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The limit on total fat is an outdated concept, an obstacle to sensible change that promotes harmful low-fat foods, undermines efforts to limit refined grains and added sugars, and discourages the food industry from developing products higher in healthy fats. ... Will the government, policy makers and the food industry take notice this time? Dariush Mozaffarian, MD, DrPH, and David S. Ludwig, MD, PhD, The New York Times (July 9, 2015)

Time to Lift the Limit on Dietary Fat

It was headline news when the 2015 report of the Dietary Guidelines Advisory Committee overturned the limit on dietary cholesterol. Less noticed, however, was the absence of an upper limit on dietary fat. If reflected in the final guidelines due any day now, it would reverse 35 years of advice on healthy eating. In 1980, Dietary Guidelines recommended limiting dietary fat to less than 30% of calories. That recommendation was loosened slightly in 2005 to a range of 20% to 35% of calories from total fat. Interestingly, the percentage used in the federally mandated Nutrition Facts panel continued to be based on the 1980 recommendation of 30% or 65 grams.  

A presentation that Carol and I attended recently by two highly regarded doctors, one a cardiologists and the other an endocrinologist, shows that the restriction on dietary fat is deeply imbedded. The focus was on the importance of coronary calcium scores in diagnosing and treating heart disease; a good thing, relatively new in our area. The only fix discussed in the main presentation, however, was drugs that reduce cholesterol production and absorption. Diet and exercise came up briefly in the Q & A at the end of the presentation, with minimal elaboration. The literature handed out before and after the presentation said that “limiting high-fat foods is the key” to lowering cholesterol. “All fats should be limited” the handed out continued, with animal fats such as fatty meats and dairy products raising cholesterol the most.

The fact that these top notch doctors had to be pressed to mention that some dietary fats (olive oil and omega-3) have been found to be beneficial makes me wonder whether government policy makers will trust the public to choose wisely.

The realization that low-fat eating is not a cure-all has been coming on for years. The Women’s Health Initiative Dietary Modification Trial may have been the decisive nail in the coffin. Begun in 1993 and reported in 2006 in a series of papers in The Journal of the American Medical Association, the trial found that limiting dietary fat had no effect on heart disease, breast cancer, colorectal cancer, or body weight.

Researchers recruited almost 50,000 women between the ages of 50 and 79 years. Of these, 19,541 were randomly assigned to follow a low-fat diet. Their goal was to lower their fat intake from almost 38% of calories to 20%. They were helped in this effort by a series of individual and group counseling sessions. Another 29,294 women were randomly assigned to continue their usual diets. They were also given diet-related educational materials.

While not without limitations, the dietary intervention didn’t work, even though it was, by far, the most expensive study of diet ever conducted (costing many hundreds of millions of dollars) and even though the women in the low-fat group received intensive dietary counseling from some of the best nutritionists and dietitians in the country. In short, the findings were about as reliable as we are likely to get. http://www.hsph.harvard.edu/nutritionsource/low-fat/

Many more studies followed confirming that reduced-fat diets rarely meet expectations; two blockbusters were reported this year.

A meta-analysis of 53 randomized controlled trials (68,000 total participants) by a team of researchers including Harvard superstars Walter Willett, MD, and Frank B. Hu, MD, found that the evidence “does not support low-fat diets over other dietary interventions for long-term weight loss.” Reducing fat isn’t any more effective for losing weight than other diets. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00367-8/abstract

The study authors concluded “that public health guidelines should stop recommending low-fat diets for weight loss, stressing that more research is needed to find what strategy is most effective and able to be maintained.” http://time.com/4091628/dont-cut-fat-if-you-want-to-lose-weight-study/

The second study, published ahead of print October 28, 2015 in The Journal of Nutrition, torpedoed guidelines recommending low-fat or fat-free dairy products.

Researchers from Brazil and Minnesota found that people who consume full-fat dairy products such as whole milk are less likely to be afflicted with “metabolic syndrome,” a set of related risk factors--high blood pressure, high blood sugar, belly fat, low HDL cholesterol, and high triglycerides--predicting heart disease and diabetes. The study, backed by the Brazilian Ministry of Health and the Brazilian Ministry of Science, Technology and Innovation, looked at more than 15,000 civil servants in Brazil and examined the connection between the types of dairy products people consume and their likelihood to suffer from metabolic syndrome. (The Washington Post, October 29, 2015)

“Our findings and the literature on the association of dairy products with obesity, cardiovascular disease, and diabetes do not support guidelines that recommend only a low-fat dairy intake,” lead author Michele Drehmer and colleagues concluded.

