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.

37 Comments

  1. I bet if you looked you’d also find that obesity doesn’t actually cause things like heart disease and diabetes. I would contend that it is a symptom of whatever underlying condition leads to those diseases and that, therefore, you would also find slender people at great risk for those diseases who just didn’t happen to also get the obesity symptom.

    Saying fatness causes early death is like saying a runny nose causes a cold. Intervening in obesity in the name of preserving health will have to involve getting to the actual cause of the obesity and solving *that* rather than merely focusing on caloric intake and calorie-burning.

    And you will need to take that approach with slender people as well. A skinny person who lies on the sofa all the time eating Chee-tos is just as much at risk for early death as is a fat person who behaves that way.

    I know this is a bitter pill to swallow for slender people who hate to look at fat people or think of fat people as human beings, but that’s too bad.

    • Peggy Holloway says:

      Amen! Thanks for this post. This is another “myth” that needs to be laid to rest – obesity is a symptom, not a cause.

    • I would say, just from personal experience, 9/10 people who are obese that cut calories and lose weight, see a majority of their health problems go away.

      The “cause” for obesity is both complex and non complex. The bottom line is healthier food choices + healthier lifestyle = healthy person.

      • Yeah, but this article is assessing what foods are healthier vs. unhealthier. You can’t just say “eat healthier!” when our concepts of healthy and unhealthy are all catty-whompus.

    • I see your point but as person who has conquered their demons not by starving myself but by eating and nourishing my body I partly disagree. Sure a skinny person who has a poor diet is unhealthier than a fat person who eats well. But as we age the system will wear out quicker if there is extra fat on it or if your diet is poor. I am no model. I was once 135kg and on my 30th birthday. I said to a friend at dinner “no more diets”. I went vegetarian the next day, ate so I was never hungry and NO LOW FAT. I noticed that I stopped putting on weight and felt great! (but when your 30 it is easy to feel great with minimal effort).

      Eventually, after a few more months I noticed my clothes were loose. This inspired me to be healthy and I read books on nutrition (not dieting)… fast forward 16 years. In all this time I have got rid of 55kg! I am now mostly vegan. Five years ago I had pain in my knees and they now have arthritis in them. Not from sport injuries but from that extra weight on them for many years. Its a well known fact that obese people commonly get knee problems. You can’t argue against the statistics.

      I do yoga every second day and take supplements and I am doing better than many but I can’t take away those years that the weight put a terrible strain on my body. Now eventually one day my knees won’t allow me to get off the couch and I won’t be able to do my beloved yoga any more. I will put on weight and my circulation will be effected. I will be back to where I started but being fat at 70 is more of a strain on the body than being fat at 30. Hey I am going down fighting I am not writing this for sympathy.

      The thing is you have to listen to your own body and see what it needs to be lighter and healthier, sooner rather than later and you cannot justify being fat and healthy forever because it will eventually get the better of you. P.s I used to be like you and say “it’s better to be fat and healthy than thin and unhealthy. I have no cholesterol”. What a dumb 25 year old was I. Of course I am not likely to have cholesterol… I WAS 25! So stop lying to yourself and get rid of your excess ASAP.

  2. I was a slim person most of my life. In my late fifties I became fat, around 50lbs over weight, I also became a type two diabetic. A chicken and egg situation. Did I become diabetic and over weight, or did I become over weight and a diabetic. I will never know. One thing is for sure I dumped the carbs and swiftly lost 50lbs. My BG returned to non diabetic.

    Regards, Eddie.

  3. A very good and well-researched book on this topic is “Good Calories, Bad Calories,” by Gary Taubes, a highly respected correspondent for “Science” magazine. In the book he shows that there have never been any studies linking dietary fat to heart disease and that the whole low-fat diet fad starting during the 1960s became a political football, which a failed presidential candidate used to salvage a plus for his senatorial career.

  4. Excellent, all good information. Need to get everyone to counter the argument that saturated fat is un-healthy. Please community… if you have time we need to counter the dogma wherever it pops up this recent article needs to be shot down http://www.uq.edu.au/news/index.html?article=26277

    We suffer from some very outdated thinking here.

