Letter III: Aren't Saturated Fats Dangerous?

This is part III in a series of hypothetical letters to my doctor.


Dear Doctor,

In our last meeting, you expressed concern that I was eating too much saturated fat in my low carb diet, and that it might be harmful, or even cause a heart attack. This is probably the most common question I deal with when people learn I follow the low carb lifestyle. I am, however, a bit surprised that an educated person such as yourself raised the concern.

The short answer: no, saturated fats are not dangerous and when eaten as part of a proper low carb diet, they probably won't cause a heart attack. The idea that saturated fats and cholesterol lead to heart disease is called the "lipid hypothesis."  Gary Taubes wrote a whole book in 2007 debunking the lipid hypothesis. And before Taubes' book, Sally Fallon and Mary Enig wrote a book in 1999 debunking that myth. And before Fallon and Enig, Michael Eades, M.D. and his wife, Mary Dan Eades, M.D. wrote a book debunking the lipid hypothesis in 1996. All of these books delved deeply into the empirical medical literature and found no empirical evidence to support the lipid hypothesis.

But there is even more recent evidence.  Three recent studies all concluded that low carb diets actually improved markers of metabolic health. None of the three support the lipid hypothesis. Dr. Malcolm Kendrick demolishes the lipid hypothesis in 1 minute and 17 seconds. One study found no association between eating eggs and cardiovascular disease. Another study found that dairy consumption was not associated with cardiovascular disease. Yet another study showed that children who ate full fat cream and other saturated fats were healthier than children who did not.  Finally, a meta analysis of 21 studies of 348,000 people over an average of 14 years concluded there was no relationship between eating saturated fats and cardiovascular diseases such as heart attacks and stroke. Even the mainstream media is now hinting that we have been mislead by the lipid hypothesis, and that carbohydrates, not fat, may be the real problem. 

The most recent book I have read demolishing the lipid hypothesis is one you ought to read, as it is targeted to physicians. It is called The Art and Science of Low Carbohydrate Living, by Jeff Volek, Ph.D., R.D. and Stephen D. Phinney, M.D., Ph.D. This book takes you into the inner workings of the low carb lifestyle and addresses head on many of the myths surrounding it, such as the lipid hypothesis.

So thank you for your concern about my cardiovascular health, but I do not think the low carb diet which is high in saturated fats will cause me to die of a heart attack any time soon.

Sincerely,

Lowering Cholesterol and Heart Disease

This article reviews three recent studies about cholesterol lowering drugs and comes to this conclusion: "Cholesterol it seems is irrelevant to cardiovascular disease."

One of the studies cited even showed a slight increase in stroke risk in patients taking the cholesterol lowering drugs. Another study was stopped 18 months early due to the high numbers of heart attacks in the placebo group.

This raises an interesting question: is lowering lipids the right way to prevent heart disease? This article gives the counter intuitive advice to eat triglycerides to lower triglycerides. That has worked for me and others.

Hat tip: Dr. Michael Eades.

Low Salt Intake and Insulin Resistance

A new study shows that a low salt diet is associated with insulin resistance. So far from being benign, cutting back on salt may actually be harmful. We have learned before that low salt intake was associated with a higher incidence of cardiovascular disease, and this may be the mechanism behind that finding.

So the advice to lower salt intake is just another load of CWOPO.

Low Carb Diet and the Treatment of Chronic Diseases

A new article in Nutrition in Clinical Practice reviews the safety and efficacy of the low carb diet as a way to treat chronic diseases such as type II diabetes and heart disease.  (Here is a link to the full text if you work somewhere, such as a university, that grants access).

The linked abstract concludes with this advice: "It is time to embrace LC [low carb] diets as a viable option in reversing diabetes mellitus, risk factors for heart disease, and the epidemic of obesity." This is a particularly important article, as it is targeted to medical practitioners. They are the ones actually treating patients with these chronic problems and some of them give bad advice, especially to those who are type II diabetics.

Hat tip: Dr. Eades.

