I want to explain the fat phobia

The saturated fat phobia is completely unwarranted nor at all supported by scientific evidence. I understand that people are confused about which fats, whether saturated or unsaturated fats are bad for them. That is, which fats are bad for them. Most people are now convinced (have been convinced) that saturated fats are bad because they increase the risk of heart attack and stroke.

In this article I wish to bring you THE EVIDENCE about the unwarranted saturated fat phobia, telling you first how we got there, and then how we proceed undeterred to recommend the same abomination with nutritional guidelines regarding saturated fats (and not only these), camped on quicksand.

Unfortunately, for decades we have been told that saturated fats are harmful, and that polyunsaturated vegetable oils are better for us. Faced with a reduction in saturated fats there has been a marked increase in the consumption of polyunsaturated fats. However, the latter are not all the same, and the constant focus on the quantity of fats allowed in the diet should be shifted to quality.

We distinguish different families of polyunsaturated fatty acids, and their consumption, excessive for some categories and insufficient for others, influences many functions and chemical reactions that occur in our bodies: such as the immune system and the regulation of inflammation.

And it is to this misinformation that we owe the major changes that have taken place in our diets over the past few decades. In the early 1900s, most fat intake was saturated or monounsaturated, mainly from butter, lard and olive oil. Nowadays most of the fats in the diet are polyunsaturated, mainly from plant sources such as soy, corn, sunflower and canola. We have an imbalance in the ratio of omega 3 to omega 6, which optimally should be 1:1-4, and instead is 1:20-40!!! Such an imbalance is at the root of chronic inflammation, which is responsible for the diseases of our time. An optimal omega 3 : omega 6 ratio is found in native populations, where polyunsaturated, monounsaturated and animal fats come from natural foods and not from the refined industrial oils that unfortunately characterize much of our diet.

According to LARNs (Reference Intake Levels for the Italian population), the daily amount of fat covers 20-35% of total caloric intake: of this absolutely less than 10% must come from saturated fat, the rest fat from monounsaturated and polyunsaturated fats.

Animal and plant fats provide both a significant energy supply to our diet and material for the formation of cell membranes, hormones and hormone-like substances. If they are part of a meal they reduce the rate of absorption of other foods, decreasing our sense of hunger. They ensure the absorption of the important fat-soluble vitamins A, D, E and K.

Dietary guidelines dictated by the so-called official guidelines are based on the theory that we need to reduce fat intake, especially saturated fats of animal origin. Never have we reduced our consumption of saturated fats globally as much as we have in the last 30 years, and never, as now, have we been so sick; just think of the soaring numbers of obesity, heart attack, stroke, diabetes, high blood pressure, dementia, Alzheimer's, cancer, osteoporosis, tooth decay, and gastritis.

We have replaced the consumption of healthy fats with abnormal consumption of refined carbohydrates associated with polyunsaturated vegetable oils in all forms: pasta, crackers, breadsticks, cookies, cakes, pizzas, brioches, snacks, etc.

 

When did the saturated fat phobia start?

"After 40 years, we saw that the more saturated fat and cholesterol and therefore the higher the calories consumed, the less elevated the blood cholesterol levels were in this group, who weighed less and were more physically active. This means that weight and cholesterol gain does not have a directly proportional relationship with dietary saturated fat intake."

William Castelli, cardiologist and director of the Framingham Heart Study, a study well known in medical circles, started in 1948 in the U.S. town of Framingham, Massachusetts, involving 6,000 local people, dividing them into 2 groups, analyzed at 5-year intervals, the first group with minimal consumption of cholesterol and saturated fat and the second group with large consumption of the same fats

It all began in 1913 when Nikolai Anitschkow, a Russian pathologist, performed an experiment on rabbits by feeding them pure cholesterol and causing their blood cholesterol levels to rise to 1000 mg/dl. He then detected the formation of arterial lesions superimposed with our atherosclerosis. The connection was immediately made: to lower blood cholesterol we needed to eat less: nothing could be more wrong.

Let us remember, however, that rabbits are purely herbivorous animals, not biologically predisposed to metabolize food of animal origin. Interestingly, a similar study was done at the same time, on dogs and rats, known omnivores, in which the administration of cholesterol caused absolutely no injury.