  5. Philippa Richard says:

    Another great article. I also agree that obesity is more a symptom than a cause. One excellent book is “The Smarter Science of Slim”. This is written, like Kris’s articles by looking at the evidence. Not unsurprisingly, the conclusions are very similar to Kris’s.

  6. Connie Berry says:

    So my question is about fried foods. Assuming fats are not the issue, I can’t believe fried foods would be considered “healthy.” I could accept that if you need to moderate calories to lose weight or to maintain a healthy weight, fried foods might be OK, but only if the calories are taken into consideration. I think french fries and fried chicken might be too high in calories for one meal, so the calories in the fat may be an issue. Am I on the right track here?

    • Hi there. The problem is the fat that is used. Saturated fat butter, ghee, coconut oil/ butter, lard are stable when heated. Meaning that they do not break down at the molecular level. Polyunsaturated oil (canola, sunflower oil, vegetable oil) breaks down as soon as it is heated this causes free radicals which once consumed cause damage internally and inflammation. Saturated animal fat is essential for health. Eating saturated fat does not make you fat.

      In actual fact fast food restaurants in the late 70′s used tallow for all their fried food. This was actually very healthy. Until they were made to use vegetable oil.

      You do not need to moderate calories to control weight. All you need to do is cut out carbohydrates, increase your saturated fat intake and the weight will fall off without hunger. personally i lost 7 kg (14 lbs) in 4 months with zero exercise. My friends and family cant believe it and all keep asking how to do the same so I started a blog.

      • Yes, saturated fat is essential but increasing it drastically and eating more red meat. I don’t agree. Look at the Japanese who eat a diet that is high is fish, rice and vegetables. Look at the Mediterraneans (I am half Italian). These diets are mostly vegetarian, high in olive oil and fish. My father would only eat red meat and have butter on his bread a few times a year of festive occasions.

        If you do your diet forever you might be slim but you will not live long like the Mediterraneans and the Japanese or vegetarians. Again you can’t argue with statistics. They live a damned long time. Now you may say look at the French! Yes they eat red meat and goose fat and they drink red wine (resveratrol which is in chocolate too) to counteract it and they don’t get heart disease but I ask why are they not then on the top of the list for the longest living races? What do they die of. Obviously something else!

        • Linda, I agree with most of what you are saying except for the example of the French diet. It was proven, about 10 years ago, that the French were actually not attributing deaths correctly in post-mortem statistics. They were not performing autopsies and determining the actual cause of death, but were actually mis-categorizing most deaths as “natural causes”. Unbelievable! After their errant ways were pointed out to them, their statistics changed dramatically after they started performing autopsies and rooting out causes of death. Their stats are, basically, no different than other European countries or USA’s or Canada’s. The French are NOT living healthier lives by drinking red wine and eating goose fat!!

    • If vegetable oils are unhealthy as this article posits, foods fried in them will be, too.

      • Yep you are spot on. Up to 1985 (appro) McDonald’s fried all their fries in Tallow. This was probably the healthiest thing they ever served and tasty!

        The CDC, the centre for disease control, were under the mistaken belief that saturated fat was the cause of heart disease (which it is not) and lobbied successfully to change from lard or tallow to vegetable oil. From that day, 99% of restaurants worldwide fry in junk unhealthy vegetable oil. This is criminal.

  7. Evelyn K says:

    Inflammation caused by sugar, grains and damaged fats are the main culprits of heart disease. This inflammation damages the walls of blood vessels causing an increase in cholesterol, which is actually a healing agent coming to the rescue as it helps to repair damaged arteries and clean up inflammation. Knowing this why would anyone want to decrease their cholesterol?

    If someone has high cholesterol it is an indication that inflammation is present and healing needs to occur. Lowering cholesterol is not the answer, in fact it is even dangerous since your are removing the “healer.” Eliminating the cause of inflammation (sugars, grains and damaged fats) makes much more sense. Then cholesterol will automatically decrease as well. It’s common sense really.

    • Good point, recent studies have proved that you need higher cholesterol as you age. It helps the brain but your GP wouldn’t know about that. He doesn’t have to.

