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?

Context.  

Food for thought...