Monday, October 25, 2010

Saturated Fat and Dietary Cholesterol Are Not the Enemies

This post is in response to Harry's comment on my last post. He wanted more information about how saturated fat isn't evil.

Dietary cholesterol from animals and dairy products has a very small effect on blood cholesterol levels. One can expect dietary cholesterol, no matter how poorly one eats, to make up for roughly 15% of blood cholesterol.

This makes sense. Think about the drugs that block intestinal absorption of cholesterol, like Zetia. Zetia lowers cholesterol levels by roughly 10% to 15%, which is about what would be expected if you blocked dietary cholesterol.

Moreover, as pharmacists and other medical professionals are learning, there's not much evidence to show that Zetia has any mortality benefits. We know from Merck's very own trial that Vytorin does not decrease mortality or reduce plaque size any better than simvastatin alone. In fact, there was a small (but insignificant) increase in plaque size in the Vytorin group.

Enormously high cholesterol levels are still bad for you. However, these levels are are due to the body's overproduction of cholesterol, which is where Statins come in. Statins have established mortality benefits, and they work by decreasing the body's endogenous cholesterol production.

(As an aside- Statins also are known to have antioxidant and anti-inflammatory effects, which may also play a huge role in their reduction in mortality. Clearly, when it comes to Statins, lowering cholesterol is only part of the story.)

Now, the question becomes why does the body produce lots of cholesterol. Well, in some people, there'a genetic predisposition for it, i.e. homo- or heterozygous hypercholesterolemia. In other people, the body produces high levels of cholesterol due to our poor diets.

As is well known, cholesterol is vital to the body. It plays an important role in cell membrane integrity. It also acts as an antioxidant in that it cleans up free radicals.

Consuming a diet high in processed sugars, trans fats, hydrogenated oils, and rancid fatty acids, our bodies produce more cholesterol. Some of it acts to help clear up our bad diet. However, some of it gets clumped up into the mess and ends up leading to blocked arteries. In this way, high blood cholesterol is more a marker for disease than disease itself.

As for saturated fat...

Modern research is finally starting to shed some light on this too. The following quotes are taken from Wikipedia (which despite what some may say isn’t a bad source for quick information. Obviously, I wouldn’t use it if writing a formal report, but most of the information is from valid sources that are cited in the articles):

In 2010, a meta-analysis of prospective cohort studies including 348,000 subjects found no statistically significant relationship between cardiovascular disease and dietary saturated fat.[8][9]”

“In 2009, a systematic review of prospective cohort studies or randomized trials concluded that there was "insufficient evidence of association" between intake of saturated fatty acids and coronary heart disease, and pointed to strong evidence for protective factors such as vegetables and a Mediterranean diet and harmful factors such as trans fats and foods with a high glycemic index.[10]. Pacific island populations who obtain 30-60% of their total caloric intake from fully saturated coconut fat have low rates of cardiovascular disease.[11]”

“Mayo Clinic highlighted oils that are high in saturated fats include coconut, palm oil and palm kernel oil. Those of lower amounts of saturated fats, and higher levels of unsaturated (preferably monounsaturated) fats like olive oil, peanut oil, canola oil, avocados, safflower, corn, sunflower, soy and cottonseed oils are generally healthier.[13] However, high intake of saturated dairy fat does not appear to increase the risk of cardiovascular disease.[14]”

We all know this information to be true, but we’ve been mislead so long that we have trouble accepting it.

Here’s another article that contains some interesting information: “”

I’ll just briefly mention a bit from the article about the Masai, a nomadic tribe in Kenya and Tanzania that were studied in the 1960s. They got 60% of their calories from fat and half of that was saturated fat. Despite this, they had an incredibly low incidence of coronary artery disease and very low cholesterol levels. However, when some tribe members moved to Nairobi and began eating a more modern diet, cholesterol levels sky rocketed, despite the reduction in saturated fat.

There are so many other cultures that we wonder how they could eat what they eat and remain so healthy. The French are a classic example of people who eat loads of butter and other sources of saturated fat, and they are some of the healthiest people in the world, and that’s even with them smoking far more than we do. The Japanese eat plenty of shrimp, seafood , and other foods that are very high in cholesterol and saturated fat, and they have a low incidence of heart disease.

When you start piecing the evidence together, it becomes readily apparent that the common medical belief that saturated fat and dietary cholesterol is bad for you is simply wrong. Eating healthy basically comes down to eating whole wheat carbohydrates in place of processed and added sugars. Eat plenty of vegetables, some servings of fruit, and grill, bake, or pan-sear your meats as opposed to frying them. Appropriate portion sizes are also important. It doesn’t matter what you eat if you eat so much of it that you’re 50+ pounds overweight.

