Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review

[Todd Allen]

https://doi.org/10.1016/j.jacc.2020.05.077

Quote

Abstract: The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke. Although SFAs increase low-density lipoprotein (LDL)-cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL which are much less strongly related to CVD risk. It is also apparent that the health effects of foods cannot be predicted by their content in any nutrient group, without considering the overall macronutrient distribution. Whole-fat dairy, unprocessed meat, eggs and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.

 

Edited June 27, 2020 by Michael R
Remove sci-hub link

[mccoy]

A moderate amount of SFAs won't even elevate LDL in many cases, as I've observed in myself.

Personally, I feel that eating whole-fat dairy products on top of vegetable fats like EVOO and nuts bloats me in an uncomfortable way. Hence I prefer nonfat or lowfat dairies.

A

 

[Saul]

Hmmmm.....

Disclosures!

Arne Astrup: Research funding from Danish Dairy Foundation, Arla Foods Amba and the European Milk Foundation. Speaker honorarium for Expert Symposium on the Dairy Matrix 2016 sponsored by The European Milk Foundation. Advisory Board/Consultant for McCain Foods Limited and Weight Watchers.

J. Thomas Brenna: Research funding from the National Cattlemen’s Beef Association/North Dakota Beef Council. Panel participation honorarium from Dairy Management (2017).

James O. Hill: Research funding from the National Cattlemen’s Beef Association. Member of the scientific advisory committee of the Milk Producers Education Program (Milk PEP). Member of the health and wellness advisory board for General Mills. Trustee of the International Life Science Institute.

Andrew Mente & Salim Yusuf: Research funding from the Dairy Farmers of Canada and the National Dairy Council to analyze data on dairy consumption and health outcomes in the Prospective Urban Rural Epidemiology (PURE) study, which is funded by the Population Health Research Institute (PHRI), Hamilton Health Sciences Research Institute, and more than 70 other sources (government and pharmaceutical).

Jeff S. Volek: Research funding from foundations (Lotte & John Hecht Memorial Foundation) and industry (Metagenics, National Dairy Council/Dutch Dairy Organization, Malaysian Palm Board, Pruvit Ventures). Royalties for books on ketogenic diets. Scientific advisory board for Virta Health, UCAN, Advancing Ketogenic Therapies, Cook Keto, Axcess Global and Atkins Nutritionals. Equity in PangeaKeto. Founder, chief science officer, and equity in Virta Health

Ronald M. Krauss: Research funding from Dairy Management. Scientific Advisory Board for Virta Health and Day Two. Licensed patent for method of lipoprotein particle measurement.

  --  Saul

 

[Gordo]

12 hours ago, Todd Allen said:

[According to the dairy industry]:

no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality

So what dietary changes DO have beneficial effects on cardiovascular disease?  As far as I know, only one diet was ever clinically proven to improve cardiovascular disease, and it didn't include dairy.

Edited June 23, 2020 by Gordo

[Todd Allen]

38 minutes ago, Gordo said:

As far as I know, only one diet was ever clinically proven to improve cardiovascular disease, and it didn't include dairy.

The problem is without a large cohort and without a control group following the same protocol except with a substitution of dairy you haven't shown anything with respect to dairy.

Edited June 23, 2020 by Todd Allen

[Sibiriak]

  Michael Rae:

Quote

On Esselsyn/Ornish/Pritikin/McDougall: the studies purported to support the ultra-low-fat approach are not worth the paper on which they're written (to the extent that anyone keeps hardcopies any more).

Esselsyn's and Ornish's  reports are in very small numbers of intensely-managed patients with existing CVD; neither of them have reported any actual improvement in survivorship; and there are major confounders for both.

Esselstyn is reporting a case series from his personal practice, and not (as is often claimed) a clinical trial: there was no control group, and moreover ALL of his subjects were on cholesterol-lowering drugs.(3)

 

[Todd Allen]

1 hour ago, Saul said:

Ronald M. Krauss: Research funding from Dairy Management. Scientific Advisory Board for Virta Health and Day Two. Licensed patent for method of lipoprotein particle measurement.Ronald M. Krauss: Research funding from Dairy Management. Scientific Advisory Board for Virta Health and Day Two. Licensed patent for method of lipoprotein particle measurement.

And he is considered a leading authority on lipidology.  Here's an interview from 4 years ago by that shill for big beef and dairy Rhonda Patrick: 

 

And here is a more recent interview by Dr. Peter Attia: 

 

[Mike41]

7 hours ago, Saul said:

Hmmmm.....

Disclosures!