Eating Eggs and Cardiovascular Disease

A new study in the European Journal of Clinical Nutrition found no association between egg consumption and cardiovascular disease in the population they studied. I routinely eat two to three eggs per day, without fear of getting a heart attack. Eggs are whole, real food that are good for you.

We eat a lot of eggs here in Belgium and they are from free range chickens, brown shells, with darker yolks than the white-shelled eggs we are used to in America. I snapped the photo above of the eggs in my refrigerator.

Statin Drugs and Heart Disease

A study of virtually the entire population of Sweden between the ages of 40 and 79 concluded that, despite a three-fold increase in the use of statin drugs to lower cholesterol , the statin drugs had no effect on overall rates of acute myocardial infarctions (heart attacks).  The theory is that lowering cholesterol will lower the rate of heart disease, but, according to this massive study of almost 4 million Swedes, they had no effect. Here is the abstract, here is the full article (PDF), and here is an Internet news report about the study.

Dairy Consumption Does Not Elevate Heart Attack Risk

According to a recent study, dairy consumption does not elevate heart attack risk, even after controlling for high and low consumption and several other factors.  The authors still fear saturated fat but suggest there are "protective" elements present in dairy products that prevent heart disease.  (They should read the first 100 or so pages of Gary Taubes' Good Calories, Bad Calories for a thorough debunking of the saturated-fat-causes-heart-disease myth).

I've mentioned before that for good health, one should consume butter and cream (and feed it to your children).  It is very nourishing.

Consume Butter and Cream

I weigh myself every day, even if I only report it on this blog once a week.  I have been trying an experiment recently, where I am consciously adding more fat to my diet and eating less protein.  I am striving for 75% fat, 15-20% protein, and the rest in carbs (5-10% for those of you bad at math).  In particular, I make sure I eat two or three eggs per day, use butter for cooking and seasoning, eat fatty cuts of meat (bacon!), and eat more cream (in sauces or whipped up and eaten with berries).  The weight keeps coming off.  Even though I do not make any attempt to count calories and eat until I am full (but I don't overeat), the weight keeps coming off.  So far this week, I have dropped 3.6 pounds.  Of course, I avoid most carbs except for green vegetables plus I am active (we walk a lot in Europe), and both of those activities contribute to the weight loss success.  But the butter and cream are great sources of fuel and help me to feel full. A recent study demonstrated that children who eat saturated fat and full cream dairy products were healthier than those who did not.

And I won't be dying from a heart attack any time soon.  Remember: saturated fats do not cause heart disease.  The fat in mothers' milk is 60% saturated and our brains are 60% fat.  If saturated fats are so bad, why is so much of it in mothers' milk?  We are designed to consume saturated fats (by evolution or our creator, whatever your belief system).  We've been around for a long time, and it's only in the past few decades that Americans in particular have become hung up on the concept of saturated fat.  And as our rates of saturated fat consumption have plunged (see table 1 in this linked document), cardiovascular disease has increased. Something does not compute.

So go ahead, eat butter and cream if you are following a low carb diet.  Don't gorge on it, and stop when you are full.  But eat butter and cream.  Put butter on your veggies, cook your meat in butter, make delicious sauces using cream for your meats, eat cream with your berries, add cream to your scrambled eggs, etc. and you will be healthier and lose weight.

CWOPO

Conventional Wisdom or Prevailing Opinion (CWOPO) has really let me down in recent months.  I have learned that salt restriction may actually be dangerous, contrary to what we have always been told.  The idea that cholesterol causes heart disease has been debunked for years now, but the USDA still issues food guidelines that assume it is true.

Soy is supposed to be the new health super food (and it's in everything we eat that is processed--just read the labels).  Yet I am discovering that soy is a very dangerous food, and that giving soy formula to infants is like giving them birth control pills.

We are told to do cardiovascular exercise, and then learn that it may actually cause heart disease.

My daughter has educated me about natural child birth and the benefits of using a nurse midwife (see the movie, The Business of Being Born on Netflix or Amazon Prime).  Naturally, this movie upset the AMA.

