• Email:
  • Password:
  • Remember Me
 
Print   Subscribe    Share
CDE,MBA,RD
Saturated Fat Controversy/Debate (Triggered By My H.A.L.T. Acronym)
Section:  Nutrition

About a week ago, I posted the entry below and it sparked a DEBATE....but many of you wouldn't know this due to the title of the blog.  So I'm re-posting it under a different title and adding the 2 replies to date that take issue with SATURATED FAT ADDING TO ATHEROSCLEROSIS...

My Original Post:
As we all know, the statistics are alarming….approximately 66% of people with diabetes will die from CVD.  Reducing dietary saturated fat in this population to <7% of calories is now an evidence-based recommendation from both the American Dietetic Association and the American Diabetes Association in 2011 (*)    So WHY reduce saturated fat?  Here's why:

H.A.L.T. Saturated Fat

 

H = Hardens cell membranes

A = Adds to atherosclerosis in arteries

L = Leads to greater insulin resistance (both “H” and “A”)

T = Triggers liver to make cholesterol

 

(*) Evidence-Based Recommendation, American Dietetic Association, 2011 (Strong, and Imperative); Standards of Medical Care in Diabetes, American Diabetes Association, 2011

 

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder

 

 

The saturated fat controversy/ debate

The idea that saturated fats clog arteries has always been controversial(1). Tragically, about three decades ago the saturated fat controversy was suppressed by the federal government(2). But research indicating that saturated fats are benign continues to accumulate(3). With growing awareness that a mistake was made, the saturated fat controversy is being openly debated(4).

 

My view is that saturated fats can be consumed over a wide range of intakes as long as they are eaten in the context of adequate supportive nutrition(5). In addition, recent research has shown that adding supportive nutrition has a far greater effect on cholesterol than saturated fat restriction(6). Finally, in light of the fact that higher LDL levels correlated with better results in a recent strength training study(7), it's likely that any effect saturated fats have on cholesterol is physiological, not pathological.

 

 

References

1. http://www.omen.com/corr.html

2. http://freepressonline.net/node/144

3. http://www.ajcn.org/content/91/3/535.full

4. http://www.cassandraforsythe.com/blog/The+Great+Saturated+Fat+Debate/

5. http://www.eurekalert.org/pub_releases/2011-05/bu-dcd051811.php

6. http://www.theheart.org/article/1267163.do

7. http://www.eurekalert.org/pub_releases/2011-05/tau-cn050511.php

 

Post by David Brown

 

Re: Mary Ann's Musings: New SATURATED FAT Patient Teaching Acronym

The efforts of most educators to reduce fat intake in patients is a well intentioned effort to implement the current recommendations.  But neither the USDA dietary guidelines, nor the ADtA dietary recommendations reflect the actual science or evidence and this cascade of fundamental errors (all attributable to cholesterol - heart disease theory) has tainted all of these detary recommendations, not only for diabetics, but for everyone.  Unfortunately, another side effect of this belief results in the high carb macronutrients guidelines in the dietary recommendations which appear to be justified as the only way to avoid higher fat intake.

As a patient, I continue to read the literature, to consider the results and weigh the evidence as a way of informing my own choices.  But given what I have found, and particularly my questioning of the cholesterol-heart theory, I find the acronyms of no use.  Given the huge controvery, simplifiying the reasons in a way that appears to be unsubstantiated does nothing for me.

I think these issues are worthy of debate, but for many these are core fundamental (almost religious) beliefs.  Science, studies, evidence are useless in convincing people who believe with their heart. 

ps. David, when are you going to start blogging again, I always enjoyed your posts.

 

Post by Brian Cohen

MEMBER COMMENTS
Re: Saturated Fat Controversy/Debate (Triggered By My H.A.L.T. Acronym)

Dear Mary Ann,

How about a post on sugar called "DEATHS" ("Don't Eat All That Horrible Stuff")?

I really like your site and was about to add you to my "diet favorites" until I realized you had the usual take on saturated fat!!!  :-0    I may relent, but please read this!
 

Like your other 2 commentators, I believe sugar and high-bad-carbs (and what thus ends up being the "low fat diet") are the problem.

