Episode Transcript
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Welcome to Nutrition For Mortals, the podcast that says life is too damn short to spend your time and attention worrying about your food choices.
So let's take a deep breath, and then join us, two registered dietitians and friends, as we explore the world of nutrition with a special focus on cultivating a healthy and peaceful relationship with food.
My name is Matt Priven, and I am joined, as always, by my co-host and the best dietitian on planet Earth, Jen Baum.
Hey, Jen.
Hey, Matt.
And just a couple of quick reminders.
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Yes, we can.
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We'll schedule an appointment for you.
So Jen, what are we talking about today?
Okay, so Matt, today we are going to be talking about saturated fat.
And there are a lot of very polarized opinions floating out there in nutrition world about saturated fat right now.
And this is actually a topic that has been pretty highly requested that we dig into and we talk about because there is a whole group of people out there, kind of like the carnivore, keto crew, who claim that we have been lied to about saturated fat and that eating saturated fat is just fine and doesn't have any associated risks.
And then we also have kind of more mainstream thinking about saturated fat, think like WHO, American Heart Association, that have recommended for quite a while that it's important that we kind of limit our intake of saturated fat.
And so it is no wonder that people are confused about this topic, and so we're going to dig into it today.
Yeah, this is a huge topic.
Just like you said, there's so many different opinions out there, and unlike a lot of other areas, that seems so split, like you meet very reasonable people who feel like they are really confident that you can eat as much saturated fat as you want without any ill effects, and then you meet, you know, an equally intelligent person on the other side who's a little concerned looking at the research.
So this is a really confusing one.
Yeah, and I think what we're going to do today is obviously we're going to dig into some history like we always do, but we're also going to talk about how this kind of rift in thinking developed, because quite honestly, it wasn't until about, you know, 10 years ago or so that we started to see a lot more people talking about and kind of creating a conspiracy theory around saturated fat.
And so, you know, we'll dig into the history, but we'll also kind of explore when this rift in thinking happened.
That sounds great.
So it sounds like we're going to do some storytelling to get up to the present moment where we're in this place where there's this rift in thinking between different groups on this topic of saturated fat.
But I do want to make sure everyone listening knows what the heck we're talking about.
So Jen, can we just briefly talk about what is saturated fat?
Yeah, okay.
I think that's a really important thing to do right off the bat.
And so saturated fats tend to be found in foods like meat, full fat dairy, butter, tropical oils like coconut oils.
And these are different than monounsaturated or polyunsaturated fats that tend to be found in things like vegetable oils, avocado oil, seeds, nuts, things like that.
And the difference between saturated and unsaturated fat, we don't have to get too sciency here, is really a difference in their chemical structure.
Yeah, perfectly done.
And so now that we know what saturated fats are, what has been the thinking over the years?
Where did we start?
If we were to look back 70, 80 years, where were we with our thinking about the role of saturated fat in health and health outcomes?
Well, this is where we're gonna get into some storytelling because in my opinion, there's really only one way for us to start this episode.
We have to talk about our buddy Ansel Keys again and the seven countries study.
And I wanna start with this, Matt, not just because it's interesting history and an interesting story, but really because this study was one of the first large scale studies done to suggest a relationship between saturated fat, cholesterol, and heart disease risk.
So I think people might remember from our Minnesota starvation experiment episode, we mentioned the seven countries study and said that we would probably come back around to it.
So here we are.
Yeah, we've talked about Ansel quite a bit on the show already in a couple episodes.
And so the seven countries study was really his crowning achievement, a lot of people would say.
This was his big work.
He was on the cover of Time Magazine when it came out.
And it made a big splash, especially because so little was known about heart disease at the time, especially when he got started on this project.
That's exactly right.
That's exactly right.
I mean, we have to remember that the time period that we're talking about is 1940s into the 1950s.
At this point in time, there was a real noticeable uptick in deaths from heart attacks, particularly in middle-aged men who were working in kind of executive-like jobs.
And what we knew about heart disease at the time was really very limited compared to what we know today.