We are told to have regular physical exams, then we are told that annual physicals don't do much for us.

The American Diabetes Association approved diet is heavy on carbs, yet these same carbs are causing blood sugar spikes.  Don't these so-called professionals know this?  Dr. Bernstein takes the ADA to task for its 2008 guidelines that are problematic for diabetics.

Last year, I had a scare with rheumatoid arthritis (fortunately for me, it was merely reactive arthritis), and all the conventional treatments are pretty scary, not to mention expensive.  Yet there is a simple, safe, inexpensive, medically proven alternative to the other expensive and dangerous rheumatoid arthritis treatments.  And this treatment is shunned by rheumatologists and the medical establishment.

I am now starting to question a lot of what I have been told to do by medical authorities.  CWOPO is often seriously flawed and out of date, in my opinion.  I have discovered that evidence based medicine is not usually practiced, though it should be.  CWOPO is what is practiced, and it is very hard to change, despite empirical evidence to the contrary.

I am learning that if it is my health problem, I must take ownership of the problem and do the research about what to do.  This is what I have done with the type II diabetes, what I did when I thought I had rheumatoid arthritis, and what I have done with my weight loss strategy.  I will not merely passively accept what an M.D. tells me in the future.

Salt Intake and Cardiovascular Health

Everything I thought I knew about nutrition and health is being turned on its head.  Now two recent studies conclude that lowering salt intake is a risk factor in cardiovascular disease.  Haven't we been told to limit our intake of salt?

The first study, published in the Journal of the American Medical Association, concluded that lower salt intake was associated with higher cardiovascular disease mortality.

The second study concluded that a low salt diet increased insulin resistance in healthy subjects.  Insulin resistance is a risk factor for developing type II diabetes, which is a risk factor for heart disease.

Cholesterol and Heart Disease

I just watched Dr. Malcolm Kendrick debunk the cholesterol/heart disease myth in one minute and 17 seconds.

Health Benefits of Following a Low Carb Lifestyle

After honestly following the low carb lifestyle for three months, you should expect the following to occur when you have blood work analyzed on your next visit to the physician, especially if you are a type II diabetic.  I have seen this information in a wide variety of sources, including Good Calories, Bad Calories and Why We Get Fat by Gary Taubes, an article by Michael R. Eades, M.D., and many other sources.

Weight loss.  If you are consuming 30 or so grams of carbs or less, you should show a substantial weight loss.

HgbA1c.  Your blood glucose profile should show substantial improvement over your previous reading, since carbohydrates drive blood glucose levels.  Eliminate the carbs, improve your blood glucose profile.

Total Cholesterol.  This will probably drop, but not by a great deal.  But this doesn’t tell the whole story.  Read on.

HDL Cholesterol (the “good” cholesterol”).  This reading should go way up.  This is a major benefit from eating all of those foods laden with saturated fats.

Triglycerides.  This number should go way down.  This is good for two reasons.  First, lower triglycerides correlate with greater insulin sensitivity, meaning your pancreas doesn’t have to work as hard.  Second, it correlates with larger LDL-cholesterol size (see below).

LDL Cholesterol (the “bad” cholesterol).  This reading may go up, into the worse range, and may cause your physician, if she or he is not up on the latest information, to express some concerns.  They might even want to put you on drugs to bring this number in line.  Don’t let her/him do this to you!  Small, dense LDL cholesterol particles are associated with increased risk for heart disease, but the larger, fluffy LDL cholesterol particles may actually protect you from heart disease.  LDL particle size is typically not measured in a lipid profile, but as triglyceride levels go down, LDL particle size goes up.  So if you have dramatically better triglyceride levels, you probably have the larger, fluffy, protective LDL particles in your blood.  On the other hand, if you have high triglyceride levels and low HDL levels, you are at much greater risk of heart disease from small, dense LDL cholesterol particles.

Triglyceride/HDL Ratio.  The lower this ratio is the better.  The low carb diet works dramatically better than the low fat, high carb diet at reducing this ratio.