 

You are invested in your “saturated fat is bad” esp. since you have designed your own (clever) acronym (we’re all fond of our own children :-) and you have a lot of support in the dietary community.  Things are changing big-time though, and you should be aware of what’s happening:

 

This comment says it well, from somebody named Tom Boyer on Gary Taubes’ blog recently:

 

“The biggest change in science since Thomas Kuhn is probably the internet. We could be entering an era where social networking and uncontrolled network dissemination of knowledge can help to drive scientific revolutions. We need dogged journalists like Taubes and brave researchers who risk their careers to break from the official paradigm. But intelligent people who take charge of their own health can probably drive the paradigm shift to an unprecedented degree. DESPITE THE DURABILITY OF THE PARADIGM, ANYONE WHO STILL INSISTS ON CAL-IN-CAL-OUT AND DENIES THAT PEOPLE CAN LOSE WEIGHT EATING FAT AND PROTEIN APPEARS LAUGHABLE IN THE EYES OF THOSE OF US -- MAYBE MILLIONS -- WHO HAVE PERSONALLY EXPERIENCED IT. From what I see, the low-carb argument has been won at the grass roots level; all that's left is for researchers to explain it, for medical schools to teach it, and for nutritionists and doctors to put it into practice. Sadly this will come too late to save millions of people from diabetes and premature death.”

 

Mary Ann, I have a few things I’d appreciate your looking at:

 

(1)    MY PERSONAL EXPERIENCE WITH MY LIPIDS (AND TAUBES’ AND KRESSERS’ AND MANY MORE, including Frank J. Spence, Jr., MD who is vegetarian – I give his and Taubes’ exchange, below):

 

MY LIPID PROFILE before cutting carbs and almost totally eliminating sugar & HFCS (i.e. before 3/21/10 – 3/21/10 is when hubby and I finished Taubes’ “GC,BC” and began eating the Taubes/Atkins recommended diet of low carb / moderate-to-high protein / high fat (including plenty of saturated)):

 

ME, CLUELESS PAULA, PRE-3/21/10:

 

WEIGHT 168

TGS 105

HDL 52

LDL 158

 

ME, CLUED-IN PAULA, POST-3/21/10 (this is a year later; but very similar to 4 mos. after beginning diet, except TGs went down 4 more points and HDL up 2 more points):

 

WEIGHT 150 (did NO exercise to lose this weight - not that I'm proud of that - Taubes in “GC,BC” explains why exercise is not necessary or effective in losing weight – Hubby went from 200 to 175 in 4 mos, no exercise either)

TGS 48

HDL 67

LDL 158

This was purely accomplished by diet.  Taubes has partnered with Mary C. Vernon, M.D. of Kansas to form www.myimsonline.com.

Dr. Vernon calls this TG/HDL scenario – which always works in tandem – "the hallmark of carbohydrate restriction."  She can see by how the TGs and HDL change whether her patients are actually on the low-carb / high fat diet.


As for heart attack and stroke, for women over 50 (I'm 56), HDL is said to be the major marker (some say ApoB).  HDL needs to be  65 or over – note that my HDL went from 52 to 67 when I cut carbs WAAAY low, including sugar and HFCS – also I went high “good” fats, including plenty of saturated – I eat 3 eggs a day, plenty of sausage and bacon and heavy cream – and of course other meats, low-carb dark green veggies and salads, macadamia nuts, berries, and don’t forget my cheatin' heart's 85% dark chocolate (about 2 squares from  a Lindt “Excellence” bar a day)!!!

 

WORRIED ABOUT MY LDL?  As the newer research shows, LDL and total cholesterol aren’t what matter – But one’s LDL subfraction sizes DO matter (take your pick of these methods as to how you want to test the size of your LDL cholesterol):    (1) test your apoB (the protein that carries the cholesterol); this tells whether LDL is light and fluffy or small, dense and atherogenic -- my LDL is 158 but my apoB tested 98, well enough below the 109 allowable upper limit for me to be very satisfied; (2) See Chris Kresser’s 2nd video at the link below for three tests you can send for which measure (I believe) your entire blood lipid profile for $80 - $100 (you only need one; they do the same thing different ways):

