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Once and For All, Saturated Fat is Not the Devil

Cardiologists want you to know this.

Olga Oksman

Image: Jaroslaw Ceborski

Misconceptions from the 1970s are still haunting us to this day. Some are relatively harmless, like the idea that culotte pants are something any human should wear. Others, like the idea that fat and cholesterol are responsible for rampant obesity and heart disease, are less benign. Three prominent cardiologists are putting their collective foot down this week in an editorial in the British Journal of Sports Medicine. Stop freaking out about saturated fat, they say (though not in those words)—you're missing the point.

Our obsession with the perceived ills of saturated fat go back to a 1977 senate hearing on health that led to a set of dietary guidelines being issued for all Americans. At the time, scientists understood that saturated fat, found in foods like eggs and meat, could raise low density lipoprotein (LDL, or "bad," cholesterol). High levels of LDL in turn was thought to be responsible for heart-disease risk.

The original recommendations told Americans to eat carbohydrates instead of fatty foods like meat, cheese or oil. To meet the new demand for less fat in the diet, the food industry changed formulas, creating fat-free versions of foods like sour cream and yogurt, mostly replacing fat with sugar. Taking the dietary recommendations to heart, Americans started eating more sugar and other refined carbohydrates. So began the obesity epidemic and its associated ills.

Since those times, research has increasingly found that lowering LDL cholesterol may not be the answer to preventing heart disease. For one thing, current research points to another marker of heart disease risk: a low ratio of total cholesterol to high density lipoprotein (HDL, or "good," cholesterol). One way to lower the ratio of total cholesterol to HDL cholesterol? Replace calories from refined carbohydrates with calories from foods high in saturated fat like nuts or olive oil, the very foods Americans were told to avoid in the 1970s.

Heart disease is also not as simple as researchers thought back in the 1970s, when it was seen as a matter of preventing fat from entering the arteries. While the focus has traditionally been on clearing very obstructed arteries, most serious cardiac events, like heart attacks, occur when a plaque ruptures in areas where there is less than 70 percent obstruction of an artery, the editorial points out.

Changing decades of dietary dogma is not simple; a visit to any grocery store will still turn up shelves of fat-free products full of sugar and other fat substitutes marketed as healthy alternatives. Changing prescribing habits is equally challenging. For years the prevailing wisdom in the medical community has been focused on lowering LDL cholesterol, usually with a category of drugs called statins. The focus on keeping LDL cholesterol numbers below certain guidelines has become so intense that statins have become one of the most prescribed medications in the US.

Those lingering misconceptions, in both physicians and the general public, and the harm they cause, is what prompted the cardiologists to write their editorial. As one of the editorial's authors, Rita Redberg, professor at the University of California San Francisco School of Medicine and editor of JAMA Internal Medicine, put it, "I see more and more patients every week who want to reduce cardiovascular risk but don't want to suffer the myriad adverse effects of statins. There is a lot of interest in healthy lifestyle."

The editorial calls for a "paradigm shift" in how cardiovascular disease is treated. The three cardiologists lay out a series of simple recommendations for heart health: Taking regular brisk walks more than three times a week for a half hour at a time, eating a Mediterranean style diet that includes foods like olive oil, nuts, oily fish and lots of vegetables, and reducing stress as much as possible. Saturated fat, they remind the reader, is not bad for you. "There has been a lot of discussion of the evils of saturated fats for many years, re-education based on our new knowledge and understanding takes time," explains Redberg.

While the doctors' recommendations are reasonable, creating change in people's habits is notoriously difficult. Solving all problems with the right pill is very appealing, and probably part of the reason statins became so heavily prescribed in the first place. But Redberg is hopeful: "I think public health campaigns as well as health professionals need to focus on the importance of diet, regular physical activity and time for relaxation with friends and family. A healthy lifestyle reduces risk of heart disease, is associated with living longer and a better quality of life."

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