I mean, in the 1940s, we knew that heart attack was the result of an artery being blocked.
We didn't really know why the arteries were becoming blocked.
We kind of thought that atherosclerosis or the hardening or the narrowing of the arteries was just kind of a natural part of aging.
And so conventional thinking at the time was that, you know, heart attack risk wasn't something we could modify or control.
And then in comes Ancel Keys, who was really interested to understand the differences, or maybe a better way to say it is to identify if there were any modifiable risk factors between those people who had heart attacks or heart disease and those that didn't.
So this was a pretty big new idea at the time.
Gotcha, that's fascinating.
And so as Ancel approached this question, why was he thinking about dietary intake in connection to heart disease?
Yeah, that's a great question.
And I mean, we know that Ancel was very into nutrition.
He was a nutrition researcher.
But more than that, from what I understand, from kind of reading back about the genesis of the seven country study is that one of the more pivotal moments was when Ancel Keys was actually invited to go to Italy.
I guess he got invited to go to Italy at the invitation of a colleague that he was working with at the time because this colleague told Ancel Keys that men in Italy didn't have heart attacks very much compared to the US.
And so this prompted Ancel Keys to go to Italy in the early 1950s.
And at this time, he does some very kind of informal surveys of volunteers.
He surveys local hospitals for heart attack victims.
And he starts to collect some very preliminary data that heart attack victims seem to have higher cholesterol compared to people who don't have heart attacks.
And so this combined with some other pilot studies really made him think about wanting to do a larger scale study where different populations across different countries were studied, followed to see if there were any differences between people who had heart disease and those that didn't.
Yeah, that makes sense.
It makes a ton of sense to look at populations who are experiencing less of the outcome you're trying to avoid.
And so this is often where research starts in this sort of population based study design.
And so let's get into the seven countries study, which I haven't read in a very long time.
So tell me who was involved?
What are these seven countries?
Yeah, we got to say that, right?
We have to at least name the seven countries to start out with.
So the seven countries that were included in this study were Finland, Greece, the United States, Italy, the former country of Yugoslavia, the Netherlands and Japan.
Okay, so US, five of them in Europe and then Japan.
That's right, yeah, that's right, that's right.
And interesting spread.
Yeah, that's right.
And other countries were invited.
I mean, they tried really hard to get as many countries involved as possible, but obviously this was a really large undertaking at the time, it was expensive.
And so these were the seven countries that agreed to participate.
Okay, all right.
And so once everybody signed up for the study, what does ANSAL do exactly?
Yeah, so they recruit participants and the final cohort of individuals ends up being just under 13,000 middle-aged men across these seven countries.
And they end up following this cohort for years and years.
And they do anthropometric measurements, weights, heights, blood pressures, things like that.
They do labs, they do dietary recalls and food diaries.
And the real hypothesis of the study that they're testing is, does the rate of heart disease vary in relation to different physical characteristics and lifestyle choices across both individuals, but also across the populations of these different countries?
So this is what you would call a prospective cohort study, correct?
That's right, that's right.
And essentially the researchers were trying to understand if there was a link between heart disease and lifestyle factors.
That was one of the big underlying hypothesis of the study.
And they took all these measurements periodically.
It wasn't just once, right?
So they found out what they were eating multiple times over the study period?
Yep, that's right, that's right.
So there was multiple data points.
Like I said, the study went on for years and years.
They were followed.
I think some of these individuals were followed up until the mid-aughts or maybe even a little bit later.
But the bulk of the data came from right around like 1958 until late 70s.
Wow, some people were followed for half a century.
Yeah, yeah, it was a big comprehensive study and it was really novel because it was the first of its kind ever.
This was the first time that there was an epidemiological study across countries.
So in that respect, it's just very cool.
I mean, not a perfect study by any means.
All studies are going to have flaws, but just very cool because it was the first of its kind.
Yeah, so with a long-term study like this, usually you have some preliminary findings kind of get shared to let the population know what's going on before they kind of sum things up years and years later.
So what were some of these preliminary findings that were coming out?