But, probably, the real culprit behind the now current and widespread belief that heart attack is the consequence of consuming saturated fats that lead to increased cholesterolemia dates back to the 1970s by Ancel Keys, an American physiologist, who with his "Seven Country Study" wanted to reveal the close link between the amount of fat consumed and the risk of heart attack in 7 countries.
It is this study that the dietary guidelines are based on, and the infamous food pyramid is based on it, unfortunately still today.

Numerous researchers, in the years to come, pointed out the errors of this theory, but unfortunately, Keys received enormous attention from the media, maneuvered by the agribusiness industry with billionaire interests, the main beneficiary of this vision. The same food industry that still produces vegetable oils and industrially refined foods, with huge profits, thus able to fund new studies piloted in order to corroborate the lipid hypothesis, all at our expense.

The tragic fact is that originally Ancel Keys evaluated 22 different countries, but in his publication he included only 7; where did the other 15 go? They were not considered because the data did not support the scientist's hypothesis: in fact, high cholesterol values did not correlate with a heart attack, or rather, high cholesterol values did not correspond to a heart attack.

Added to this is another serious flaw in the Ancel Keys study: it was of natural epidemiological nature, that is, even if it were accurate, it is still not sufficient to represent a causal relationship of high cholesterol and heart attack.

In recent years there have been many studies performed looking at the possible relationship between saturated fat and heart disease: no link has ever been found between them!!! Of all the studies I will mention just one from 2012 from the Cochrane Database*: this is a meta-analysis of 48 studies, in which the effect of fat reduction or modification of fat in the diet was examined.

Participants reduced their intake of saturated fats and/or replaced them with polyunsaturated fats, i.e., vegetable oils. The result was that the dietary intervention reduced neither the risk of death from cardiovascular disease nor the risk of death in general. Why have you never heard of this? Because no one had the interest in making this study known, but rather in keeping it hidden.

Should anyone wish to delve into the subject, I can only recommend reading three texts, which for me were particularly enlightening, to say the least:

- Know your fats, by Mary Enig, a distinguished nutritional biochemist, who in her text dissects the subject of fats with proficiency and precision, as few do.

- Fat and cholesterol are good for you, by Uffe Ravnskov, a Swedish physician, who like no other disquisitions on the subject of fats.

- The big fat surprise, by Tina Teihholz, science journalist, whose volume has meticulously investigated the topic.

The result is decades of erroneous dietary claims, which have done incalculable damage to our health. The biggest profit has come from the food industry, which on the hysterical wave of saturated fat phobia has marketed countless products with low-quality vegetable oils, trans fatty acids and light foods!!!

*GL Hooper et al: Reduced or modified dietary fat for preventing cardiovascular disease, in Cochrane Database Syst Rev, 16. Mai; (5): CD 0021

There are numerous studies of traditional populations that are an embarrassment to diet autocrats:

- The Masai, basically men, eat mostly milk, blood and meat: they have low levels of cholesterolemia and no heart disease.

- The Eskimos fed exclusively on animal fat from sea fish: by following their native diet these people never experienced the diseases typical of the industrialized civilization that characterizes us. Coming into contact, however, with Western eating habits they too began to develop the same diseases.

- In China, regions with high consumption of whole milk and dairy products had half as many cases of heart disease as areas with lower consumption of animal fats.

- Many Mediterranean populations have a low incidence of heart disease despite consuming up to 70 percent fat-including saturated fat from lamb, dairy products of goat origin. The inhabitants of Crete were known for their good health and longevity.

- In Okinawa, Japan, where the average age of women is 84, residents eat large amounts of pork and fish, cooking it all in lard.

- The relative good health of the Japanese, who are among the longest-lived in the world, is mistakenly attributed to a low-fat diet. In truth they eat moderate amounts of animal fats from eggs, pork, chicken, beef, seafood and organic meats. With the amounts of shellfish and fish broth consumed by the Japanese, they are likely to take in more cholesterol than we do.

What they definitely do not consume are large amounts of vegetable oils, white flour or refined foods (although they do eat rice). Their average life span has increased since World War II along with the consumption of animal fat and protein in their diet.