It sounds so simple, right? It would be if we weren’t so addicted to high glycemic index sugars and fried food. It’s harder to quit sugary and fried food than it is to stop smoking. Just try, and you’ll see what I mean. It’s an addiction, and it’s very very hard to break. I know how unhealthy this stuff is, and I still have a lot of trouble giving it up, especially when society is not on the same page. If you want to quit smoking, there a bunch of nicotine replacement products and self-help classes you can take. If you want to stop eating junk food, people look at you like there’s something wrong with you, especially if you’re not overweight. When a group of people get together and order a pizza, it’s just about impossible to be that one person who chooses not to eat it for health reasons. Eating these kinds of food are a personal problem, but it’s also a societal problem. Since society is doing nothing to help people change their eating habits, most people will not be able to do it on their own, even if they knew how unhealthy they're being.

Anyway… that was my long-winded explanation as to why saturated fat and dietary cholesterol is not bad for you. You can do more research on your own, and in doing so, I’m confident you’ll come to the same conclusion. It’s the one that makes the most sense. It’s funny how good science usually makes sense.


Harry said...

After reading your two blog posts and the links you published, I understand that what it all comes down to is "moderation". Eat whatever you want, but try to maintain a healthy, active lifestyle. Don't sit on the couch and wait for a silver bullet (pill/food etc) to do the heavy lifting for you. Secondly, maintaining a healthy weight is more important than what you eat to achieve that (as long of course as you get all the necessary vitamins, minerals, fibre etc etc, so we go back to "moderation").

The only thing that confused me a bit was the cholesterol bit. The link you published in your previous blog post claims that high cholesterol is not the culprit, but just the indicator (it even goes as far as to liken cholesterol to a cop). If that is true, why are statins good? Unless the beneficial properties of statins have nothing at all to do with lowering cholesterol and the observed decrease in LDL is only the after effect.

Pharmacy Mike said...

High LDL cholesterol is a problem, and it does clog arteries. However, the main point of the Mary Enig article is that high LDL is not a result of eating cholesterol laden foods such as whole milk, eggs, red meat, and seafood.

There is a distinction to be made between dietary cholesterol and endogenously produced cholesterol. This is why despite all the efforts to make food "cholesterol free," high cholesterol levels are still rampant in the United States. High blood cholesterol levels have little to nothing to do with dietary cholesterol or saturated fat intake like most doctors and other health care professionals will lead you to believe.

You can drink all the whole milk and eat all the egg yolks you want, and your cholesterol level will not go up by very much. However, if you start dramatically increasing your high glycemic index sugar intake and eat fried foods or foods that contain trans fats or partially hydrogenated oils, your cholesterol level will sky rocket.

The point is that people think they're being healthy by drinking skim milk, eating only egg whites, and never using any butter, but the research shows that the saturated fat in these products isn't harmful and, in many ways, is very healthy for us.

Anonymous said...

I thought Mary Enig disapproved of the use of statins in treatment of hypertension.

Also, what do you think of the use of statins when there's no evidence of hypercholesterolemia? There were studies at the turn of the century touting benefits of statins in osteoporosis using evidence of decreased Colles and hip fractures.

Pharmacy Mike said...

Mary Enig is a lipidologist. Therefore, her expertise is on everything that has to do with fats, fatty acids, and the like. However, she is not an expert on medication, and her suggestions regarding drug therapy should be taken with a grain of salt.

Statins have proven mortality benefits. They have been extensively studied. Therefore, we know their positives and negatives pretty well. High LDL is still a problem. LDL still contributes to plaques in arteries.

The question is not whether high blood cholesterol is bad for you. The question is why do we have high blood cholesterol in the first place. Saturated fat and dietary cholesterol are not responsible for hypercholesterolemia contrary to what the medical community seems to preach. Trans fats, partially hydrogenated oils, rancid fatty acids, and high glycemic index sugars cause elevated blood cholesterol levels.

As for statins being used in the absence of high cholesterol... I think that is really dumb without very hard data to back it up. I mean, get me a well-designed randomized double blind study that specifically looks for the effects of statins on other disease states, and then I'll start paying attention. These retrospective studies and meta analyses pulling data from trials designed to look for other endpoints are too shaky to encourage the use of statins in the absence of a well-studied indication.

Anna said...

1 in 500 people are predisposed to producing too much cholesterel and I'm finding it difficult to find any information on what you should eat if you are one of these. All very well saying less butter, less fat, less red meat, but if you aren't eating this in the first place then it is pretty hard to know what to do next and taking medication isn't without complications either as most have side effects.