 

NMR:  Nuclear Magnetic Resonance

VAP:  Vertical Auto-Profile

GGE:  Gel Electropheresis (see the Berkeley Heart Labs test)

 

 

CHRIS KRESSER’S LIPID RESULTS & GARY TAUBES’ LIPID RESULTS (you need to know that LDL Pattern A is GOOD, LDL Pattern B is BAD):

 

See Chris Kresser's lipid profile at 7:38 in top video at this link:

http://chriskresser.com/i-have-high-cholesterol-and-i-dont-care

 

See Gary Taubes' lipid profile at

http://www.garytaubes.com/2011/04/before-sugar-were-talking-about-cholesterol/

They're both in the Pattern A (light bouyant LDL) range, as my ApoB score indicates that I am as well.

 

FRANK J. SPENCE, JR., M.D.(VEGETARIAN!!)s WAY OF EATING AND LIPID RESULTS, AS HE REPORTED THEM TO GARY TAUBES:

 

FROM frankjspencejr

 

Gary, this is spooky. As you know I have also been on the 3 eggs a day, high fat, very low carb diet about 2 years. Just yesterday I had my lipids checked, with almost identical results as yours:
T Chol 192, TG 65, LDL-C 114, HDL-C 65.3, VLDL 13, Chol/HDL 2.9
Weight staying mid 180s. Thanks again for your good work.

 

FROM garytaubes

 

Hi Frank,
Spooky it is, since you don't eat any meat at all and I live on it. Nice numbers and nice to hear from you, as ever.
gt

(2)  Look up Christopher D. Gardner, Ph.D.'s "A-Z" study.  He called it a "bitter pill to swallow."

(3)   Chris Kresser (at "The Healthy Skeptic" - he's a Taubes follower, so watching his two videos can get you up to speed and he presents clearly - even if you don't believe this, you'll see the arguments you're going to be up against):

 

http://chriskresser.com/i-have-high-cholesterol-and-i-dont-care

 

(4)   http://www.proteinpower.com/>Blogs>Michael R. Eades>Search For:>saturated fat>next page>next page>Saturated Fat and Heart Disease:  Studies Old and New (January 26, 2010).  In it Dr. Eades writes:

 

“Ron Krauss and his group published a paper in the Articles in Press section of the American Journal of Clinical Nutrition (AJCN) stating there is no evidence that saturated fat intake increases the risk for heart disease.  The paper, titled Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease, is not a study per se, but is a meta-analysis, a compilation of numerous studies looking at the relationship between saturated fat intake and the risk for developing heart disease.

[here Dr. Eades explains why he doesn’t prefer meta-analyses]

“But having said all this, I’m still happy to see a researcher with the academic credentials of Ron Krauss coming out with a meta-analysis showing no correlation between saturated fat intake and cardiovascular disease risk.  And getting it published in the AJCN, probably the world’s most prestigious nutritional journal, no less.  Many academics to whom I’ve spoken admit that there is no correlation, but wouldn’t risk their academic reputations doing a meta-analysis to ‘prove’ it.

“Pro-saturated fat studies have been around for years.  Not just observational studies or meta-analyses, but real controlled studies looking at death rates from heart disease as a function of fat intake.

“Let’s look at a couple.

“Over 40 years ago, way back in 1965, there were two studies published showing that heart patients – the kind of people who today assiduously avoid saturated fat – who ate saturated fat were more likely to survive than those who didn’t.

“One paper titled Low-Fat Diet in Myocardial Infarction, published in The Lancet, looked at the survival of subjects who had suffered heart attacks who went on either low-fat diets or their regular high-saturated-fat diets.

“Here’s what they did:

[shows study in detail including charts,etc.]

“Here is another.

“A paper published in the British Medical Journal (BMJ) in 1965 titled Corn Oil in Treatment of Ischemic Heart Disease looks at the differences in the rates of death or a second heart attack in patients following one of three diets: Their regular diet (control diet), a high-olive-oil diet, or a high-corn-oil diet.”

YOU HAVE TO SEE THE CORN OIL STUDY!!!!   ARRGH! 