- The Swiss have longevity equal to that of the Japanese, despite one of the fattest diets in the world.

- In France the diet is high in saturated fat from butter, eggs, cheese, cream, liver, meat and pâté. However, the French have less coronary heart disease than other Western populations. Just think that in the Gascony region, where duck and goose liver is a staple of their diet, they have an incidence of coronary heart disease of 80 per 100,000 inhabitants. This phenomenon is known as the French paradox. In fairness, however, we must also say that the French suffer from many degenerative diseases, attributable to their large consumption of sugar and refined grains.

Here are now excerpts from the article by Nina Teichholz, an American science and investigative journalist and author of the book The big fat surprise:

A short history of saturated fat: the making and unmaking of a scientific consensus

 

Saturated fat phobia - recent findings

Recent findings include shortcomings in the scientific review processes on saturated fat for both the current Dietary Guidelines for Americans 2020-2025 and the previous edition (2015-2020).

Revelations include the fact that the 2015 Advisory Committee acknowledged in an email that there was no scientific justification for any specific numerical limit on these fats. Other findings, not previously published, include significant potential financial conflicts on the 2020 guidelines subcommittee, including the participation of proponents of a plant-based diet, an expert who promotes a plant-based diet for religious reasons, experts who have received extensive funding from industries, such as those in nuts and soy, whose products benefit from maintaining policy recommendations in favor of polyunsaturated fats, and an expert who has devoted more than 50 years of her career to "proving" the diet hypothesis for the heart.

 

SATURATED FAT STUDIES

Governments around the world, including the United States, Norway, Finland, and Australia, recognized the need for more rigorous clinical data that could establish a causal relationship between saturated fats and heart disease.
Large randomized controlled trials (RCTs) were conducted in the 1960s and 1970s in which saturated fats were replaced by polyunsaturated fats from vegetable oils.

Overall, these "core" studies tested the diet-heart hypothesis on about 67,000 people [15] and were particularly important because they assessed long-term clinical outcomes, i.e., "hard endpoints," such as heart attack and death. These results are considered more reliable for public health policymaking than studies using "intermediate endpoints," such as cholesterol or inflammatory measures, whose value for predicting cardiovascular events is debated.

These studies provided surprisingly little support for the diet-heart hypothesis. According to one analysis, drastic reductions in saturated fat consumption successfully lowered participants' cholesterol by an average of 29 mg/dl, "indicating a high level of compliance" among subjects [16], but the expected reductions in cardiovascular or total mortality were not observed in most studies [15]. In other words, although the diet could successfully reduce blood cholesterol, this reduction did not appear to translate into long-term cardiovascular benefits.

By the time these results emerged, however, Keys' hypothesis had gained wide acceptance by his colleagues, including, importantly, the leadership of the National Institutes of Health (NIH) [2]. By the late 1960s, the bias in favor of the diet-heart hypothesis was strong enough that researchers with contrary results found themselves unable or unwilling to publish their findings.

For example, the largest study of the diet-heart hypothesis, the Minnesota Coronary Survey, which involved 9057 men and women for 4.5 years, tested a diet with 18% saturated fat against controls consuming 9% saturated fat, but found no reduction in cardiovascular events, deaths from cardiovascular causes, or total mortality [17].

Although the study was funded by the NIH, the results were not published for 16 years. The decision of Ivan Frantz, the principal investigator, not to publish the results in a timely manner meant that these contradictory data were not considered for another 40 years [18].

Other unpublished findings come from one of the most famous heart disease surveys ever undertaken, the Framingham Heart Study, which began in 1948. Vanderbilt University professor George Mann conducted a dietary survey, collecting detailed data on food consumption from 1049 subjects [19]. When he calculated the results in 1960, it was very clear that saturated fat was not related to heart disease.

Regarding the incidence of coronary heart disease and diet, the authors simply concluded, "No relationship was found" [20]. However, it was not until 1992 that a Framingham study leader publicly acknowledged the results of the fat study.

In Framingham, Massachusetts, the more saturated fats one ate. ... the lower the person's serum cholesterol ... and [these] weighed less," wrote William P. Castelli, one of the Framingham directors, in an informal commentary [21].