On the other side of the spectrum, Denise Minger a prominent and prolific nutrition blogger—a mostly-raw foodist who eats red meat once every few years—just posted an 18,000-word piece in defense of the low-fat diet. (Part 2 is promised soon!) Clearly, low-fat diet proponents are alive and kicking. The 709 replies to Minger’s lengthy article run on longer than the text. People are moved—one way or the other—by her analysis.

Minger concluded that the hard data comes down on the side of low-fat eating.....http://rawfoodsos.com/2015/10/06/in-defense-of-low-fat-a-call-for-some-evolution-of-thought-part-1/

Mozaffarian and Ludwig Speak Out

Writing in The Journal of the American Medical Association (JAMA) and The New York Times, nutritional science heavy hitters Dariush Mozaffarian, MD, DrPH, and David S. Ludwig, MD, PhD, came down four square in favor of lifting the limit on dietary fat. Mozaffarian is dean of the Friedman School of Nutrition Science and Policy at Tufts University and Ludwig is director of the Obesity Prevention Center at Boston Children’s Hospital. “It is time…to help people understand that limiting total fat does not produce any meaningful health benefits and that increasing healthful fats, including more than 35% of calories, has documented health benefits,” they wrote in their JAMA viewpoint piece.

“It’s long past time for us to exonerate dietary fat,” they stated confidently in their NY Times op-ed.

As suggested above, the 2005 increase in the upper limit to 35% and the addition, for the first time, of a 20% lower limit were largely ignored by federal food policy makers. Mozaffarian and Ludwig offered two blatant examples. One is oblivious to the benefits of healthy fat and the other values no-fat dairy with added sugar over the fat in whole milk.

The FDA formally warned a manufacturer of snack bars to stop marketing their products as healthy when they exceeded “decades-old limits” on total and saturated fat—“even though the fats in these products mainly come from nuts and healthy vegetable sources,” the doctors related. Their second example raises my hackles even more. “Astoundingly, the National School Lunch Program bans whole milk, but allows sugar-sweetened skim milk.”

Even more ludicrous is pairing whole milk with candy, chips, and regular soda in the “once in a while” eating category, as Mozaffarian and Ludwig highlighted in JAMA.

“Consumers didn’t notice [the 2005 change] either,” the doctors added. “Most Americans still actively avoid dietary fat, while eating far too much refined carbohydrates.”

So what do these doctors recommend besides lifting the limit on total fat intake? What should we eat and what should we avoid? Here in a nutshell is their sensible and easy to understand prescription for healthy eating and long-term weight management. (Sure sounds familiar.)

This is not to say that high-fat diets are always healthy, or low-fat diets always harmful. But rather than focusing on total fat or other numbers on the back of the package, the emphasis should be on eating more minimally processed fruits, nuts, vegetables, beans, fish, yogurt, vegetable oils and whole grains in place of refined grains, white potatoes, added sugars and processed meats. How much we eat is also determined by what we eat: Cutting calories without improving food quality rarely produces long-term weight loss.

Follow that prescription (and stay physically active) and there will be no need to count calories or keep track of macronutrients. You’ll be fine. No worries about too much or too little of anything. http://www.cbass.com/foodselection.htm

Good Fat and Healthy Living May Have Saved My Life

As I’ve related here before, adding good fat to my diet—I had been following the prevailing medical advice to keep fat intake as low as possible—is one of the best things I’ve ever done for myself. It may have saved my life.

Arnie Jensen was my doctor at the Cooper Clinic when calcium was discovered in my coronary arteries in 2002. This was surprising, because my lipid profile was good. "Your total cholesterol of 159 and LDL cholesterol of 78 are perfect," Dr. Jensen wrote in his report. "Your HDL cholesterol is wonderful at 65," he added. "This gives you an excellent ratio of 2.4. My triglycerides, homocysteine and inflammation level were also good. My weight was ideal, my fitness level was very good, and I had never smoked.

Arnie surmised that the calcium was in the wall rather than the channel of my coronary arteries and not blocking blood flow. And his educated guess proved to be correct.

