It Ain’t The Fat, People!

Man Sticking Knife Through MeatThe health authorities have been telling us for decades that saturated fat raises the risk of heart disease.

For this reason, we’ve been told to avoid foods like meat, eggs, coconuts and dairy products.

The theory goes like this:

  1. Saturated fat raises LDL cholesterol in the blood.
  2. LDL cholesterol lodges in the arteries, causing atherosclerosis and eventually, heart disease.

This is also known as the diet-heart hypothesis.

This theory has never been proven, despite it having been the cornerstone of dietary recommendations since 1977 (1).

Cholesterol and The Risk of Heart Disease

Butter

When referring to cholesterol, be it LDL or HDL, we’re actually not talking about the cholesterol itself.

LDL stands for Low Density Lipoprotein and HDL for High Density Lipoprotein.

The lipoproteins are proteins that carry fat, cholesterol, phospholipids and fat soluble vitamins around in the bloodstream.

The thing with cholesterol (or more accurately, the lipoproteins that carry around the cholesterol) is that elevated blood levels of it are associated with an increased risk of heart disease.

This does not necessarily mean that high cholesterol causes heart disease, just that people who have a lot of cholesterol are more likely to get it (2, 3).

This graph from the massive MRFIT study (4) clearly shows that in men, total cholesterol above 240 mg/dL (6.2 mmol/L) is associated with an increased risk of death, specifically from heart disease.

MRFIT, blood cholesterol and heart disease

Photo source.

However, it’s important to note that cholesterol that is too low is also associated with an increased risk of death, but not from heart disease (5, 6, 7).

The relationship between total cholesterol and cardiovascular disease is complex. For example, in very old individuals, more cholesterol appears to be protective (8, 9).

The Type of Cholesterol Matters

It is now well acknowledged that the type of cholesterol matters.

We have HDL (High Density Lipoprotein) which is called the “good” cholesterol, and is associated with a lower risk of heart disease (10, 11, 12, 13).

Then we have LDL, also known as the “bad” cholesterol, associated with an increased risk (14, 15, 16).

However, the situation gets even more complicated than that. It turns out that there are subtypes of LDL, specifically relating to the size of the particles.

It is now known that the size of the LDL particles is of critical importance.

People who have mostly small, dense LDL particles are at a much greater risk of heart disease than those who have mainly large LDL particles (17, 18, 19, 20, 21, 22).

Scientists now realize that the number of LDL particles (LDL-p) is more important than their total concentration (LDL-c). The greater your LDL particle number, the more likely you are to have mostly small, dense LDL particles (23, 24, 25).

Bottom Line: The relationship between cholesterol and heart disease is complex. HDL is associated with a lower risk, while small, dense LDL particles are associated with a greater risk.

Saturated Fats Don’t Raise LDL That Much… if at All

Cracked Coconut

The first part of the diet-heart hypothesis is that saturated fats raise blood levels of LDL cholesterol.

However, despite this idea being so deeply ingrained in the minds of laypeople and health professionals alike, there is no clear link.

Some short-term feeding trials do in fact show that increased saturated fats raise LDL in the short term.

However, the effect is weak and inconsistent and many of these studies have been criticized based on methodological flaws (26, 27, 28).

If saturated fats were such a dominant factor in LDL, the association should be strong and consistent in observational studies, but it’s not.

In fact, plenty of studies don’t support an association between saturated fat consumption and total LDL (29, 30, 31).

There are populations in the world that eat a massive amount of saturated fat, such as the Masai in Africa who drink lots of fatty milk and the Tokelauans who eat lots of coconuts (32, 33, 34, 35).

Both of these populations have low cholesterol and an absence of heart disease.

Bottom Line: If saturated fat really raises LDL, then the effect is weak and inconsistent. Saturated fat is certainly not a dominant factor in LDL levels.

Saturated Fats Don’t Harm The Blood Lipid Profile

Doctor With Thumbs Up

If you take into account the size of the LDL particles, you see that saturated fat doesn’t actually harm the blood lipid profile… it improves it!

Studies show that:

  • Saturated fats shift the LDL cholesterol from small, dense LDL to large LDL – which should lower the risk of heart disease (36, 37, 38).
  • Saturated fats raise HDL, which should also lower the risk (39, 40, 41, 42).

The small, dense LDL particles are much more likely to become oxidized and lodged in the arteries (43, 44, 45).

If saturated fats reduce the small, dense LDL particles and raise HDL, then they should decrease the risk of heart disease, not the other way around.

Bottom Line: Saturated fats shift the LDL particles from small, dense to Large and raise HDL. If anything, this should decrease the risk of heart disease.

Low-Fat Diets Make Your Cholesterol WORSE

The low-fat diet that is commonly recommended by the health authorities is a miserable failure. In the beginning, there were only observational studies backing it up. Since then, many controlled trials have been conducted.

This diet actually makes the blood lipid profile worse, not better.

