Agents of Health & Death

Now that I've got your attention ...

Another day, I'll have a few more words to say about the recent editorial in the British Medical Journal "exonerating" saturated fat, but for now, one of the things that stuck out at me was the following (I broke the paragraph up a bit):
Indeed, recent prospective cohort studies have not supported any significant association between saturated fat intake and cardiovascular risk. Instead, saturated fat has been found to be protective.
The source of the saturated fat may be important. Dairy foods are exemplary providers of vitamins A and D. As well as a link between vitamin D deficiency and a significantly increased risk of cardiovascular mortality, calcium and phosphorus found commonly in dairy foods may have antihypertensive effects that may contribute to inverse associations with cardiovascular risk. One study showed that higher concentrations of plasma trans-palmitoleic acid, a fatty acid mainly found in dairy foods, was associated with higher concentrations of high density lipoprotein, lower concentrations of triglycerides and C reactive protein, reduced insulin resistance, and a lower incidence of diabetes in adults.
Red meat is another major source of saturated fat. Consumption of processed meats, but not red meat, has been associated with coronary heart disease and diabetes mellitus, which may be explained by nitrates and sodium as preservatives. ...
... The scientific evidence is mounting that sugar is a possible independent risk factor for the metabolic syndrome ...  
The first thing I'll note is that, for better or worse, the parts about saturated fat are referenced while there are no references provided for the "mounting" scientific evidence against sugar. But here's the other thing that caught my eye. Sugar is blamed with no reference to the food context in which it is consumed. Saturated fat, on the other hand is specifically "itemized":

The source of the saturated fat may be important. 

Leaving aside the silly "fruit makes you fat" brigade, even Robert Lustig concedes that fructose from fruit is not the problem.  Indeed one could rewrite the paragraphs about saturated fat for sugar ... something like:
The source of the sugar may be important.  Fruits are exemplary providers of vitamins C and A. As well as a link between vitamin C deficiency and atherosclerosis, potassium and lycopene found commonly in fruits may have antihypertensive effects that may contribute to inverse associations with cardiovascular risk.  One study in the NEJM showed that plant sterols like those found in fruits lowered both total cholesterol and low density lipoproteins.   Sugar in artificially flavored beverages has been shown to induce insulin resistance in many studies, but this has only been demonstrated with high intakes in caloric excess.  Further, the problems may be due to the chemicals used to flavor and color these beverages as orange juice consumption is generally associated with beneficial health outcomes.
See where I'm going with this?  Well, if the context matters, then perhaps it's not the specific dietary agent after all.  Perhaps saturated fats, just like sugar, are neither to blame nor to be credited for either detriment or benefits.  

Perhaps it's time to let go of classifying foods as types because all of these run a gamut of nutrient composition.  Take dairy -- you have different types, fat contents, soft vs. hard cheeses have different protein contents, etc  How about fish?  Fish varies widely from salmon to cod, etc.  Meat?  Well, "You don't eat meat?  That's OK, I make you lamb."  {My Big Fat Greek Wedding}.  Vegetables?  Beans?  Fruit?   For every classification of foods you can probably find a few exemplary "super foods", the hangers-on that really aren't all that much nutrient bang for the buck, and perhaps a few that are not so good for you at all.  

Macronutrients are no better, even subsets of macros.  So fat is good or bad?  Well first its saturated fat, but then along comes coconut oil.  Then it's PUFA ... but damn those nuts and their health benefits.  Protein?  Gluten is a protein, so are animal meats.  Legumes have a decent protein punch.  Potatoes and amaranth have complete protein!  Too much?  Not enough?  Carbs?  We could be here all day.  What is it about "refining" that turns sucrose, glucose, fructose and starch into demonecules?    Just exactly what level of refining is required for this transformation?


Food for thought...


