Q: Should I avoid saturated fat for a healthier heart?
—J.H., BOCA RATON, FLA.
A: Everyone knows saturated fat raises cholesterol and leads to heart disease, right? Not so fast. The great writer H. L. Mencken once said, “For every complex question, there is a simple answer. And it is always wrong.”
If you ask your average doctor why you should avoid saturated fat, he or she will probably tell you this: “Saturated fat raises cholesterol and causes heart disease.” In fact, saturated fat has become so demonized that it’s next to impossible to find it mentioned in a newspaper or magazine article without being accompanied by the description “artery-clogging.”
But what most people—including, sadly, your average doctor—don’t know is that studies have never convincingly demonstrated the relationship between saturated fat in the diet and heart disease. Never.
In fact, several research review papers found quite the opposite. One of the reviews, published in the American Journal of Clinical Nutrition, compared the advice we get regarding saturated fat from leading health organizations to what the science actually says. The authors found that despite the admonitions to avoid saturated fat due to its connection to heart disease, the science shows nothing of the sort. Their conclusion: “Results and conclusions about saturated fat intake in relationship to cardiovascular disease, from leading advisory committees, do not reflect the available scientific evidence.”
Another article, published in the Journal of Nutrition, went even further: “There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of (coronary heart disease) or CVD [cardiovascular disease].”
And if that weren’t enough, a systematic review of the evidence supporting a causal link between diet and coronary heart disease published in the August 2013 issue of the Archives of Internal Medicine found that there was “no evidence” to support the need for overall reduction of saturated fats, with the authors raising concerns about making recommendations without the benefit of randomized control trials. There was also concern that limiting dietary fat in general results in increased consumption of carbohydrates. That was especially worrisome, since, unlike saturated fats, high-glycemic foods—along with trans fats—actually are associated with an increased risk of heart disease.
In other words, despite its demonization by health authorities and despite the massive efforts by Big Food to sell you junky, sugar-filled “no-fat” products, no evidence exists to support a direct relationship between saturated fat and heart disease. None.
Studies Vindicate Saturated Fat
A Harvard study in the American Journal of Clinical Nutrition concludes that “greater saturated fat intake is associated with less progression of coronary atherosclerosis, whereas carbohydrate intake is associated with a greater progression.”
Did you get that? To prevent atherosclerosis, skip the bread and other high-carb foods, not the healthy saturated fats from whole foods like coconut, palm oil, and grass-fed beef. In fact, in the famous Framingham, Mass., heart study, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. Sound incredible? It’s right there in the data. Researchers found that “people who ate the most cholesterol, ate the most saturated fat, [and] ate the most calories weighed the least and were the most physically active.”
But what about those studies that do connect saturated fat with heart disease? Closer examination reveals a somewhat different story. Most often, the studies that condemn saturated fat look at its effect on cholesterol. They do not look at its effect on heart disease. There’s a big difference.
Saturated fat in the diet does sometimes makes total cholesterol go up. But let’s look at the bigger picture.
First thing to know: the old division of cholesterol into two categories—“good” (HDL) and “bad” (LDL)—is past its expiration date. We now know that there are several different sub-types of both HDL and LDL, and the effect of saturated fat on these different sub-types is very different.
Let me explain. LDL-A is a large, fluffy molecule that is essentially neutral. It’s like a cotton ball. LDL-B, on the other hand, is a whole different story. It’s a small, hard, dense oxidized molecule that’s highly inflammatory and very damaging. You want your LDL-A numbers to be higher and your LDL-B numbers to be as low as possible. This desirable state of affairs is known as Pattern A, while its opposite—a much more atherogenic and potentially troublesome situation—is Pattern B, when the angry little inflammatory molecules predominate.
Saturated fat lowers LDL-B and raises LDL-A. It actually moves you toward Pattern A, literally changing the composition of your LDL population. And as a bonus, it raises HDL, the so-called “good” cholesterol. So while saturated fat might raise your total cholesterol, your blood lipid profile has actually improved, and your risk for heart disease has gone down!
Ask your doctor for a particle test. The particle test not only tells you what type of LDL you have (the essentially harmless LDL-A or the very nasty LDL-B), but it also gives you an even more important metric—total particle number. This number is much more predictive of heart disease than LDL. The cholesterol particle test is available from a number of labs, and has been around at least a decade. And it will give you far more useful information than the old-fashioned standard cholesterol test.
Saturated Fat and Brain Health
Besides having a surprisingly positive effect on your cholesterol, saturated fat is also critical for the brain. David Perlmutter, MD—an integrative neurologist who is also a fellow of the American College of Nutrition—points out that both cholesterol and saturated fat are vitally important for brain health. He’s right. A Mayo Clinic study, published in the New England Journal of Medicine, found that those individuals consuming the most saturated fat experienced a whopping 36% reduction in the risk for developing dementia. Low cholesterol is also associated in a number of studies with higher rates of depression—further evidence, thinks Perlmutter, of the importance of both cholesterol and saturated fat for brain health. “Saturated fat is a fundamental building block for brain cells,” says Perlmutter. “It’s certainly interesting to consider that one of the richest sources of saturated fat in nature is human breast milk.”
This is precisely why I never tell anyone to eliminate saturated fat. Trans fat? Sure. Damaged, re-heated fats used for frying in restaurants? You bet. Processed vegetable oils? Absolutely.
There’s definitely such a thing as “bad fat” (see examples in paragraph above). But saturated fat doesn’t belong in that category. In the words of Michael Gurr, PhD, author of Lipid Biochemistry, “Whatever causes coronary heart disease, it is not primarily a high intake of saturated fatty acids.”
Jonny Bowden, PhD, CNS, aka “the Rogue Nutritionist,” is the author, with cardiologist Stephen Sinatra, MD, of The Great Cholesterol Myth. His program “Unleash Your Thin” can help you conquer cravings and food addictions and is available at jonnybowden.com. Visit him at jonnybowden.com and follow him on Twitter @jonnybowden. Do you have a health question for Jonny? Send it to email@example.com. Write “Health Q&A” in the subject line.