Can Saturated Fats Actually Be Safe?
Playing off of the article last week "How Does the Ketogenic Diet Impact Your Cholesterol Panel", I figured we'd discuss a little more on fats... particularly saturated fats. The focus of today's discussion will be on whether or not saturated fats are actually safe, particularly in the setting of a ketogenic diet. To help discuss this, we will go through what saturated fats are, what foods contain saturated fats, and why we learn that saturated fats should be avoided. I will then discuss the counter argument of why they should NOT be avoided. So stick around for the whole article and learn the truth about dietary intake of saturated fats. If you work in healthcare, this is especially helpful for you as you’re likely telling your patients to avoid saturated fats. Could you be causing your patients harm? Read on to find out!
What are saturated fats? Where do they come from in our diet?
As you an see above, saturated fats are a fatty structure absent of double bonded carbon molecules. This results in them being in a more solid form at room temperature and changes how they’re broken down in the body. Something else you may notice is that the structures are more straight. This is an important factor when you think of how they actually move through the blood and are less likely to get hung up in the bloodstream.
Common sources of dietary fat are coconut, pork, beef, dark chocolate, most cheeses, tallow, macadamia nuts (and other nuts), chicken (with the skin), avocados, and even olive oil. While some of these sources have much higher concentrations of saturated fats than the others, there is a fairly notable amount in each of these. There is no trans-fat in any of the foods mentioned here and most of these would be considered a staple within the ketogenic lifestyle. While your healthcare provider may actually advise you eat some of these, such as avocados, nuts, and olive oil, they’ve likely told you to avoid most of them. Lets discuss why that is…
Why do we learn that saturated fats are bad?
The primary motivation for teaching the American public that saturated fats are unhealthy stems from a poorly constructed and even more poorly interpreted study in the 1950’s-1960’s by a scientist named Ancel Keys. This study was called the diet-heart hypothesis and was centered around proving that dietary fat would increase your risk for coronary artery disease. This is where the confounding factor and major issue with this study came in… Ancel Keys had a profound inherent bias going into this study that would go on to overshadowed all of the data that was collected that might conflict with his view point. In fact, this study was conducted to try to shut down another scientist’s research showing that dietary fats likely weren’t harmful and that carbohydrates may be more harmful for us. Interesting how we’re only just now seeing this in modern medicine isn’t it?
So, Ancel Keys published this paper after conducting informal surveys in different populations in Europe between 1951 and 1952. This data, which was purely observation and obtained from patient recall - not lab data, was then used to drive dietary recommendations. So, despite only showing extremely weak correlation, they used this data to try to show causation… which is the next massive issue. Correlation is NOT causation. If anything, this study should have been the basis for prompting actual research such as controlled trials. But it didn’t… it went on to shape the dietary recommendations made in 1976 by the US Government wherein they advised that all Americans reduce their intake of dietary fat to reduce their risk for heart disease. It may also help to know that, at the time, Ancel Keys had no way of knowing the different types of cholesterol being affected by dietary intake and simply saw a rise in total cholesterol. This means he has no idea if it was an increase in HDL, LDL, VLDL… any of them. He just knew cholesterol went up in some of his participants. Poor data, poorly representative population, and poor followthrough on a study that, from its inception, was of poor design.
So why do we still learn fats are bad? Surely better studies have been done by now… right?
Well, not really. Many of the studies that try to paint fat as the most horrible macronutrient you could ever possibly ingest are absolutely loaded with conflicts of interest and confounding factors before test subjects are even selected. Whether it has to do with their funding coming from sources like Lipitor (or other cholesterol lowering drugs), from the National Sugar Institute, companies like Coca-Cola, or other highly biased sources or if it has to do with an inherent bias of the scientists that play a role in the selection of participants, interpretation of the data, and how the data is actually then relayed to the public, good trials just haven’t been performed which actually show that dietary fat causes or increases risk for heart disease. Despite this, there is a great deal of money to be made by companies like Lipitor, Crestor, and now the class of PSK9 inhibitors by funding research that could support the diet-heart hypothesis and getting people to utilize their medications to reduce possibly non-existent risk for heart disease. On the flip side, there is very little money to be made in preventing disease through lifestyle change.