Well, one of the major findings from the study and the finding that really pertains to our conversation today was that there seemed to be significant differences in cardiovascular disease rates in relation to the amount of saturated fat consumed across countries.
And what I mean by that is that they collected all of this intake data and they found that there was a big range in how much energy intake was coming from saturated fat across countries.
And so you had Northern Finland, for example, consuming around 22% of their energy intake from saturated fat.
And then you have Greece and Japan, where only about 3% of their energy intake is coming from saturated fat.
And beyond that, or even more than that, there seemed to be a correlation between countries that had higher intakes of saturated fat and they seem to have a higher risk of heart disease.
So this was, again, pretty novel finding that seemed to suggest that intake of saturated fat may be correlated with an increased risk of cardiovascular disease.
I see.
Okay, and so I want to give kudos to Ansel for even asking this question of type of dietary fat source, because when we're in the 40s and 50s, I'm surprised he didn't just say how much total fat are people eating in these different countries, right?
It's kind of cool that he broke it out into the different types of dietary fat, right?
It's so cool.
It's so cool.
And like I said, he had done some preliminary data, he had done some studies earlier where he was kind of starting to think about and explore this hypothesis.
But yeah, I mean, to put this into play on such a large scale at the time, I think it's just amazing.
Yeah, so we're starting to see this difference in heart disease or cardiovascular disease risk that may be correlated with one's dietary intake or a country's dietary intake based on the type of fat they consume.
So, folks in Finland or Northern Finland with lots of saturated fat, maybe from meat or full fat dairy or probably not tropical oils in Northern Finland.
If you compare those to Japan with very low saturated fat intake, we see this difference in CVD risk.
And that's really interesting.
And again, if he had just asked about total fat, we might not see a difference between these populations.
But now we are seeing this difference, that again, these are associations, correlations, if you will.
So we're not getting any conclusive findings about the cause of cardiovascular disease, but we are getting new hypotheses to test, right?
That's right.
And Ancel Keys and the other authors of the Seven Countries study at the time, you know, they also said they actually in the published study said that this is a correlation and that it should not be considered causal without further investigation.
But what also did happen at the time is that a few years after they start to get this data from the Seven Countries study, we do start to get the first kind of population level recommendations by organizations like the American Heart Association that men, because they weren't thinking about women at the time, but that men should think about trying to reduce their intake of saturated fats.
So we start to get some population level nutrition recommendations based on some of the early data from the Seven Countries study.
And what should women do?
Well, they thought about women later, but it was the kind of, it was a very typical language of the time where they were just, the AHA came out and said, all men should limit their saturated fat intake.
And then a couple of decades later, it was updated to all people should limit their intake of saturated fat.
So it was just language that was very characteristic of the time.
Yeah, totally.
Okay, so what year are we in roughly when the study comes out?
Yeah, so the seven country study is published in 1978.
And again, there's been a lot of preliminary data.
There has been obviously, like I just said, population recommendations now coming from information gleaned from this study.
But it's 1978 where the study is published.
And so we're in the late 70s right now.
Gotcha.
Do you need a music cue from 78 to get the vibe right?
Do you need a music cue from 1978?
I think we all do.
I think we all do too, because we've been talking about some heavy science stuff.
So let's hit it.
I would have been a disco guy.
I want to admit it.
I'd like to think I'd be this cool punk rocker in the late 70s.
I would have 100% been a disco guy.
Wearing bell bottoms, like full out.
Full out.
Yeah, that was great to change the vibe a little bit, because the truth is, we're not going to talk much more about the seven country study.
But I will say that it's not just the seven country study that comes out.
It's not the only study in these decades that comes out that seems to suggest that there is a correlation between higher intakes of saturated fat and cardiovascular disease risk.
There are many subsequent studies that seem to suggest the same thing.
And that's kind of the general thinking, Matt, for a while.
I mean, this idea of, again, higher intakes of saturated fat, higher rates or risk of cardiovascular disease is kind of the norm for a long time.
But then things start to change.