Blood Pressure. You should see a significant lowering in your blood pressure.  Both systolic and diastolic blood pressure readings should go down.

Overall, you should experience a much lower risk of cardiovascular disease.

And just so you know that I am not making this stuff up, Gary Taubes has just posted his most recent lipid profile online (April 18, 2011), along with his daily menu (eggs, bacon, sausage, cheese, hamburger, butter, and a pound of steak for dinner).  Note that I wrote all previous paragraphs of this post before I discovered Taubes’ lipid profile online.  

More Interesting Articles

First off, Gary Taubes has a new article on the link between sugar (either refined or high fructose corn syrup) and obesity, diabetes, and, gulp, cancer.  It is titled, "Is Sugar Toxic?"  I know his next book is on the effects of sugar in the diet and this is a taste of his upcoming work.

Second, can an active (non-sedentary) person get heart disease from eating a diet of grains, fruits, vegetables, and very little meat?  I don't know, but an article on Egyptian mummies with heart disease certainly raises the question.

In an obesity study on rats, a diet high in fat is compared with a diet similar to the high carb, junk food laden American diet.  The junk food diet leads the rats to develop metabolic syndrome, whereas the high fat diet does not.  True, these are rats, not humans, but the results are very interesting nonetheless.

A comprehensive review of "heart healthy diets" (low fat, high carb, and including psychological counseling) over the last several decades concludes that they "had little or no impact on the risk of coronary heart disease mortality or morbidity."  The research was performed by the Cochrane Collaboration, a non-profit group that independently reviews medical research in a non-biased way.  They do not accept monies from pharmaceutical companies or other entities with vested interests in the outcomes of research.  They also review and rate research conducted by other researchers, and they are big proponents of evidence based medicine.

Interesting Research Articles

As I continue on my journey, I am discovering more and more scientific literature with conclusions that are startling.  Why did I not know this information before?  Nutritional public policy is way behind the times.  I spent a bit of time on the Metabolism Society web site and discovered many scientific studies on the impact of the LCD on cardiovascular disease, type II diabetes, obesity, cancer, etc.  Below are a few gems I found from this site.

Saturated Fat and Cardiovascular Disease.  A meta-analysis of 348,000 subjects over 5 to 23 years leads to this conclusion:  "[T]here is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [coronary heart disease] or CVD [cardiovascular disease]."

Are Refined Carbohydrates Worse than Saturated Fat?  This article still believes saturated fats are bad, but it also concludes that replacing fat in the diet with refined carbohydrates is bad, too, and suggests adding more sources of vegetable fat and consuming non-refined carbs and lean protein.  It reports on a large scale study on the affects of saturated fat on myocardial infarction (MI; heart attacks) and concludes that "saturated fat intake was not associated with risk of MI compared with carbohydrate consumption" but that replacing saturated fat with refined carbs "significantly increased the risk of MI."

Low Carb Diets and Cardiovascular Disease.  Conclusion:  "A diet based on restricting carbohydrates leads to spontaneous caloric reduction and subsequent improvement in emerging markers of CVD [cardiovascular disease] in overweight/obese men who are otherwise healthy."

The Effect of a Low Carb Diet on People with Severe Type II Diabetes.  Conclusion:  "The 30% carbohydrate diet over 6 months led to a remarkable reduction in HbA1c levels, even among outpatients with severe type 2 diabetes, without any insulin therapy, hospital care, or increase in sulfonylureas.  The effectiveness of the diet may be comparable to that of insulin therapy."

But Won't a Low Carb Diet Give You a Heart Attack?

This is perhaps the most common reaction I get when telling people about the low carb diet (LCD).  The belief that saturated fat will lead to heart attacks is well ingrained in the American psyche.  (It's also illogical.  Obesity leads to heart attacks, so getting lean reduces heart attacks, but a diet designed to make you lean also leads to heart attacks?  You can't have it both ways).  Just because you believe something doesn't make it true.  There has been a fair amount of research recently on the effects of the LCD (see below).

So no, in fact, I won't have a heart attack because of following an LCD.  But I might very well have had one following a traditional high-carb, low fat diet.