Arne Astrup: Research funding from Danish Dairy Foundation, Arla Foods Amba and the European Milk Foundation. Speaker honorarium for Expert Symposium on the Dairy Matrix 2016 sponsored by The European Milk Foundation. Advisory Board/Consultant for McCain Foods Limited and Weight Watchers.

J. Thomas Brenna: Research funding from the National Cattlemen’s Beef Association/North Dakota Beef Council. Panel participation honorarium from Dairy Management (2017).

James O. Hill: Research funding from the National Cattlemen’s Beef Association. Member of the scientific advisory committee of the Milk Producers Education Program (Milk PEP). Member of the health and wellness advisory board for General Mills. Trustee of the International Life Science Institute.

Andrew Mente & Salim Yusuf: Research funding from the Dairy Farmers of Canada and the National Dairy Council to analyze data on dairy consumption and health outcomes in the Prospective Urban Rural Epidemiology (PURE) study, which is funded by the Population Health Research Institute (PHRI), Hamilton Health Sciences Research Institute, and more than 70 other sources (government and pharmaceutical).

Jeff S. Volek: Research funding from foundations (Lotte & John Hecht Memorial Foundation) and industry (Metagenics, National Dairy Council/Dutch Dairy Organization, Malaysian Palm Board, Pruvit Ventures). Royalties for books on ketogenic diets. Scientific advisory board for Virta Health, UCAN, Advancing Ketogenic Therapies, Cook Keto, Axcess Global and Atkins Nutritionals. Equity in PangeaKeto. Founder, chief science officer, and equity in Virta Health

Ronald M. Krauss: Research funding from Dairy Management. Scientific Advisory Board for Virta Health and Day Two. Licensed patent for method of lipoprotein particle measurement.

  --  Saul

 

Thank you Saul! I will ignore this research!

There’s a lot of conflicting information about saturated fats. Should I eat them or not?

The American Heart Association recommends limiting saturated fats – which are found in butter, cheese, red meat and other animal-based foods. Decades of sound science has proven it can raise your “bad” cholesterol and put you at higher risk for heart disease.

The more important thing to remember is the overall dietary picture. Saturated fats are just one piece of the puzzle. In general, you can’t go wrong eating more fruits, vegetables, whole grains and fewer calories.

When you hear about the latest “diet of the day” or a new or odd-sounding theory about food, consider the source. The American Heart Association makes dietary recommendations only after carefully considering the latest scientific evidence

Edited June 23, 2020 by Mike41

[Todd Allen]

59 minutes ago, Mike41 said:

The American Heart Association recommends limiting saturated fats

...

When you hear about the latest “diet of the day” or a new or odd-sounding theory about food, consider the source. The American Heart Association makes dietary recommendations only after carefully considering the latest scientific evidence

And here are some of their "carefully considered" endorsments...

Edited June 23, 2020 by Todd Allen

[TomBAvoider]

It seems the situation with SFA is as confused as ever. The Cochrane Review reached the conclusion that SFA were not the primary driver of CV mortality, although substituting some SFA with polyunsaturated FA reduced CV morbidity (not mortality!) - though again, it may be a small factor:

Reduction in Saturated Fat Intake for Cardiovascular Disease

"Authors' conclusions: The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear."

But I keep thinking about Finland and France - both take in about the same amount of SFA, but Finland's intake has a greater proportion of intake from dairy products and meanwhile the Finnish diet does not offset that intake with the amount of F&V that the French diet does. And I keep remembering the harrowing epidemic of sky-high deaths from heart attack in Finland, and how they brought it down dramatically with the reduction of SFA intake from diary... seemingly indicting SFA.

Here's an interesting comparative study:

Differences in Coronary Mortality Can Be Explained by Differences in Cholesterol and Saturated Fat Intakes in 40 Countries but Not in France and Finland. A Paradox

"Conclusions: Over the years, France and Finland, with similar intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follows. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat were associated with increased CHD mortality, possibly through their effects on thrombosis as well as on atherosclerosis."

Now, I know this is an epi study, so all appropriate caveats apply, but in general the case of Finland weighs pretty heavily in my mind - after all, the governmental intervention was in effect a kind of "intervention study", even if it's still epi. So, moved by that and a lot of other studies on the effects of SFA, I personally avoid SFA.

Does it mean the case against SFA is fool-proof - no. But I'm not taking the risk, since I have access to other FA and SFA are not EFA. YMMV.

 

 

[Sibiriak]

11 hours ago, TomBAvoider said:

 "France and Finland ....had very different CHD mortality rates.

At the very least,  you gotta look at all-cause mortality,  not a single-disease,  especially given the wealth  of evidence suggesting that what may be best to reduce CHD may not be the best to reduce cancer.  Double-edged swords dangling all over the place.