Despite having little to no research to support the diet-heart hypothesis and a causal relationship between fats and heart disease, the American public has taken this as absolute truth since the 1970’s. To make matters worse, western medicine has indoctrinated it into their practice standards. At this point, changing this recommendation would essentially mean admitting to having harmed over 50 years worth of patients across the US and even the world… which is unlikely to happen.
If there are no studies to show that these dietary fats are bad… how do we change things?
Aside from having to change what is being taught in medical schools, schools of nutrition science, and practice standards, changing how we think about dietary fats and, in particular, saturated fats would mean overcoming a number of obstacles. Many heads of cardiology groups are actually vegetarian and promote vegetarian lifestyles to their patient stating they need to avoid animal based fats and proteins and should follow a low-fat vegetarian diet… this results from the current guidelines but has a trickle down effect into the rest of healthcare. Many animal rights activists groups also lobby against taking in any animal sources including dairy. And lets face it, eliminating all animal products certainly makes it harder to eat good fats. To top it off, companies like Coca-cola, companies who make glucose lowering drugs for diabetics, and the corn segment of the agricultural industry have a lot riding on us continuing to eat copious amounts of sugar. So what is easy to replace with sugar? Fats! The FDA actually pointed this out in a publication at the end of 2018 wherein they stated to avoided low-fat foods as they are typically reinforced with added sugars. So I’m sorry to say that this question has no easy answer. We have to change everything about our society in order to change these medical recommendations.
But before we talk about how to change the recommendations, why don’t we talk about the counter argument. To start, let me briefly recap the premise of the ketogenic diet and then we can head into the counter argument on why saturated fats are not causing the harm that Ancel Keys would have liked us to believe. A ketogenic diet is centered around eating in a way that puts you into the metabolic state of ketosis. While in this state, the body utilizes fat for its metabolic demands rather than glucose. That is because dietary intake of glucose, and foods that break down as glucose, is severely limited to deprive the body of available glucose. By changing themselves over to a metabolic state that runs on fat for fuel, most individuals hope that their metabolism will target stored body fat and help them lose weight. While this is certainly one of the wonderful things about following a ketogenic lifestyle, it is not the only benefit.
When the body starts to target fat for fuel, it does so non-selectively. Therefore, your body begins to use stored fat (adipose tissue), dietary fat (fat you're eating), and generated fat (cholesterol). Consumption of these different sources allows for a constant flow of energy and actually helps to stabilize fluctuations in your metabolism - seen most prominently in medication dependent diabetics (particularly seen in insulin dependent diabetics). Beyond allowing for a constant bioavailable source of energy, this metabolic state has actually been shown to be protective against episodes of hypoglycemia for diabetic patients due to the presence of ketone bodies in the bloodstream.
But just because ketones are helpful, does that mean eating saturated fat is okay? Well according to the article Dietary Fat and Coronary Heart Disease: Summary of Evidence from Prospective Cohort and Randomized Controlled Trials, "intake of total fat was not significantly associated with CHD mortality..." and went on to say, "Intake of total fat was also unrelated to CHD events," (Skeaff & Miller, 2009). Also, remember how earlier I stated, "it does so non-selectively" when referring to fat metabolism? Well this holds true to dietary fat sources as well. A study that references this finding quite clearly is Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition Markers of Inflammation wherein they state, "Total saturated fatty acids and 16:1n-7 were consistently decreased following the very low carbohydrate ketogenic diet." It also goes on to say, "Both diets significantly decreased the concentration of several serum inflammatory makers, but there was an overall greater anti-inflammatory effect associated with the VLCKD," (Forsythe, Phinney, Fernandez, et al, 2008). Those are two very good appraisals for this particular lifestyle, wouldn't you say?
