By Megan Buck, PharmD Student Cedarville University
In 1970, Ancel Keys’ “seven countries study” correlated the incidence of coronary heart disease and total cholesterol concentrations then observed a correlation between heart disease and saturated fat.1 Due to this study, saturated fat has been held responsible for cardiovascular risks. Since then, scientists have reviewed several studies and examined the differences between types of fats and cholesterols. New scientific evidence suggests that the last forty years of convincing people to remove saturated fat from their diets actually increased their cardiovascular risks.2
Aseem Malhotra of Croydon University Hospital in London recently published an article explaining this discovery. “Saturated Fat Is Not the Major Issue” describes the importance of saturated fat in the diet. Consuming saturated fat is not harmful, but we should be concerned with overmedicating with statin drugs.2 3 A diet consisting of a maximum of 10% of total nutrients coming from saturated fat has not be proven efficient at reducing cholesterol or reducing cardiovascular risks. Saturated fat produced large and light-weight (Type A) LDL particles rather than the small and heavy (Type B) particles, the later are likely responsible for cardiovascular disease.2 Also, Malhotra states that studies found processed meats contribute more to coronary heart disease than dairy products and red meat. Kewick and Pawan’s study showed that a group with a 90% fat-consuming diet lost more weight than groups with 90% protein and 90% carbohydrates, indicating that fat does not have to be terrible in the diet. Fat-free food is not necessarily healthy because the saturated fat is often replaced with sugar, which is being investigated for lowering HDL cholesterol. Statins are very popular in the US and UK, partially because the Framingham heart study claimed total cholesterol was a risk factor for coronary artery disease.2
I agree with Aseem Malhotra’s article; he supports his point with the literature. My search of the literature also yielded a recent meta-analysis and a systematic review that support Malhotra’s conclusion that saturated fat is not the major issue. Patty W Siri-Tarino et al. performed a meta-analysis to see how reducing saturated fat influenced coronary heart disease (CHD), stroke, and cardiovascular disease and concluded that saturated fat does not increase CHD or cardiovascular disease.4 The discussion of statin therapy is beyond the scope of this post, however the decision to take a statin should be discussed with a medical provider, some patients may still benefit from a statin if they have already had a heart attack.
A patient can eat foods containing cholesterol without getting a heart attack.5 For example, even though egg yolks have cholesterol, they have thirteen essential nutrients, so they should not be automatically eliminated from the diet. However, it is noteworthy that people typically do not consume only one nutrient per meal. Saturated fat should be consumed in context of a balanced meal. Our bodies crave different foods because of the nutrients in them. Strictly limiting a person to a diet of a few items would not be my primary recommendation for my patients.
This information will slightly change my self-care recommendation because it differs from the dietary standard of care. If you have high cholesterol and high cardiovascular risk, you may eat saturated fats, dairy products and red meats but should minimize or avoid intake of trans fats and processed meats. Red meats are not even particularly high in saturated fat.6 O’Sullivan et al. conducted a meta-analysis which demonstrates that large consumptions of the fat-containing foods of butter, cheese, yogurt, and milk “were not associated with a significantly increased risk of mortality compared” with small consumptions.7 Fat-free foods may not be a better choice than regular-fat foods containing saturated fat because the saturated fat is often replaced with sugar.2 Scientists are currently investigating whether sugar leads to low amounts of the “good” HDL cholesterol and raised triglycerides, or fat in the blood.2 If you have high blood pressure, I encourage you to limit your caffeine intake.
High cholesterol does not appear to increase risk risk for heart disease. High cholesterol may be falsely accused for heart disease, further studies need to be identified to determine if statins or any cholesterol lowering therapy is beneficial when targeting cholesterol numbers alone. Involving the patient in discussion of therapy and treating the whole patient vs. numbers from a holistic approach may be more fruitful.
Does this study affect your current perception of treating high cholesterol? How would you counsel your patients with high cholesterol after reading this post? What other foods should be avoided in patients with increased cardiovascular risks?
- Available at: http://www.epi.umn.edu/cvdepi/study.asp?id=12. Accessed November 12, 2013.
- Malhotra A. Saturated Fat Is Not the Major Issue. BMJ. 2013;347(oct22 1):f6340. Accessed November 1, 2013.
- Available at: http://www.medterms.com/script/main/art.asp?articlekey=33979. Accessed November 2, 2013.
- Siri-tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535-46.
- Kresser C. The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy. Available at: http://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy. Accessed November 5, 2013.
- Kresser C. New Study Puts Final Nail in the “Saturated Fat Causes Heart Disease” Coffin. Available at: http://chriskresser.com/new-study-puts-final-nail-in-the-saturated-fat-causes-heart-disease-coffin. Accessed November 5, 2013.
- O’Sullivan T, Hafekost K, Mitrou F, Lawrence D. Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis. American Journal Of Public Health [serial online]. September 2013;103(9):e31-e42. Available from: Business Source Complete, Ipswich, MA. Accessed November 1, 2013.