And like I said, at the onset of the show, it's really about a decade ago that we start to see a shift in the conversation around saturated fat.
I can't wait to get into it because I've seen a lot of the shift recently, which I'm sure we'll have a lot to say about.
But it makes sense that these population studies like the seven country study and all the other ones you were alluding to integrated into our dietary recommendations, right?
We're not necessarily saying that saturated fat causes heart attacks, but we're saying is we're seeing a strong association in these studies.
And that's good enough to give prudent advice at the population level to say, hey, if you're going to choose between different fat sources at the dinner table, maybe skew this way instead of that way, it might protect your heart, which sounds reasonable.
Yeah, for sure.
Because I mean, the truth is there are many, we now know that there are many modifiable risk factors to decrease potential heart disease, things like not smoking, right?
Things like not having high blood pressure.
So this is just, you know, one of many potential risk factors that we identify may be connected to heart disease.
Okay, so let's get into the last decade or so where we start to hear some rumblings of descent.
And so tell me about where we are recently in this discussion about the risks of saturated fat.
Yeah, and you know what, I mean, I think it's honestly even more than rumblings of descent.
Honestly, we need like we need like ominous sound effect at this point, because it almost starts to shift into like a huge conspiracy theory.
I mean, you start to see the rise of the carnivore diet, you start to see this real increase on social media about how the population has been lied to and how saturated fat is perfectly fine.
So, yeah, I mean, we definitely need to talk about what happened in the last decade to really shift the narrative around saturated fat and as a consequence, really confuse the heck out of people.
You're welcome.
Thank you.
That was perfect.
That dun dun dun, that's exactly the ominous sound effect that we needed.
So give me some examples.
What are we talking about?
Sure.
So there have been several articles.
There was a meta-analysis in 2014 that the media got a hold of.
It was a meta-analysis that seemed to suggest that there was no link between saturated fat intake and cardiovascular disease.
It actually prompted a New York Times article called Butter is Back.
Butter is Back was very big in 2014, evidently, because Time Magazine also had Butter is Back on its cover as well.
There have been a couple very similar meta-analyses that have seemed to suggest, again, same thing.
There was an article that came out in 2022 called Saturated Fat, Villain and Boogeyman in the Development of Cardiovascular Disease.
This was another one that the media really had a field day with because it seemed to suggest that there was no link between saturated fat intake and cardiovascular disease.
As a consequence, like I said, social media then became rife with people having very strong opinions about how eating saturated fat is perfectly fine, and we've all been lied to.
I wonder how the trans fat argument kind of works its way in here too, because especially with butter, people were purchasing margarine with all of these partially hydrogenated oils in them, which we then learned these trans fats in there actually really increased people's risk of heart disease.
And so we pulled that out, and then we start thinking, all right, let's bring butter back.
And so in a way, I'm like, yeah, bring butter back.
Also, butter is delicious.
Let's bring butter back.
I get that motivation, but it was almost looked at, it sounds like, where people said, oh, I guess the research we've been looking at for 40 or 50 years is wrong.
Here's this new way of thinking.
So I'm on the fence about the butter is back argument, because I love butter, but I also want to acknowledge the science.
Right.
And I am incredibly glad that you just said what you said about margarine.
Can we just like table that and come back?
Like, we put that on a shelf for a moment and come back to it, because it's going to be like very important when we talk about some science later in the episode.
Totally.
I think you can put it on a shelf for five years and it'll still be.
That's right.
It won't change at all.
So where are we going next?
All right.
Well, I want to do I want to do that thing that we do where we kind of survey the landscape of social media.
Can we do that where we play some clips to give people an idea or to just kind of represent what people are likely hearing about saturated fat from the the pro saturated fat or like the carnivore crew?
How quickly are you going to play a Paul Saladino clip is the question is the first thing you're going to do or is it later 100% right now?
“Word saturated fat is almost like a bad word.
It is.
Yeah.
I think the recent political events really made people more aware of the way that the media can really program us, right?