Thomas said…
Oh, and by the way, you may be able to eat all Twinkies and Ho Ho's
(don't forget your multivitamin) and lose weight and improve your blood
profile as long as you are in a modest caloric deficit. Or potatoes.
Jeesh, this stuff gets complicated. I can't find an entirely "evil" food
anymore. Now what can I blame? Cue the Michael Jackson song......
Dan said…
This is the general problem with regarding food as medicine, or conversely, obsessing endlessly about nutrition (orthorexia nervosa, which you have blogged about before).

Have you ever seen the website If you go under the fruit subpage, they show various pictures of very delicious-looking fruit juxtaposed with how much fructose is contained therein (in the form of stacks of sugar cubes). This just feeds orthorexic patterns of eating, imho.

I am going to paraphrase and subvert Pollan here: "Eat well, eat happily, and don't think too much about it." But one then replies: "Ah, the problem is the 'eat well' part" - we need to define and microdissect the nutrients and degree of processing, the relative amounts of sugar and saturated and trans fat. Yet if you eat a balanced, well-rounded, diverse diet that is rich in whole foods - about 75% whole-foods or so - you don't really need to worry about it very much. Just make sure you get your veggies, fruits, and other healthy things on board.

This is separate and apart from the ethical issue of meat consumption - I learned a lot by reading Safran-Foer's book "Eating Animals", which describes his family's journey to vegetarianism. I find I cannot eat in a healthy fashion if I am also contributing to suffering at the same time.
billy the k said…
"Why do people say that refined, white sugar is bad?", asked Robert Wolke (professor emeritus of chemistry) in his 2002 book [What Einstein told his cook. WW Norton; p10]
"This nonsensical claim is a mystery to me. It seems that some people take the word
'refined' as an indication that we humans have somehow defied a law of Nature by having the audacity to remove some undesirable materials from a food before eating it." Then he asked, with regard to molasses--but could equally apply to fruit--"When the other molasses
[or fruit] components are removed, will someone please explain to me how the remaining pure sucrose suddenly becomes evil and unhealthful?"

Likewise to John Yudkin: How is it that the sucrose inside an apple is A-OK, but becomes
"sweet and dangerous" when that same quantity is outside the apple? (Nevermind "toxic"
or "poison" as Lustig claims).
Laurent Therond said…
Clearly, classifying foodstuff as "evil" or "heavenly" is unwise.

This being said I think there is a lot of context and implied meaning that is attached to the words people use.

With "refined" sugar, the context appears to be as follows:

"Human beings have become denatured and no longer follow their instinct to seek the nutrients they need. They will eat to excess unless some physical or physiological limitation prevents them from doing so."

With that context, one must realize it is trivial for one to drink a liter of soda, but difficult to consume the same amount of sugar by ingesting carrots or apples.

So, it's not that "refined" sugar is evil, it's that we do not have the discipline to consume it in moderation and in a manner that keeps us satiated.
"Yet the reduction in LDL cholesterol from reducing saturated fat intake seems to be specific to large, buoyant (type A) LDL particles, when in fact it is the small, dense (type B) particles (responsive to carbohydrate intake) that are implicated in cardiovascular disease."

Heh. We're back to this again, are we?
billy the k said…
"Human beings have become denatured and no longer follow their instinct to seek the nutrients they need. They will eat to excess unless some physical or physiological limitation prevents them from doing so."

Both statements are incorrect, and (ironically!) it is John Yudkin who shows us why:

1. Humans won't eat to excess if the food is of low palatability. In many of Yudkin's writings he distinguished between hunger and appetite:

"The drive simply to eat food is hunger, and the drive to eat particular foods is appetite. When income is not limiting, it is possible for one to eat enough to satisfy both hunger and appetite. But even a wealthy man will eat less food than he really needs if it is of low palatability, and more than he needs if it is of extremely high palatability. We have suggested that when the choice of foods is confined to fresh and preserved foods but does not include manufactured foods, THE EFFECT OF THE HUNGER DRIVE IS TO GIVE MAN CALORIES, AND THE EFFECT OF THE APPETITE DRIVE IS TO GIVE HIM MORE OF THE ESSENTIAL NUTRIENTS. These effects however have recently been changed because of the existence of manufactured foods..."