Recent studies in major journals all confirm that the LCD improves cardiovascular health.  This blog post by a Ph.D. in medical biochemistry links to and summarizes the results of three major studies appearing in the Annals of Internal Medicine, The New England Journal of Medicine, and The Journal of the American Medical Association.  All show that an LCD lowers risk factors for cardiovascular disease, such as high blood pressure, high blood sugars, and high cholesterol.  Plus click on the review article listed below, which concludes basically the same thing.  The LCD is a heart healthy diet.

A 2007 review article in the American Journal of Clinical Nutrition concluded that LCDs "lead to appetite reduction, weight loss, and improvement in surrogate markers of cardiovascular disease."  Further, it concluded that LCDs improved blood sugar levels in both healthy people and those suffering from type 2 diabetes.

Why am I doing this?

Twice in my life, I have lost 100 pounds, both times using Weight Watchers.  I was even a leader at Weight Watchers meetings for about a year.  And within two to three years, I gained my weight back.  Now, approaching 50, I have become concerned about my health and determined to make one final attempt at becoming lean.  I am a type II diabetic who recently had to switch to insulin shots and my third try at Weight Watchers was a complete bust.  I was 100% honest on the new program for four weeks, but only lost 0.8 pounds in that time, not my normal experience.  Something wasn't working.  At first, I blamed the new Weight Watchers program.  But one day, I was reading www.instapundit.com, and the author, Glenn Reynolds, linked to a book by Gary Taubes, called Why We Get Fat and What to Do About It.  I downloaded the book from Audible.com and listened to it one weekend.


This book changed my life.  I was converted, completely, as my weight loss biography mirrored the failed attempts detailed in Taubes' book.  I had considered myself weak-willed, gluttonous, and slothful for failing at keeping weight off, but then I learned why I had failed:  too many carbs and too much insulin in my system.  It's too complicated to explain how that works, just read Gary Taubes' book if you are interested.  It is short and interesting.  But a low carb lifestyle boils down to this:  avoid most carbohydrates and eat a lot more saturated fat and protein.  Eat as much meat, poultry, and fish as you like (but stop when you are full), and consume fat, including the saturated fat in animal products.  Eat small quantities of leafy green vegetables (and a few other vegetables) but avoid most carbohydrates:  flour, sugar, starchy vegetables like potatoes and rice, and anything made with those ingredients.  I am striving to live on fewer than 20 carbs a day.  Bye bye bread. Hello bacon, eggs, and steak.

My wife and I went on a business trip to Las Vegas, and without telling her, I decided to begin my very low carb journey.  When she found out about my decision, she was not happy.  We fought a lot about what, and why, I was eating and I kept insisting she read the book.  She finally did, and saw the light, too.  Now she is not heavy at all, but has seen the value of the very low carb lifestyle.

Now I am three weeks into my journey.  My blood sugars have stabilized, I am reducing the amount of insulin I am injecting by more than half, and my blood pressure has gone down.  Oh, and in three weeks, I have dropped 13 pounds.  And I am no longer hungry.  On Weight Watchers, I was hungry all the time.  Gary Taubes calls WW a "semi-starvation" diet, and it was.  That is why I failed, and why most people who do semi-starvation diets fail to keep the weight off.  But protein makes you feel full, and keeps you full.  It helps me to not obsess about food.  Prior to embracing my inner carnivore, I could hardly make it past 9:30 a.m. without eating something else, despite eating (what I thought was) a healthy and hearty Weight Watchers approved breakfast.

I was going to die of a heart attack on my previous high carb, low fat diet, but I won't now.  For those of you who still believe saturated fat causes heart attacks, look at the empirical research before you comment.  Hint:  there is none.  Here is a piece of medical research to chew on if you still think I am crazy:  http://www.ajcn.org/content/86/2/276.full.  If you cannot trudge through the turgid and dense academic prose, skip directly to the summary at the end of the article.  "LCD" stands for "low carb diet" and CVD stands for "cardio-vascular disease."