This last month, the American Heart Association released a Presidential Advisory titled, “Dietary Fats and Cardiovascular Disease.” You may have seen attention-grabbing headlines such as, “ Coconut Oil Isn’t Healthy. It’s never been healthy,” or, “Health Alert: Coconut Oil is Just as Bad as Butter and Beef Fat, Heart Docs Say.”
Obviously, the controversy about fat and deciphering choices to promote health is alive and well. Unfortunately, this is another example of “Fake News.”
I am profoundly distressed by this report as it promotes confusion and poor health and will require valuable time and effort to sort through with each of my patients who want to do the right thing. This report rehashes multiple studies that have significant flaws but have been used to prop up arguments against saturated fat.
Under a barrage of mis-information and industry marketing about fat, we have eaten low-fat diets since the mid-1970s. In that timeframe, Americans have reduced our intake of fat from 43% to 33% with an even greater decrease in our saturated fat intake. Has this improved our health? No! In fact, we have seen a doubling of our obesity rates and a ten-fold increase in the number of Americans with type 2 diabetes.
The recent AHA Advisory culls the evidence for its recommendation from four “core” studies published in 1968, 1969, 1970 and 1979. They conclude that cardiovascular disease is decreased by replacing saturated fats (butter, beef fat, palm and coconut oil) in the diet with polyunsaturated fats (such as corn, soybean, and cottonseed oils along with other processed vegetable oils). There are many points of this assertion to argue, but one of the greatest flaws is that it is based on studies that show correlation but not causation.
In scientific studies there is a great tendency to assert that an outcome is due to a certain action (a cause), but most of the time there are other factors that might also cause the outcome. This is called correlation. A simple example would be the assertion that heart disease deaths dropped during the 1970s and 1980s due to decreased intake of saturated fats in the American diet. However, during the same time period there was a drastic decrease in cigarette smoking. So how can we be sure which factor caused the decrease rates of heart disease? In truth, we can’t.
Despite the leap in logic from correlation to causation, the so-called “Diet-Heart Hypothesis” (the belief that high saturated fat intake causes high cholesterol in the blood which causes heart disease) is firmly entrenched in the dietary world. This hypothesis has its origins in the work of Ancel Keys who first created the “Six Country Analysis” showing that citizens in countries with higher fat intake experienced more heart disease. In 1956, the American Heart Association began promoting the replacement of saturated fats with margarine, corn oil, chicken and cold cereal. The Lipid Hypothesis was further propagated in the following decades through the infamous “Framingham Heart Study” which proposed that people with higher blood cholesterol levels were more likely to have plaque in their arteries and more likely to die from heart disease.
In 1977, the Senate released “Dietary Goals for the United States” recommending avoidance of foods containing saturated fats in meat, dairy and tropical oils such as coconut and palm oils. This paved the way for the multi-million dollar food industry to seize the marketing opportunity of playing on our fear of heart disease by promoting low-fat food options.
We are living with the results of this “grand experiment” where the standard American dietary recommendations have promoted a low-fat diet, and the over-consumption of vegetable oils and grains and they are not good.
Eating cholesterol has very little impact on the cholesterol levels in the body. Most of the cholesterol we eat is not absorbed because it does not easily cross into the gut wall. Peter Attica says it this way, “Plasma cholesterol levels (which is what clinicians measure with standard cholesterol tests) often have little to do with cellular cholesterol, especially artery cholesterol, which is what we really care about. For example, when cholesterol intake is decreased, the body will synthesize more cholesterol and/or absorb (i.e. recycle) more cholesterol from our gut.”
Other factors that must be considered in whether any fat, saturated or not, will produce health effects in the body include whether the remainder of the diet is comprised of minimally processed, low-glycemic foods, and the person’s internal level of inflammation.
This advisory from the AHA turns back the clock of progress in the quest to understand optimal nutrition for each of us. I’m sorry to say that this article is a stick-in-the-mud to the paradigm shift in medicine today. However, it challenges me to communicate the answers better and seek broader evidence for our dietary choices. I hope you’ll join me in truth seeking!
Dr. Brossfield is the medical director at the Eisenhower Wellness Institute and can be reached at (760) 610.7360.