2. Humans have not become "denatured" and so no longer follow their instinct to seek out the nutrients they need. On the contrary, it is just our ancient dietary instinct that gets us in trouble, because that is precisely what the food manufacturers rely on to get us to keep buying and eating their concoctions, which skillfully put together "new foods more attractive [and palatable] and sometimes cheaper than many of the foods in their natural state. The qualities of attractiveness [and palatability] do not, however, ensure that the foods contain much, if any, of the necessary nutrients."

Humans have not become"denatured". We can still rely on our ancient dietary instinct--so long as we avoid the manufactured foods:

"If the wrong foods are avoided, instinct will determine the amounts and selection from the correct foods. These are the foods that can be gathered, taken out of the soil, or slaughtered..."
charles grashow said…
Doesn't it depend on what you replace the saturated fat with? Suppose you replace it with mono unsaturated fat?
Lighthouse Keeper said…
This editorial seems to be an opinion piece written by one doctor, not scientific consensus. Towards the end he praises the Mediterranean diet which is strange as one of it's hallmarks is the replacing of saturated fat with monounsaturated fat in the form of extra virgin olive oil or canola (rapeseed ) oil and PUFAs from fish, also restricting red meat consumption. It's perplexing why lately some high profile paleo and low carb bloggers have been jumping on or at least trying to get one buttock cheek on the Mediterranean diet bandwagon even though it advocates the eating of bread, whole grains, beans, lentils, pasta and dairy.
Lighthouse Keeper said…
Your last paragraph sums it up nicely. This piece is now being spouted off left, right and centre in the low carb/paleo blogosphere as if it were a major new study because of it's B.M.J. source and not the musings of one doctor who has clearly fallen into a certain camp.
Laurent Therond said…
If it tastes bad, people don't eat it. Big revelation right there.

There is no shortage of crappy food that tastes great, though. Humans consume it to excess too.

For your second point, I don't think there is natural instinct to seek sweet or salty foods. And sweet and salty are the 2 main weapons of processed food manufacturers. (As a side note, if you don't consider the author as a credible source, it's odd to use their words to support your point.)

Once upon a time, you could say: "If you want to eat healthy, eat as the poor eats." Nowadays, that means: "Eat Crhappy Meals day in and day out because they are only a couple of bucks a piece."

If that's our instinct at work, we are well on our way to extinction.
StabbyRaccoon said…
Great post. I think I'm going to start being a real douchebag to people who say that "X food/nutrient is bad" by asking them how much of X is bad and how does it vary according to context? Ain't nobody got time fo' that. Except us :D
Wuchtamsel said…
Sadly it's not only the cranks and woos who rave about it...
Wuchtamsel said…
"There is no shortage of crappy food that tastes great, though."

This depends on what you are conditioned to eat... I can asure you my first visit to North America was a shock. I wouldn't have expected it to be possible to create products that are so sweet that they actually are literally nauseating. So "great taste" seems to be pretty relative.
carbsane said…
:-) I'll start with the Whole9 gang ;-)
carbsane said…
For the most part, the research isn't the problem, it's the interpretation. This BMJ editorial is a perfect example.
carbsane said…
It is amazing how sweet (and salty) many foods are. When I first started cooking more my husband used to share foods with his peeps. His friend used to comment on how I had a heavy hand with the salt. Over a year or so, that hand got rather light to the point where he adds salt to my food sometimes now!
carbsane said…
" Yet if you eat a balanced, well-rounded, diverse diet that is rich in whole foods - about 75% whole-foods or so - you don't really need to worry about it very much."

