Wednesday, December 10, 2014

The Nutrition Debate #269: “Eat Good Fat”

In bold black letters on a yellow field, the post-card-sized thank you note said, “Eat Good Fat.” It was packed with my 32oz jar of Ancients Organics ghee. I eat a dab of ghee on salted radish halves, a sometimes snack before supper. It helps to get my supper k/g (ketogenic) ratio above 1.5, a desired ratio which I easily achieve at breakfast and lunch. I prefer Ancient Organics brand, although expensive, for its “delicious sweet and nutty flavor” and its “incredible caramelized aroma.” It’s also “cooked in small batches over open flames” and made from “milk of grass fed and pastured cows.” It’s really good fat!

But this is not a column about ghee. It’s about the roiling transformation in the world of nutrition concerning dietary fats in general and saturated fats in particular. Saturated fats are enjoying a Renaissance everywhere except in government and “public health” circles, principally the USDA and ACC/AHA. The reason simply is that these institutions have been bought and paid for by their commercial interest supporters. But this column is not another rant about that either. It is about two major scientific papers in influential medical journals that deserve more attention.

The first study was a really large mostly British meta analysis (643k participants), published last March in the Annals of Internal Medicine, of 49 observational studies and 27 randomized controlled trials, in part funded, by the way, by the British Heart Foundation. The title: “Association of Dietary, Circulating, and Supplement Fatty Acids with Coronary Risk: A Systematic Review and Meta-analysis. The CONCLUSION: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

The second study appeared in the British Medical Journal (BMJ) in 2013 and was titled, “Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: Evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis.” (“Secondary prevention” is to prevent a heart attack in those who already have heart disease. “Primary prevention” is for those who do not already have Coronary Heart Disease (CHD).) This Australian study concluded:

Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats INCREASED THE RATES OF DEATH FROM ALL CAUSES, CORONARY HEART DISEASE, AND CARDIOVASCULAR DISEASE. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats.” (Emphasis added by me, obviously. I wish I could just SHOUT IT FROM THE ROOFTOPS!)

The reference to “advice to substitute polyunsaturated fats for saturated fats” as a “key component of worldwide dietary guidelines” and “these findings could have implications for worldwide dietary advice” couldn’t be more pointed. The U.S. Dietary Guidelines Advisory Committee, currently preparing the 2015 update, is expected to double down in the coming months on their advice to substitute polyunsaturated fats from processed vegetable and seed oils. Alice H. Lichtenstein, D. Sc., Vice-chair, “2015 Dietary Guidelines Advisory Committee, U.S. Department of Agriculture/U. S. Department of Health and Human Services,” is in charge and is also the lead author on the AHA’s current “Diet and Lifestyle Recommendations.”

Lichtenstein also served on the AHA committee in which Robert H. Eckel, M.D., was co-chair and lead author of the “2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Together, they are a formidable force.

The current 2010 Dietary Guidelines state (pp. 24-25), “Saturated fatty acids contribute an average of 11 percent of calories to the diet, which is higher than recommended. Consuming less than 10 percent of calories from saturated fatty acids and replacing them with monounsaturated and/or polyunsaturated fatty acids is associated with low blood cholesterol levels, and therefore a lower risk of cardiovascular disease. Lowering the percentage of calories from dietary saturated fatty acids even more, to 7 percent of calories, can further reduce the risk of cardiovascular disease.”  That’s the status quo ante.

Now, there is rampant speculation that the new 2015 Dietary Guidelines for Americans will recommend “a dietary pattern that achieves a macronutrient composition of 5% to 6% saturated fat, 26% to 27% total fat, 15% to 18% protein, and 55% to 59% carbohydrate.”  Why? That is the further reduction in saturated fat consumption that Eckel and Lichtenstein, et al., teamed up to recommend in the ACC/AHA Practice Guidelines, as published in Circulation, the organ of the American Heart Association. “Strength of evidence: high,” they said (Table 10, pp 17-18). Such is the current state of affairs in U. S. dietary matters. Does it sound eerily like the world of domestic politics? And we have to vote every day with the food choices we make. So, choose wisely and remember the roiling transformation is trending away from PUFAs and toward SFAs.

Are you afraid to “go against” the “Dietary Guidelines” or the practice guidelines your doctor is required to follow? Do you avoid whole eggs, full-fat milk, yogurt and cheese, or red meat? Ask yourself why? You doctor is trapped, but you’re not…

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