Whether you're eating mono-unsaturated fats like those found in avocados and olive oil or you're eating saturated fats such as those found in a chicken thigh or coconut oil, you're body will burn them all. In fact, some of them have shown a better affinity to being utilized in the creation of ketone bodies by the liver. Saturated fat just so happens to be one of those fatty structures that helps quite a bit with this. That is why many studies have included the use of coconut oil and coconut/palm oil derived MCT oil in their research on the ketogenic diet. These have been shown to be some of the most beneficial structures in creating beta-hydroxybutyric acid (the primary ketone body we thrive off of).
Whatever your views on saturated fat are, there is one thing that cannot be denied... dietary intake of saturated fat is not the demon nutrient we've made it out to be. In looking at many of the population surveys and dietary studies surrounding the intake of dietary saturated fats and its "correlation" with heart disease related death, this so called "link" has only continued to grow weaker and weaker over the years as evidence that carbohydrate intake and its associated risk of heart disease and all cause mortality has grown exponentially. Ironically enough, there is a fair amount of current peer-reviewed research that shows dietary carbohydrate intake has a more significant impact on your levels of saturated fat in the blood than eating saturated fat itself! Don't believe me? Feel free to venture over to the Virta Health page where they discuss this in depth in their blog "The Sad Saga of Saturated Fats" - which I find quite insightful.
Another issue is that many individuals who have bought into the saturated fat fear end up replacing the calories from this source with calories from carbohydrate. This has led to increasing cases of obesity, diabetes, and heart disease across our nation and across the world. Ever since we began advising patients to decrease dietary fat intake in the 1970's to decrease their risk of heart disease, what have we seen? More obesity, more diabetes, more chronic health conditions crippling our healthcare economy, and NO reduction in heart disease occurrences. It remains the number 1 killer in the United States as well as several other countries.
So what do we do about all this? Should we all just start eating more saturated fats? Well, thats not exactly what I'm getting at here. ALL dietary recommendations need to be individually specific. Factors such as allergies, access to certain foods, budget, existing health conditions, and an individual's knowledge base can all play a role in the dietary choices we should be making. It is up to the individual to discuss their needs and concerns with their healthcare provider. On the flip side, it is up to the healthcare provider to remain informed and to stop practicing out of tradition but, rather, practicing based on science. Real, current, evidence-based, peer-reviewed research that shows that what we've been doing for the past several decades has been wrong and has been harming our patients.
If you are a healthcare provider and you're reading this article, I implore you to remember your oaths.
- Respect the scientific gains of those physicians in whose steps you walk by reading their research and working to implement it into your practice.
- Apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism by using true primary prevention and taking the time to educate your patients on how THEY can take control of their health and their lives.
- Remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug by educating patients on lifestyle change, finding their barriers to change, and helping them to overcome these barriers. Not every obese patient needs bariatric surgery and not every diabetic needs insulin. Help them to succeed!
- Do not be ashamed to say "I know not" or that you will fail to call in your colleagues when the skills of another are needed for your patient's recovery. Science and medicine are constantly changing. But, you can't be afraid to change with it and acknowledge the change even if it makes your old ways seem wrong.
- I will prevent disease whenever I can, for the prevention is preferable to cure which can be achieved for many through the lifestyle changes we discuss here.
There are more components to the Hippocratic oath but I believe the ones I've covered here will suffice to make my point in this discussion which is this... We need to do better in medicine. We need to stop the fear mongering about a topic we've been so incredibly inaccurate in discussing over the last 50 years and open our eyes to change. Change in the research, change in our practice, and a change in the needs of our patients.
That is all for today's post folks. I hope you've found this subject insightful and I hope it prompts more discussion in the community about how we define a healthy diet, a healthy fat, and a healthy lifestyle.
If there are any other topics you'd like me to discuss surrounding the ketogenic lifestyle and health, please feel free to shoot me a message on my Instagram @the.keto.np or follow me on Facebook under @keto.np and message me there!
Remember, this blog does not constitute medical advice and I am not your medical provider. So when making any dietary changes, include your healthcare provider so it can be does safely and sustainably!
References
Forsythe CE, Phinney SD, Fernandez ML, Quann EE, Wood RJ, Bibus DM, Kraemer WJ,
Feinman RD, Volek JS. Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids. 2008 Jan;43(1):65-77.
Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from
prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55(1-3):173-201.