carbsane said…
Somewhat related, I had a FB message exchange with Mira Calton a while back about GMOs and citric acid. She and her husband claim that citric acid in a product is to be avoided because some of it comes from GMO sources. Even if that is true, the molecule/chemical that is citric acid is just that. As is fructose or sucrose or any of these other things. It's a stretch too far by the anti-GMO folks. There are some legit concerns about GMO (in my opinion more from an ecological POV than food supply concerns) but that nonsense isn't!
carbsane said…
I've never understood the overreaction to Stephan Guyenet's food reward posts. I had a friend that worked for Stop & Shop (grocery chain in NE) as a taster for development of things like their "crack" seafood salad. There is no secret that these foods are "engineered" to make us eat more of them. Which is not to say you need to live a bland existence, but avoiding the foods designed for overeating is a great start.
Wuchtamsel said…
This artificial degree of sweetness and saltyness is really an aquired taste that doesn't exist in nature or in a halfway "kitchen-based" diet. When I first traveled the US I went to Dunkin Donuts to have some coffee and thought I could try one of these eclairs. And I really got sick after two bites. I have no idea how they even achieve this taste. Probably a lot of fructose?
Sanjeev Sharma said…
hah ... try Indian sweets some time for a new level of "pound your tongue with a sledgehammer" sweetness.
Wuchtamsel said…
Really? I sometimes enjoy eating at an indian restaurant in cologne, but I have never tried anything of the sweet stuff. Guess I will head for another "sweetness torture" experiment. :-)
H Ford said…
Katz has a very good blog post on the paper Did Katz points out a howler:
from the paper:
"In the past 30 years in the U.S. the proportion of energy from consumed fat has fallen from 40% to 30% (although absolute fat consumption has remained the same), yet obesity has rocketed."
Katz continues
the author himself ignored the implications of what he wrote. We never really cut our fat intake-we simply diluted it as a percent of total calories by eating more sugar and starch. So we kept the saturated fat, replaced some of it in time with trans fat, and applied a generous icing of starch and high-fructose corn syrup. And yet, amazingly, we didn’t wind up healthier. Well then, yes, clearly saturated fat must be good for us! Or not.
Wuchtamsel said…
Yes, it's a terrible, really terrible paper, literally full of downright errors, mistakes and omissions. The problem is that this fact will be widely ignored. It just fits too well into the perception of many people.
eulerandothers said…
I love seafood salad! Stop and Shop's ss is not bad. Better than most. My own attempts to make ss in my own kitchen have been dismal failures, meaning I had to throw out the results. So, yeah, the ss at a grocery store IS engineered - to taste good. That's what good cooking is: food engineering to make food taste good. Wish I knew the ss secret.
eulerandothers said…
Eat some Japanese pickles (canned in Japan to make sure they are really Japanese) to experience true saltiness! When I make Japanese (bran-fermented) pickles at home, I have to stop the process half-way through to keep them from getting too salty.
Wuchtamsel said…
OK, asian cuisine is very special. My roommate stores her kimchi in our freezer and for my uneducated european nose it smells (and tastes...) exactly like vomit. ^^
eulerandothers said…
Don't Stop Til Ya Get Enough!
The blog post doesn't seem to turn up from the link.
When its mainstream consensus going against our biases--such as ideas about heart disease--then we're all misguided victims of appeal to authority. However, when it's supporting our personal biases, then bring on the authority without a question, even have the concerned authority throw in completely baseless claims into the mix and take the entire farce at face value.
^ This! My friend had some a few years back with the immediate response "I swear, that is so absurdly sweet, it could probably heal an ulcer."
H Ford said…
He's moved it, its on Huffington Post now.
Laurent Therond said…
"the closer you look, the messier the situation is"

That's the crux of the matter. In this situation, I really see no avenue to promote any particular public health policy. When you address the general well being of entire populations, you'd be sure your basis is sound. I think we are far from that here.

