6s). Thus, making the food more inflammatory. All to say, I believe the quality of the meat we eat has a lot to do with the healthfulness of it. This also applies to the actual preparation of the meat- another limiting factor in nutritional studies. When meat is cooked at high temperatures (girling, oven broiling, pan frying, or deep trying) the Maillard reaction takes place that ultimately creates carcinogens called heterocyclic amines. Also, if you fry, you then have to take into account the healthfulness of the oil that you are using.

Again, while cholesterol is starting to be de-villonized, there are quite a few accusations against red meat. To be honest, we could go back and forth all day. Honestly, there is research supporting both sides. Again, nutritional science is very difficult. I recognize that not everyone will agree with me… but here are some of the research articles that support my opinions.

1.     Red meat and heart disease: https://www.ncbi.nlm.nih.gov/pubmed/8842068 This study actually accounted for lifestyle factors by comparing vegetarians and carnivores who shopped at health food stores- a population that is typically more prone to invest time and money and engage in certain behaviors for their health. Therefore eliminated the “healthy user bias”. There was no difference in heart disease or lifespan between vegetarians and omnivores who shopped in health food stores.

2.     Red meat and colon cancer: https://www.ncbi.nlm.nih.gov/pubmed/20663065 A comprehensive review of 35 prospective studies regarding the associating between red meat and colon cancer. Conclusion: “The currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer.”

3.     Red meat and colon cancer: http://www.sciencedirect.com/science/article/pii/S0309174014001922 A review from Harvard School of Public Health. They pooled data from over 1.2 million study participants spanning over 20 countries. Conclusion: They found no correlation between heart disease and red meat. They did; however, find unfavorable correlations when it came to processed meats.

4.     LDL cholesterol and heart disease: http://bmjopen.bmj.com/content/6/6/e010401.full A review of 30 cohort studies with a total of 68,094 elderly (age ≥60) people. Conclusion: High LDL was inversely associated with mortality in most. (Meaning people over 60 with a higher LDL lived longer). This is inconsistent with the cholesterol hypothesis.

5.     Red meat and heart disease: http://www.sciencedirect.com/science/article/pii/S0309174015300188  A 2015 systematic literature review of 11 epidemiologic studies. Conclusion: A larger intake of red meat was a significant risk factor for coronary artery disease (CAD) in four studies, but no significant association was found in five other studies.

6.     Red meat and heart failure: https://www.ncbi.nlm.nih.gov/pubmed/26005173 A 2015 epidemiologic study. Conclusion: Processed meat was associated with an increased risk of heart failure- but not unprocessed red meat.

7.     Red meat and colon cancer: https://www.ncbi.nlm.nih.gov/pubmed/25941850 A meta-analysis on red meat intake and colorectal cancer that reviewed 27 independent studies. Conclusion: No increase in colorectal cancer risk up to 100 g daily when it is primarily unprocessed meat.

8.     Saturated fat and heart disease: https://www.ncbi.nlm.nih.gov/pubmed/24723079 A review of 72 studies examining the link between several types of fatty acids on coronary disease. Conclusion: They found no evidence that saturated fat increased the risk of coronary disease- only trans fatty acids increased the risk.

9.     Saturated fat and cardiovascular disease: https://www.ncbi.nlm.nih.gov/pubmed/20071648 A meta-analysis of 21 prospective epidemiological studiesthat included nearly 350,000 baseline healthy subjects. Included the Framingham Heart Study, The Nurses Health Study, The lipid Research Clinic Study, The strong Heart Study, and others. Conclusion: After combining all of the data, the researchers were unable to conclude that dietary saturated fat is associated with increased risk of coronary heart disease or CVD.

10. Dairy and heart disease: http://advances.nutrition.org/content/3/3/266.abstract   https://www.ncbi.nlm.nih.gov/pubmed/20372173 A prospective study of 1500 Australian adults examining the associating between dairy foods and mortality due to CVD as well cancers. Conclusion: those participants with the lowest intake of full-fat dairy products, those with the highest intake of full-fat dairy actually had decreased deaths due to CVD.

Moral of this story: Don’t rely on what the mainstream dogma tells you! Be proactive and research for yourself. Challenge the paradigms. Develop your own opinions and ideas. Don’t follow me and don’t follow someone else just because. Nutrition is so incredibly different for everybody. Try following a high fat, lower carbohydrate diet for a few weeks and see what happens. Start incorporating more meats and removing inflammatory foods.

Part III of this series is going to include the hows-to on doing this! Time to apply all of this info to everyday life! Coming next week!

References:

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