RIP Sat Fat Rat Pack: The American Heart Association Ends The Debate Over Your Plate

June 15, 2017 marks the end of a decade of wasted energy, insincere messages, and confusion that has led to patient harm over the important topic of optimal nutrition for the human body. It would seem relatively simple to identify components of a diet that favor health and not disease. Indeed, nearly 100 years of scientific endeavor in the laboratory and in human populations has led to decades of recommendations to eat predominantly fruits, vegetables, whole grains and legumes while avoiding an excess in animal products and tropical oils typically rich in saturated fats which raise cholesterol levels and increase the risk for coronary heart disease. Indeed, although many data points led to this fairly uniform message as exemplified by the Harvard School of Public Health food plate published in 2011, a group of naysayers, armed with vitriolic criticisms but not original research, began to appear and indeed often dominate the public mind through repeated headlines. Why journalists and physicians who do not contribute original research get more media than scientists doing the hard science is uncertain as there are many influences from industry and lobbies.

The battle for the attention of the masses appears to have begun 3 years after the death of iconic researcher Ancel Keys, Ph.D who was among many who did decades of research concluding that the amount of calories from dietary saturated fats in foods like butter, cheese, pastries, and meat correlated strongly with the development of coronary heart disease. The publication of Good Calories, Bad Calories by journalist Gary Taubes in 2007 began the incessant spewing of inaccuracies about the work of Dr. Keys and questioned 100 years of science supporting the diet-heart hypothesis relating to calories from saturated fats. The work of these confusionists gave many the permission they hoped for to add back foods rich in saturated fats into the diet without any apparent concern for the development of heart disease. Two flawed meta-analyses on the topic in 2010 and 2014, the publication of The Big Fat Surprise by journalist Nina Teicholz, and the promotion of butter and full fat dairy by English cardiologist Aseem Malhotra all created enough confusion in the lay press to to cause many of my patients to add back butter, cheese, and substantial amounts of red meat into their diets in recent years.

June 15, 2017 officially ends the decade of fabricated confusion. In a Presidential Advisory from the American Heart Association on the topic of dietary fats and cardiovascular disease, definitive recommendations for maintaining severe limits on foods high in saturated fat were published in the strongest of words. A news release from the American Heart Association summarized the major findings as:

“Saturated fats are found in meat, full-fat dairy products and tropical oils such as coconut, palm and others. Other types of fats include poly-unsaturated fats, found in corn, soybean, peanut and other oils, and mono-unsaturated fats, found in olive, canola, safflower, avocado and other oils. The advisory reports that:

• Randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced cardiovascular disease by approximately 30 percent –similar to that achieved by cholesterol-lowering drugs, known as statins.
• Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of cardiovascular disease.
• Several studies found that coconut oil — which is predominantly saturated fat and widely touted as healthy — raised LDL cholesterol in the same way as other saturated fats found in butter, beef fat and palm oil.
• Replacement of saturated fat with mostly refined carbohydrate and sugars is not associated with lower rates of CVD.”

It could not be more clear. Cut back on dairy, cheese and meats of all kinds, do not replace them with processed foods rich in the “deadly whites” of refined flour and sugar, but rather, replace them with polyunsaturated fats and whole grains. The argument is closed and over and the confusionists decade of headlines should be considered as RIP.

An accompanying editorial to the Presidential Advisory had an example of the implications of this clear statement from the American Heart Association that was so useful that it is worth sharing here. The example offered by the authors was that

“1.7 ounces of cheddar cheese contains 9 grams of saturated fat. The 81 calories this fat provides would make up to 4.5% of a 1600-calorie diet. If this high-saturated fat food is replaced with 81 calories from fat-free cookies (no saturated fat, but plenty of refined carbohydrates from white flour and sugar), both common sense and science inform us that this change provides no improvement in health. When the cheese is replaced with equal calories from either oatmeal (everyone’s favorite heart-healthy whole grain) or almonds (with most of its calories coming from monounsaturated fat), cardiovascular risk improves by 9% or 15%, respectively. But if the cheese is replaced with walnuts, a rich source of polyunsaturated fat, risk is reduced 25%. In addition to the healthier fat profile, the walnuts — like other whole plant foods — also provide a host of other benefits such as vitamins, minerals, antioxidants, phytonutrients, and fiber.”

There it is, your marching orders. Eat far less meat, dairy, and cheese and consume more foods like oatmeal, almonds and walnuts. In additon, please do not forget to up your intake of fruits and vegetables, a health message so obvious it was not considered by these new publications focused on calories from fat.

Critics and confusionists are hard to silence and it is likely they will not give up, roll over, and join the party line. They will continue to raise questions, quote obscure studies, and pit sugar against saturated fat even though most people can recognize we eat way to much of both calorie sources as exemplified by the ever present donut in hospital cafeterias. Just like surfing the Internet for a movie you want to watch, you have the ability to skip past the headlines, articles, books and podcasts that will still sell you the idea that you can eat all the butter, cheese and meat you want without worry. My advice is to tune out the harmful noise that has been heard for a decade, declare the faux controversy over, and Rest In Peace the idea that adding butter, coconut oil, red meat and cheese to your diet is somehow good for your heart health.