After reading more of this blog, I now realize most commenters here are proponents of the traditional food pyramid, but I don't think you should tag everyone who comes up with a different theory as a crook.
Wuchtamsel said…
No Sir, I'm not! The traditional food pyramid without a doubt overemphasizes grain products and starch as a whole, with vegetables and fruit lacking most certainly.
But to come back to the topic of saturated FA... Please do yourself a favour and take the time to look at the data we have. And I don't mean the cherrypicked "writeups" of this or that "guru", but the raw data. You can find it en masse if you search pubmed, often in full text. To say that of today we can't conclude what the role of SFAs are in CVD is just WRONG. And if someone comes up with a different "theory" (flat earth anyone???) it's on him to provide at least a grain of evidence for it. And sorry, there is none!
By the way, this role (of SFAs) is probably not as big as general overnutrition, but it's there. And that's not my fault.
Jethro Bodine said…
To the best of my knowledge, whether you eat good or bad foods, the body will not make any distinctions and will process equally proteins, carbohydrates, fats, vitamins and minerals consumed.
charles grashow said…
"After reading more of this blog, I now realize most commenters here are proponents of the traditional food pyramid"

You are sadly mistaken if you believe that to be true.
carbsane said…
I don't know when it happened, but they changed the recipe from a few years ago. Hadn't had it in ages and got some about a month ago. Sooo disappointed. Not sure my friend knew what was in the stuff, she just tasted and offered feedback.

I find with most of the "addictive stuff" if I just eat it in a pre-portioned amount and stop, it's done. This includes real foods like nuts as well as I could eat pistachios, macs or cashews to great excess just being mindless. So I tend to grab nuts on my way out the door and if I eat chips, I put them in a bowl rather than reaching into the big bag.
charles grashow said…
On 10/18/12 I had blood work done - TC was 242 mg/dL and LDL-C was 158 mg/dL. I started doing research on diet and statins. On 7/19/13 I started on low dose of statins (10 mgs/day Atorvastatin) and reduced my saturated fat to around 15% per day. I still eat 8 ounces of grass fed ground beef per day, 6-8 ounces of grass fed yogurt per day plus nuts, seeds, fruits, veggies, etc.. I eliminated coconut milk and reduced egg consumption to 3-4/week.

blood test results - 10/18/13
TC 126
LDL 71
ApoB 64
HDL 48
TG 36
non-HDL 78

Vitamin D3 - 46 with normal 30-100 (must increase this)

Any comments
That's exactly my issue. I think metabolism issues can be addressed through a variety of dietary methods, including high-starch and grain, for quite a few people, but not so much for others. Fruits, vegetables and the fatty fruits (nuts, olives, etc.) can sometimes be a good buffering element.

It's this absolute love for SFA as the holy grail, even if it comes at the cost of LDL-particle denialisms and the 'large fluffy' meme, that's been a problem from my perspective having personally seen the health of quite a few people fatally decline linearly with LDL particle rise (regardless of fluffiness). People should eat whatever works for them, but if their metabolic markers are moving away from what they've normally had and what is known to be healthy, with a rising LDL trend that is absurdly out of control and not settling down after literally years of adaptation, then something's gotta' give. Yet people in the alternative sphere prefer to play the martyr card against the food pyramic and instead of confronting the real elephant in the room, resort to the usual scheme of nonsensical apologies for 'moar fluffy LDL good'; moar SFA good.

Not that the traditional recommendations are ideal for everyone, but personally, I think in the midst of all this babble, the traditional food guidelines/pyramid get unfairly bashed since not many folk actually follow them in the first place.
Wuchtamsel said…
Yes, the additional problem is that it got pretty much abused(!) by what I would call junkfood manufacturers. I don't think that the scientists responsible for the composition of the food pyramid were happy with it being printed on boxes of Honey Smacks and so on. No nutritionist I know ever would have recommended eating stuff like that. And right so.
There have been made mistakes, of course. Eating rather caloric dense bread and pasta ad libitum(!) and by doing so indirectly limiting the amount of vegetables might be a necessity for a cyclist during the tour de france, but is probably not such a good idea for a sedentary office worker.
Wuchtamsel said…
I wouldn't do anything about the Vitamin D at all. 46ng is perfect and pretty much exactly(!) where traditional hunter gatherers average. I'm not sure if this is really relevant, but for the time it's probably the best guestimate for an optimal level we have.
carbsane said…
" People should eat whatever works for them, but if their metabolic markers are moving away from what they've normally had and what is known to be healthy, with a rising LDL trend that is absurdly out of control and not settling down after literally years of adaptation, then something's gotta' give. "

Exactly Kade!