As a consequence of not publishing or ignoring the results of studies contrary to the diet-heart hypothesis, for decades most nutrition experts did not seriously consider the idea that saturated fats had been unfairly vilified.

 

RECONSIDERATION OF SATURATED FAT STUDIES

Reviews and books critical of the diet-heart hypothesis were not unknown in the 1960s and 1970s, including a publication by a former editor of the Journal of the American Heart Association [22] and articles by other leading scientists [23-25]. They argued that the hypothesis was not supported by the available data and was contradicted by numerous observations.

Over time, however, these critics were effectively marginalized and silenced [2]. It was not until the 2000s that this science came back into the light, mainly through the work of journalist Gary Taubes [26,27]. The first comprehensive collection of arguments on why saturated fats are not bad for your health was published by this author, also a journalist [2].

The first formal analyses of early data on saturated fat were conducted by Ronald M. Krauss, a cardiologist and nutrition expert, and published in two articles in the American Journal of Clinical Nutrition in 2010 [28,29]. Krauss encountered incredible obstacles in the peer review process, evidently because of widespread resistance to reevaluate a long-standing hypothesis [2]. A colleague of Keys's attempted to refute these papers [30], but shortly thereafter other scientists joined Krauss in reevaluating the same data.

Keys' study results have been reviewed extensively by scientists around the world, including the prestigious Cochrane Group, most recently in 2020. In all, more than 20 review articles have been published, including so-called umbrella reviews, most of which conclude that data from randomized controlled trials do not provide consistent or adequate evidence to continue recommending restriction of saturated fat intakei [15].

Some reviews gave contrary results [31,32], but these were mainly explained by the inclusion of a study, called the Finnish Mental Hospital Study, which did not have adequate randomization, among other problems, and was therefore excluded in the most recent reviews [16]. The Cochrane 2020 finding of an effect on cardiovascular events disappeared when subjected to a sensitivity analysis within the report, in which studies that had not successfully reduced saturated fat were excluded [33▪▪▪].

Reviews that have focused on LDL cholesterol have ignored the much more definitive long-term outcomes of cardiovascular events and mortality [31,32]. Overall, then, despite extensive testing of the diet-heart hypothesis, the data do not support the continued advice to limit these fats for heart disease prevention.

Results from observational or epidemiological studies constitute less robust data, as these studies are usually limited to demonstrating associations rather than cause-and-effect relationships.

However, substantial epidemiological findings that contradict a hypothesis provide reasonable evidence that the hypothesis may be incorrect. Data from the largest epidemiological cohort study ever conducted, called Prospective Urban Rural Epidemiology (PURE), provide this kind of contradictory evidence regarding the diet-heart hypothesis. PURE followed people aged 35 to 70 years from 2003 to 2013 in 18 countries, with a median follow-up of 7.4 years.

PURE researchers found that saturated fat was not associated with the risk of myocardial infarction or cardiovascular disease mortality, while it was significantly associated with lower total mortality and stroke risk [34].

The latter finding, related to stroke, is particularly significant because it is consistent with other observational studies [35], and saturated fats are the only type of fat found to have a positive effect on this important cerebrovascular health outcome. In addition, nine reviews of observational data conducted since 2010 have found no significant associations between consumption of these fats and coronary heart disease [15].

Epidemiological data of this quality and scope contribute significantly to our understanding of the relationship between saturated fat and cardiovascular disease. These data reinforce the results of the more rigorous clinical studies described above.

Despite these extensive findings debunking the relationship between saturated fat and heart disease, speculation about the diet-heart hypothesis continues. For example, the AHA journal Circulation published findings of an association between linoleic fatty acid, a major component of vegetable oils, and a lower incidence of cardiovascular events and mortality [36]. However, this finding is based on nonstandardized, country-level (ecological) data, which are generally considered among the lowest quality evidence.

 

U.S. DIETARY GUIDELINES ON SATURATED FAT

The U.S. government was the first in the world to recommend a restriction of saturated fat.

In 1977, theU.S. Senate Select Committee on Nutrition and Human Needs published the Dietary Goals for the United States, which recommended that the public "reduce consumption of saturated fat so that it accounts for about 10 percent of total energy intake" [37]. The report was heavily influenced by AHA experts and was written by a single member of the Senate with no background in science or nutrition [26].