(5)    BLAME SUGAR!!!  How about a post called "DEATHS" ("Don't Eat All That Horrible Stuff")?  Google the YouTube video by Jorge Cruise ("Death by Sugar")  you can see blood magnified by means of a darkfield microscope -- BEFORE and 15 MINS AFTER a carb binge.   


 Before the blood is round, separate, beautiful. Look what happens to it AFTER.

All I can say is, Wow.  It floored me.

I believe it is sugar, the bad carbs and industrialized seed oils that lead to your HALT issues.  See p. 172 of Taubes' "GC, BC" - and see Jerry Brunetti on cholesterol.

Thank you for your consideration.

Best!!!   :-)  Paula

Re: Saturated Fat Controversy/Debate (Triggered By My H.A.L.T. Acronym)

Hi Paula,

Wow!  You certainly are passionate about the composition of a healthy diet in terms of carb, protein and fat!  I did read ALL your information and found it quite intriguing and informational.  I'm so bummed, though, that you're not adding me to your "diet favorites"!   Does a difference in opinion on the "science" of nutrition which is ALWAYS changing going to make you hit the  "delete" button on a colleague??  We can't just surround ourselves with people who share our same thoughts, can we?  Life would be SO boring and UN-educational!!!

Did you have a chance to read the 32 responses on the blog I started on 7-18-11 under NUTRITION titled: 

Type 2 Patients Avoiding ALL Carbs: Good or Bad?

PLEASE read the posts!  
 


One that is of particular interest to me in this onging debate is from HOPE WARSHAW.  Here it is:

All -Interesting discussion and dialogue. A couple of thoughts:

 

1) The current recommendations from American Diabetes Association (and remember the nutrition recommendations were updated last in 2008 yet I hear new ones are likely in 2012/13?) suggest individualizing the amount of carbohydrate within a range of carbohydrate within the Institute of Medicine 2002 Dietary Reference Intakes of 45 - 65% of calories - a moderate (in case there's any room for moderation!!). This range is reiterated in the more recently released Dietary Guidelines for Americans. Reality is people simply can't eat healthfully if they don't get at least 45% of calories as carbohydrate - that's fruits, veggies, starches, whole grains, low fat dairy.

 

2) We've GOT to encourage people with diabetes to balance both glycemic control and health (that is healthy eating). The two aren't mutually exclusive and one isn't a higher priority than the other. They are both important. I understand how and why healthy eating sometimes seem to fly in the face of logic when it comes to glycemic control. People become simplistic as well with this logic....if carbohydrate from food raises BG then restrict carbohydrate. Unfortunately that really doesn't mesh with what today we know about healthy eating, the pathophysiology of type 2 or the progressive disease process of type 2. In addition it doesn't mesh with current recommended medication treatment algorithms from ADbA or AACE.

 

Marion Franz and I just presented at AADE Battle Zone Carbohydrate: Applying Research Evidence  to Answer Complex Questions. In addition I've written a number of NutriZines on this topic. Most recently you can find Carbohydate and Diabetes: The Debate Continues

Let's make sure we let science drive our clinical advice vs. diet books like South Beach or self-proclaimed physicians like Richard Bernstein, MD who has never published a research study (that I know of) testing and documenting his low-carb hypotheses re: glycemic control.

 

Thanks for the terrific dialogue on this hot topic,

Hope

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much







Re: Saturated Fat Controversy/Debate (Triggered By My H.A.L.T. Acronym)

Hi Mary Ann!  Thank you for your response.  You ARE in my diet database, sorry.  I thought I'd thrown my hands up and not put you in, but I HAD!!!  :-)  You're there, you're staying!  You're right, we've got to let the science decide things and not shut people/ideas out.

I am going to read your post in detail ASAP and will respond after I have.  I too will read your links etc.  I was pleased you read mine!

My work schedule (for a crazy busy lawyer) is loooong hours for 3 days, then a few on other day of the week to total 40 hours... But I want to and will answer ASAP!

:-)

Paula  (P.S.  There are some SERIOUS issues/disagreements in the LCHF (low carb high fat) world - I'd like to share those with you so you can see where the "in-house" disagreements are.  I won't be just a cheerleader for my side!)