It's been ages since I frequented PaleoHacks, but for the several months that I did, it seemed almost daily someone would come along and ask the group to "hack" their exploding cholesterol levels. Same for folks expressing concern on Jimmy's forum when I participated there. It's easy to fall into that trap as well -- the martyr/smart person trap. It's nice to feel smarter than all the rest, right? Let's face it, there are probably quite a few caught in that in-between land whose mildly elevated markers are actually quite "normal" too.

But when things go VERY south, instead of encouraging folks to get to the bottom of it, or reverse the dietary changes that brought it about, they are told to ignore stupid mainstream thinking and keep doing what they are doing because "healthy" has been redefined.

Nevermind that in the 70's and 80's and before that, "healthy" LOOKING people were dying suddenly of heart attacks which is why the scientific and medical community started looking for *hidden* clues to detect those at risk.

My how far we've come, eh?

If your health markers are headed in the wrong direction -- especially after making a change for the supposed better healthwise -- it's time to change course. There. I just gave out a little advice ;-)
charles grashow said…

LDL- P 1430nmol/L
Small LDL-P 127nmol/L
Price said…
I don't think we've "kept the saturated fat." Hasn't PUFA gone up and SAFA gone down?
charles grashow said…
This bears repeating one more time

"Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or
non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL's? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia
have inter-cellular gaps and express receptors that facilitate
apoB-particle entry. So the worse scenario is to have both high apoB and an inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation: please see Ira Tabas, Kevin Jon Williams, Jan Borén. Subendothelial Lipoprotein Retention as the Initiating Process in Atherosclerosis
Update and Therapeutic Implications Circulation. 2007;116:1832-44.
carbsane said…
I doubt SF has gone down. PUFA up? Perhaps in a segment of the population and, unfortunately, in "healthy" substitute products.

When the dust settles I think the PUFA thing will end up being a transfat issue from hydrogenation far more than anything else. But we do have a love affair with our salad dressings and mayo based dipping sauces and such. That stuff was never made with lard and MCT oil by the way -- even in the dark ages of the neolithic ;-)
Dan said…
"that's been a problem from my perspective having personally seen the health of quite a few people fatally decline linearly with LDL particle rise (regardless of fluffiness). "

Yup. That's my direct experience too. There are convincing studies that suggest LCHF diets can harm people. Not just case reports (those exist too). Large cohort studies. And my own lipid panel looked precisely like a heterozygous familial hypercholesterolemia picture on LCHF. These people succumb to MI in their 30's or 20's. I am very happy now to be a vegan. I avoid the foods at the top of the food pyramid as well as dairy.
Dan said…
I've never been convinced by the holy OM6:OM3 ratio. I believe it's an epiphenomenon. We need arachidonic acid and linoleic acid is the precursor of this. High OM6:OM3 foods are simply markers for the various toxins they travel with (e.g. trans fats).
Price said…
PUFA has certainly gone up. Meanwhile, dairy, beef, and pork consumption have gone down, poultry and soybean oil up:
Screennamerequired said…
It's hard to deny the saturated fat/atherosclerosis link. Even
Cordain will tell you that it's atherogenic. When you see almost daily
paleo forum posts about how their LDL doubled when they started
slathering foods in butter and lard you'll realize it's a problem no
matter how much denial accompanies it.
I think the problem is
these days with correlation studies is that saturated fats are no
longer dietary enemy number 1 when you see all the other processed foods
people are living on. When you today have people living on a steady
diet of foods like deep fried chicken and fries in vegetable oils, sodas
and candy with hydrogenated oil, saturated fat is no longer their
biggest concern.
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