An earlier draft of the report also recommended "reducing meat consumption," based on its saturated fat content. This advice was revised to read, "choose meats...that reduce saturated fat intake," with an emphasis on "lean meat." Some observers have interpreted this revision as due solely to meat industry interference, but a 2014 article in the American Journal of Public Health, which reviewed the Senate committee process in detail, concludes that "lack of scientific consensus" was the main reason for the change in the meat language [38]. The latter interpretation also reflects the absence of rigorous data linking saturated fat to heart disease, as described above.

Dietary goals led to the establishment of a policy, issued jointly by the U.S. Departments of Agriculture and Health and Human Services (USDA-HHS), called the Dietary Guidelines for Americans (DGA), first published in 1980 and every 5 years since then [39]. The inaugural edition of the guidelines included the advice to "avoid too much fat, saturated fat, and cholesterol," but did not include a specific numerical limit for saturated fat. The 1990 guidelines and all subsequent editions included a goal of limiting these fats to 10 percent of total calories or less.

According to U.S. law, ADIs must reflect "the preponderance of current scientific and medical knowledge at the time the report is prepared" [40]. The topic of saturated fats presents a unique difficulty, however, because the original baseline studies ended before the guidelines began. A review of all DGA expert reports found that none of the expert committees charged with reviewing the science for each new edition of the guidelines had ever undertaken a direct and systematic review of these basic studies on saturated fats [41].

The guidelines had simply inherited the widely held view that saturated fats were linked to cardiovascular disease without their own scientific review.

A growing awareness of the core studies since 2010 should have prompted one of the subsequent Dietary Guidelines Advisory Committees (DGACs) to undertake a systematic review of these core studies, but this was not done. The 2015 DGAC decided, late in the ADI process, to undertake a new review of saturated fats, in response to the publication of a review paper on this topic, with authors including professors from Cambridge and Harvard Universities [42], and a major Wall Street Journal article on the same topic [43].

Both publications suggested a lack of evidence linking saturated fats to heart disease. The DGAC's decision to initiate a review of saturated fats was revealed by e-mails obtained through a request made under the Freedom of Information Act and reflected the unease of some DGAC members that these publications "contradict the AHA's conclusions" on saturated fats [44].

DGAC vice chairwoman Alice Lichtenstein, a Tufts University scientist who has also twice chaired the AHA's nutrition committee, suggested in an e-mail to other DGAC members that a numerical limit be set for saturated fat, although, she wrote, "there is no magic/date for the 10 percent or 7 percent number that has been used before."[45]

The 2015 DGAC review on saturated fats resulting from this e-mail exchange was a narrative, non-systematic review of seven external review papers [46]. Two analyses of this 2015 DGAC review found that it omitted at least one paper with null findings on saturated fats, while inappropriately including other papers that supported the advice to promote vegetable oils over saturated fats [11,33].

In one case, the DGAC included a paper that focused exclusively on linoleic acid and not on saturated fats [47]. In another case, a review paper was included that relied heavily on the Finnish psychiatric hospital study, whose data, for reasons already discussed, had been deemed unreliable [16]. The result was evidently a DGAC review that did not provide a balanced or thorough assessment of the external review documents in place at the time the 2015 report was written.

The 2015 DGAC concluded that the evidence for a relationship between saturated fat and heart disease is "strong."

For the 2020 guidelines, the DGAC also conducted a review of saturated fats [48]. A recent analysis of the studies included in this review found that 88% did not support a link between these fats and heart disease [33].

 

Saturated fat phobia - CONCLUSIONS.

For decades after the introduction of the diet-heart hypothesis, many scientists were unaware of the lack of evidence to support this theory. However, the rediscovery of rigorous clinical studies that tested this hypothesis and the subsequent publication of numerous review articles on these data have provided a new awareness of the fundamental inadequacy of the evidence supporting the idea that saturated fat causes heart disease.

The resistance observed against consideration of this new science by successive DGACs can be seen as reflecting long-standing biases in the field and the influence of vested interests. Until the recent science on saturated fat is incorporated into the dietary guidelines in the United States, (but also by usin ITALY ), policy on this topic cannot be considered evidence-based.

 

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