[Mike41]

21 hours ago, Todd Allen said:

And here are some of their "carefully considered" endorsments...

Well yes, the AHA has a fund raising arm and they go after donors and they promote junk products. But their positions are still based on science. In fact they criticized a Favorable 2014 study on SFA based on the fact that People had replaced SFA with sugary carbs.  I don’t mistrust their overall recommendations wrt diet, exercise etc., but I realize the funding arm is going to go after money and make compromises.Is that ethical? No, but we live in a very imperfect world.

Edited June 24, 2020 by Mike41
https://www.heart.org/en/news/2018/05/01/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks?utm_campaign=sciencenews16-17&utm_content=phd06-15-17&utm_medium=phd-link&utm_source=science-news

[Todd Allen]

4 minutes ago, Mike41 said:

Well yes, the AHA has a fund raising arm and they go after donors and they promote junk products.

These junk products are loaded with refined sugars.  They acknowledge sugar is problematic.  And yet they endorse these products as "heart-healthy" in a fashion designed to encourage the purchase and consumption of these products by a gullible public.  At least the products are vegan so consumers can kill themselves with minimal guilt.

 

[mccoy]

To be honest, the dairy industry makes profits out of nonfat or lowfat products as well... I myself, rarely buy whole fat products any longer.

[corybroo]

New perspectives challenge the idea that saturated fats cause heart disease

In a new article published today in the American Journal of Clinical Nutrition, three scientists have raised a question that challenges the diet-heart-hypothesis: Why do saturated fats increase blood cholesterol, and why should this be dangerous? 

A cell is surrounded by a fluid membrane that controls cell function, and the cells depend on the ability to incorporate a certain amount of cholesterol molecules, so that their membranes don't become too stiff or too fluid.

The basis of the model is that when saturated fats replace polyunsaturated fats in the diet, less cholesterol is needed in the cell membranes . . . because polyunsaturated fats from the diet enter our cell membranes and make them more fluid. The cells adjust the fluidity of their membranes by incorporating cholesterol recruited from the bloodstream. According to the model presented by the researchers, this can explain why blood cholesterol levels decrease when we eat more polyunsaturated fats.

Cells need to adjust their membrane fluidity according to changes in their environment, such as the access to different types of fat

With this model we propose to disconnect the blood-cholesterol raising effect of diet from the elevated blood cholesterol that is causally linked to heart disease

[the paper] questions the benefit of lowering blood cholesterol by adding polyunsaturated fatty acids to the diet, and not addressing the root cause [of cardiovascular disease]

The research and reasoning that the HADL (Homeoviscous Adaptation to Dietary Lipids) model is based on indicates that the effect of dietary fats on blood cholesterol is not a pathogenic response, but rather a completely normal and even healthy adaptation to changes in diet.

 

[Mike41]

 

Volume 112

Issue 1

July 2020 

Public health guidelines should recommend reducing saturated fat consumption as much as possible: YES

Penny M Kris-Etherton,  Ronald M Krauss

The American Journal of Clinical Nutrition, Volume 112, Issue 1, July 2020, Pages 13–18, https://doi.org/10.1093/ajcn/nqaa110

[Todd Allen]

1 hour ago, Mike41 said:

Public health guidelines should recommend reducing saturated fat consumption as much as possible: YES

Public health guidelines should recommend reducing saturated fat consumption as much as possible: NO

Quote

Furthermore, analyses of fatty acid composition in human adipose tissue have shown no significant correlations with dietary intakes of SFAs, with the exception of 2 (C15:0, pentadecanoic acid, and C17:0, heptadecanoic acid) that are derived from dairy sources (20), and which, as described below, have actually been associated with cardiometabolic benefit. In fact, the predominant in vivo source of plasma and tissue SFAs is not dietary saturated fat, but rather SFAs derived from de novo lipogenesis, a process stimulated by dietary carbohydrates (21).

 

Edited January 23, 2021 by Todd Allen

[Mike41]

Keeping it simple I think Michael Pollan got it right for the most part. 
Eat WHOLE foods, mostly from plants, and not too much.

also the term carbohydrate which the keto crowd tosses out there is very misleading. Are we talking about kale, lentils, blueberries or are we talking about sugar, Oreos, white bread, French fries, crackers, fruit loops, jellybeans etc.

 

 

Edited January 24, 2021 by Mike41

[mccoy]

On 1/24/2021 at 4:37 PM, Mike41 said:

also the term carbohydrate which the keto crowd tosses out there is very misleading. Are we talking about kale, lentils, blueberries or are we talking about sugar, Oreos, white bread, French fries, crackers, fruit loops, jellybeans etc.