Dr. Jensen was convinced that my lifestyle would keep the blood flowing freely in my heart. Adding good fat helped to made his prognostication come true.
Photo by Justin Joseph

Fortunately, I began the cure before I knew there was a problem; I started adding good fat to my diet about four years before the discovery of calcium in my left anterior descending (LAD) coronary artery.

In 1998, my total cholesterol/HDL ratio improved from "very good" to "excellent" after I added a small amount of vegetable oil (olive and then flaxseed) to each of my meals and snacks. My total cholesterol dropped below 200 for the first time in years, perhaps ever. My triglycerides dropped 50 percent, from 153 to 76.

My diet was already low in saturated fat. (Perhaps too low; see below) I was eating very little processed food. My carbohydrate intake was almost all from whole foods. I thought my diet was just about perfect. But something was missing. That something, it seems, was vegetable oil, which is generally low in saturated fat, and high in poly- and mono-unsaturated fatty acids.

As time went on, I learned about the benefits of omega-3 polyunsaturated fatty acids, found mainly in fatty fish. In 2009, I started taking three fish oil capsules a day with meals. (I was already having salmon several times a week.) My HDL “good” cholesterol skyrocketed to 78. It went from a very good 60 to stunning; 45-70 is the reference range for men.

My HDL hit 83 after I started having sardines as a regular part of my breakfast. And 86 after I switched from skimmed to organic whole milk. See http://www.cbass.com/HDLCholesterol.htm

My latest visit to the Cooper Clinic (October, 2015) demonstrated the long term payoff in the size and openness of my coronary arteries.  It appears that my diet and overall lifestyle have allowed me to override the calcification found in my coronary arteries more than a dozen years ago.  dr. McFarlin says, "I dodged a bullet."

For full details, see the report on my latest visit to the Cooper Clinic:  http://www.cbass.com/ClarenceBassCooperClinic15.htm

The JAMA piece by Drs. Mozaffarian and Ludwig offers a convincing explanation for my very large and open coronary arteries. They lay out the negative effects of limiting dietary fats and the beneficial effects of including dietary fat—and the reduction in carbohydrate intake that typically comes with it.

They begin with the reasoning behind the limitation on total fat:

The primary rationale for limiting total fat was to lower saturated fat and dietary cholesterol, which were thought to increase cardiovascular risk by raising low-density lipoprotein [LDL “bad”] cholesterol blood concentrations. But the campaign against saturated fat quickly generalized to include all dietary fat. Because fat contains about twice the calories per gram as carbohydrate or protein, it was also reasoned that low fat diets would help prevent obesity, a growing public health concern.

And then explain why limitation hasn’t worked. 

The complex lipid and lipoprotein effects of saturated fat are now recognized, including evidence for beneficial effects on high density lipoprotein [HDL “good”] cholesterol and triglycerides and minimal effects on apolipoprotein B when compared with carbohydrate. These complexities explain why substitution of saturated fat with carbohydrate does not lower cardiovascular risk. Moreover, a global limit on total fat inevitably lowers intake of unsaturated fats, among which nuts, vegetable oils, and fish are particularly healthful. Most importantly, the policy focus on fat reduction did not account for the harms of highly processed carbohydrate (eg, refined grains, potato products, and added sugar)—consumption of which is inversely related to that of dietary fat.

Note that saturated fat can raise good cholesterol and lower triglycerides, especially when replacing processed carbohydrate. The combination of canola oil, sardines, and whole milk are very likely my salvation.

William S. Yancy JR, MD, MHS, FTOS, Director, Duke University Diet and Fitness Center and Associate Professor of Medicine at Duke, keyed on full-fat dairy products in the December 2015 Duke Medicine Health News: “The [most recent dietary] guidelines stop short of the evidence…by restricting dairy products and saturated fat. Full-fat dairy products have been linked to lower weight and to reduced risk for diabetes, yet the guidelines advise low-fat versions. Saturated fat carries less risk for weight gains and cardiovascular risk compared with high glycemic foods, yet saturated fat is restricted when some high-glycemic foods are not.”

This photo by Pat Berrett was taken about the time my coronary calcium was discovered.
The “good fat fix” had been in place for four years. My condition was the real deal.

Will the government, policy makers, and the food industry take notice this time? Let’s hope so. We’ll soon know. Fortunately, individuals are free to decide for themselves.

December 1, 2015

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