Boy Eating Salad

Controlled trials show that low-fat diets reduce the size of the LDL particles, while low-carb, high-fat diets increase them (46, 47, 48, 49).

For this reason, low-fat diets have a net harmful effect on the blood lipid profile, while low-carb diets have a positive effect.

Low-fat diets can also reduce blood levels of HDL (the “good) cholesterol (50, 51, 52).

Eating a lot of carbohydrates is a great way to increase blood levels of triglycerides, another important risk factor. Low-fat, high-carb diets can raise blood triglycerides (53, 54, 55).

Low HDL and high triglycerides are two components of the metabolic syndrome, which is a stepping stone towards obesity, type II diabetes and heart disease.

Bottom Line: A decrease in HDL cholesterol and LDL particle size, along with an increase in triglycerides, should all lead to an increased risk of heart disease.

Saturated Fats and Heart Disease – Where is The Proof?

Meat

If saturated fats caused heart disease, then people who eat more saturated fats should be at a greater risk… but they aren’t.

Review articles of prospective observational studies don’t see any associations.

One study published in 2010 that looked at 21 studies with a total of 347.747 individuals concluded (56):

“A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”

Other reviews of the evidence lead to the same conclusion. There is no link between consumption of saturated fat and the risk of cardiovascular disease (57, 58).

But observational studies can’t really prove anything, they can only demonstrate correlation. So we can’t exonerate saturated fat based on such studies alone.

Evidence From Randomized Controlled Trials

Fortunately, we do also have randomized controlled trials. Such studies are considered the “gold standard” of research.

The Women’s Health Iniative is the largest randomized controlled trial on diet in history. In this study, 48.835 postmenopausal women were randomized into a low-fat diet group and a control group who continued to eat the standard western diet.

After a period of 8.1 years, there was no difference in the rate of cardiovascular disease between the two groups (59). The diet did not work for weight loss, breast cancer or colorectal cancer either (60, 61, 62).

Another massive study, the Multiple Risk Factor Intervention Trial (MRFIT) involved 12.866 men at a high risk of heart disease. This is the group of people most likely to see a benefit if the low-fat diet actually worked.

However, after 7 years, there was no difference between the men randomized to a low-fat diet and the group eating the standard western diet, despite the fact that more men in the low-fat group also quit smoking (63).

The low-fat diet got tested, it didn’t work. Period.

Overall, there is zero evidence that saturated fat causes heart disease, or that reducing saturated fat leads to a reduction.

Just for fun, I’d also like to show you this graph of how the obesity epidemic started at the exact same time the low-fat dietary guidelines were released to the American public:

Low Fat Guidelines and Obesity Epidemic

Obesity is a major risk factor for heart disease, diabetes and other chronic diseases.

Of course, this graph only shows a correlation and doesn’t prove that the low-fat guidelines caused the obesity epidemic, but it’s still an interesting observation.

Despite having been repeatedly proven to be ineffective, mainstream health authorities and many nutrition professionals still continue to peddle the low-fat diet.

Bottom Line: There is no evidence that saturated fat increases the risk of heart disease, or that diets low in saturated fat reduce the risk.

Saturated Fats May Lower The Risk of Stroke

Doctor Pointing His Finger

Another important cause of death that doesn’t get mentioned often in discussions about saturated fat, is stroke… otherwise known as a cerebrovascular accident.

A stroke happens when there is a disruption in blood flow to the brain, either due to a blockage or bleeding.

Strokes are actually the second most common cause of death in the world, accounting for 6.15 million deaths in the year 2008 alone (64).

In 2008, strokes killed 6.15 million, while heart disease killed 7.25 million… judging by these numbers, stroke is almost as significant as heart disease when it comes to mortality in the population.

Observational studies show that saturated fat is associated with a significantly lower risk of stroke, although some studies show no effect (65, 66, 67, 68).

Bottom Line: Consumption of saturated fat is associated with a lower risk of stroke in many studies. Stroke is the second most common cause of death worldwide.

Good Fats, Bad Fats

Girl Eating Kebab

Of course, there are some bad fats in the diet that actually DO raise the risk of heart disease.

Trans fats are monounsaturated fats that have been put through a hydrogenation process.

This increases the shelf life of the fats and makes them resemble saturated fats in consistency.

Trans fats, found mainly in processed foods, are strongly associated with an increased risk of heart disease (69, 70, 71, 72, 73).

Vegetable oils like soybean and corn oil that are very high in Omega-6 fatty acids and strongly associated with heart disease risk (74, 75, 76, 77, 78).

To lower your risk, eat healthy foods with plenty of saturated and monounsaturated fats. Eat some Omega-3s from fish and grass-fed animals, but stay away from trans fats and vegetable oils.

It’s Time to Retire The Myth

Thanks to Dr. Stephan Gueyenet and Dr. Axel F Sigurdsson – I found many of the references for this article on their sites.

It’s time to retire the decades old myth that saturated fat is in any way related to heart disease.

It wasn’t proven in the past, it hasn’t been proven today and it never will be proven… because it’s just flat out wrong.