 

Carbs are the devil, the incarnation of Satan in any food matrix they appear. As we all know, the devil may disguise as a beautiful woman, and those are our healthier carbs, found in vegetables, nuts, fresh fruit, legumes and whole cereals. The devil may also disguise in ugly bodies, and that's the carbs in the junk food. But, at the end, the devil is always the devil!

Edited January 26, 2021 by mccoy

[Alex K Chen]

Quote

In vitro, even-chain SFA, including myristic acid (14:0) and palmitic acid (16:0), activates pro-inflammatory cascades, induces skeletal muscle insulin resistance, and damages pancreatic β-cells, while the MUFA oleic acid (18:1) may partly protect against some of these effects [35,47–49]. However, in vivo, dietary SFA and MUFA may be readily oxidized as energy sources [50,51], while tissue levels of major SFA and MUFA may be at least equally influenced by endogenous hepatic synthesis of fatty acids rather than direct dietary intake [52]. This explains why dietary starch and sugars, which activate hepatic de novo lipogenesis, are positively associated with blood levels of major SFA and MUFA [52–54]. Thus, effects of blood and tissue SFA and MUFA may not inform and should be separately considered from biologic effects of dietary SFA and MUFA.

 

[Mike41]

https://doi.org/10.1093/ajcn/nqab287

This study contradicts the low fat hypothesis. A higher fat diet, including 21% saturated fats coupled with eating healthy carbs and avoiding processed carbs was the most heart healthy when compared to a relatively healthy low fat diet that included whole grains and some sugary foods. I am starting to to think Ornish and esseltyne may be wrong at least when it comes to fats. Fats tend to lower quite a few cardio sensitive markers like triglycerides, lp(a) and raise HDL levels while having only a very modest effect on ldl. Joel Furman is an advocate of this hypothesis and has had some influence with Dr. Ornish who has recently modified his diet for heart patients allowing more nuts and seeds.

Edited January 18, 2022 by Mike41

[mccoy]

Good article, although there seems to be no age stratification and the sample is not much representative of low BMI CR practitioners.

Quote

We enrolled adults aged 18 to 65 y with BMI ≥25 kg/m², excluding those with known CVD or diabetes.

 I 'm alluding to age stratification because I observed on myself how the glucose homeostatic system started slowly to lose efficiency with age (due probably to sugars abuse during life: lots of fruit juice, fruit fresh and dried, honey....)

[alexthegra8]

On 1/24/2021 at 4:37 PM, Mike41 said:

Keeping it simple I think Michael Pollan got it right for the most part. 
Eat WHOLE foods, mostly from plants, and not too much.

also the term carbohydrate which the keto crowd tosses out there is very misleading. Are we talking about kale, lentils, blueberries or are we talking about sugar, Oreos, white bread, French fries, crackers, fruit loops, jellybeans etc.

 

Our digestive tracks wouldn't be 5-6 meters long if we were not meant to eat carbs -- I agree with your whole food statement, it is all about whole foods, things like french fries, fruit loops, are obviously not whole foods. Thus it would be helpful if people would refer to carbs as whole food carbs or non.

 

[mccoy]

5 hours ago, alexthegra8 said:

Our digestive tracks wouldn't be 5-6 meters long if we were not meant to eat carbs -

We were meant to eat carbs (simple and complex).. until we were able to reproduce. After that, we are expendable as far as the preservation of the species goes.

This goes back to my previous comment about age. We are meant to eat carbs until it is evident that the glucose homeostatic mechanism is efficient.

Then there is apparently a bifurcation: very few fats apparently can avoid high blood sugar, but AFAIK there is not a decisive set of studies, just a few articles.

The other path leads to carbs restriction, the one I'm following now. 

Edited January 20, 2022 by mccoy

[Mike41]

10 hours ago, mccoy said:

We were meant to eat carbs (simple and complex).. until we were able to reproduce. After that, we are expendable as far as the preservation of the species goes.

This goes back to my previous comment about age. We are meant to eat carbs until it is evident that the glucose homeostatic mechanism is efficient.

Then there is apparently a bifurcation: very few fats apparently can avoid high blood sugar, but AFAIK there is not a decisive set of studies, just a few articles.

The other path leads to carbs restriction, the one I'm following now. 

I disagree with the expendable hypothesis. We are social, tribal creatures. Older adults helped out and contributed to survival in many ways. The whole grandparent effect, also tribal leaders who had lots of experience dealing with life etc. That is why we are programmed to live beyond reproductive age.