  8. The picture containing leafy greens put in your “Low-Fat Diets Make Your Cholesterol WORSE” paragraph was a poor choice to represent low-fat. Leafy greens like kale and spinach are some of the most nutritionally dense foods you can eat. Your picture should be a loaf of bread or a plate of pasta.

  9. Sarah Ong says:

    What do you think of avocado oil? Is it just as good as coconut oil?

    • Avocado oil is ok, however coconut oil/butter is really the absolute winner. Making a berry smoothie with coconut oil and heavy cream is fantastic. The saturated fat has an appetite suppressing effect and is good for you. The taste is great too.

      Biochemist Mary Enig spent her whole life researching fats and oils – her lecture is presented on youtube: http://youtu.be/fvKdYUCUca8

  10. Catherine Britell, M.D. says:

    Another great article, Kris! You’ve mastered this information well and have a great way of making it accessible to everyone.

  11. Excellent article! I will be tweeting this out. The amount of people still believing in eating all things low fat and still misguided by which fats are unhealthy, drives me nuts. It’s important that the correct information is shared and circulated as much as possible.

  12. Then do you support the Atkins diet?

  13. I love peanut oil – I use a little for flavor when I sautee things. Also I have a penchant for sesame oil – it too has a nice taste. How are these oils for us heart and health wise?

    • I’ve written a fairly extensive article about it here: http://authoritynutrition.com/healthy-cooking-oils/

      Peanut oil and sesame oil are both pretty high in polyunsaturated fats, which means that they easily damage at a high heat. I wouldn’t use them to cook at a high heat.

      It’s also best to eat fats that are high in Omega-6 fatty acids in moderation only, too much of these fats can cause harm. See here: http://authoritynutrition.com/are-vegetable-and-seed-oils-bad/

    • If you can find a “cold pressed” oil then this would be ok. You should NEVER cook in polyunsaturates, the heating breaks down the molecules and causes free radicals, these in turn cause inflammation in the body.

      Saturated fat… butter, ghee, coconut, lard, tallow does not break down. Any seed oil or peanut oil or canola, generic mystery vegetable oil… the list goes on are already rancid due to the industrial processing, they have to be bleached, deodorised and stabilised.

      Do a youtube search for the “oiling of America” very detailed lecture about fats and oils by biochemist Mary Enig.

  14. Hi there,

    I thought it worth mentioning that although the Masai don’t die from heart disease, their average life expectancy is 42 years for men and 45 years for women (http://www.diseaseproof.com/archives/diet-myths-do-primitive-peoples-really-live-longer.html).

    Instances of heart disease tends to present its self in a person’s 50s and 60s.

    Cheers, Jonno.

  15. What about olive oil for pan frying and dressing veggies and salads?

  16. No, for frying it is just too tricky. Much safer and tastier to use butter, ghee, coconut oil, palm oil, lard or tallow dripping.

    For cold uses, salads, dressing and mayonnaise, Extra virgin cold pressed every time. Have a look at my earlier responses above.

    Highly recommend the YouTube video “the oiling of america” – explains about all the benefits and faults of all the fats on the human body.

  17. You link to a study of the Masai claiming that they do not have heart disease but either failed not notice or chose not to point out this very important fact:

    “The most conspicuous finding for the Masai was the extremely high energy expenditure, corresponding to 2565 kcal/day over basal requirements, compared with 1500 kcal/day in the rural and 891 kcal/day for the urban Bantu. Mean body mass index among the Masai was lower than the rural and urban Bantu. Mean systolic blood pressure of the Masai was also lower compared with their rural and urban Bantu counterparts. The Masai revealed a favourable lipid profile.”

    Are Americans as active as the Masai? Not even close. I doubt Americans are even remotely as active as the Bantu.

    My point is that while the health risks of a high fat diet can appear to be somewhat mitigated by high caloric expenditure, most Americans do not live such a lifestyle and could thereby be putting their lives and health at risk by eating too much saturated fat.

If you made it all the way down here, you probably liked the article. Please share it:

Speak Your Mind

*