And I would say that in the same way we've been programmed by the media over the last seven years to think saturated fat bad, LDL bad, but saturated fat is essential.
Like if you're eating a saturated fat from the animal, that's associated with increases in things like high density lipoprotein, HDL, even colloquial is considered to be good.
Saturated fat seems to raise testosterone, do many, many positive things in the human body for obvious reasons.
It's a backbone for the formation of the cholesterol molecule, which is a steroid molecule."
I mean, pro Paul Saladino actually has his shirt on in this clip.
So I feel like we're already ahead of the game.
So respectful.
So respectful.
Thank you, doctor.
Okay.
Can we play?
Let's play one more clip.
I think I just titled this one shirtless bro.
Oh, so now we're getting a shirtless bro.
I mean, I had to have somebody with their shirt off talking about saturated fat.
Otherwise, I feel like I'd be doing our listeners a disservice.
I eat meat, butter, eggs and other fats every single day.
And I'll tell you why.
“When studying anthropology at UC Santa Cruz in one of our medical anthropology classes, we studied a lot of tribes who had amazing health and we found what they ate was a lot of animal protein, healthy fats.
So I started to look into where did this demonization of fats and saturated fats really come from.
So in 1958, this guy Ancel Keys released the seven countries study where he basically claimed that saturated fat clogs your arteries.
This has been debunked by the top nutritionists worldwide.
You're talking Harvard, Cleveland Clinic, the Cleveland Clinic, one of the most respected organizations in the United States says you should no longer worry about cholesterol in your food.
The latest research on heart disease is pointing towards inflammation and triglyceride levels causing your arteries to get sticky.
So in the next 10 to 15 years, we might see triglycerides and inflammatory markers such as C-reactive protein become way more important than cholesterol.
So don't be afraid of cholesterol or saturated fat.”
Sounds like a cool anthropology class.
I was just thinking, okay, it kills me every time that he's just like, I took an I took an anthropology class at UC Santa Cruz.
So I know about nutrition.
Like, I love it.
It just kills me.
There's just like so many problems with this clip.
I mean, like the Cleveland Clinic actually, if you go on to their website, does recommend reducing saturated fat intake.
And people in the comments were like, bro, like the link you included to the Cleveland Clinic actually says the opposite of what you were saying.
And there was just like silence.
I mean, it's just like, it's just Robert Lustig is the person that he cites, right?
As, as, oh, yeah.
Right.
Did you catch that?
He's the, he's noted in the leading as the leading nutrition expert, right?
Who's saying saturated fat is okay.
So that's just, there's just so many problems here.
And he seems to be confusing dietary cholesterol and saturated fat.
So I think he thinks they're the same thing, but they're different, right?
So if we look at a food like shrimp, it's very high in cholesterol, but it's low in saturated fat.
And so we used to be like, ah, don't eat any shrimp because it has cholesterol in it.
And therefore, it will raise your cholesterol.
And then we've learned over the past couple decades that dietary cholesterol doesn't make a huge impact on our own cholesterol levels.
Maybe I'm getting in the weeds here, but he doesn't seem to be understanding that we're talking about saturated fat specifically.
And he's assuming that this has already been debunked because of his anthropology class.
Correct.
Yes.
So there are some real problems in many of the things that he's saying throughout this clip.
This is a very classic example of many of the TikTok reels that I watched.
These are the kind of narratives that we're seeing, and this is the kind of logic, I guess, being used.
And his proof that he knows what he's talking about is the fact that his shirt is off and he has pecs.
That is the proof, right?
This is the annoying thing about social media is like, oh, this guy figured it out because he's strong.
He's a strong guy, so he knows what he's talking about.
It's like he has no idea what he's talking about.
Yeah, this is when people on social media are using their body currency or their body image to try to come off as just more trustworthy, reliable.
And the truth is that science is the science, whether you have your shirt on or not, that's going to be my slogan.
On the shirt that I'm about to create.
Or the tattoo I put on my chest, I can't tell.
All right, so help me make sense of all this.
So we have all these people on social media saying that we've been lied to, and Ansel Keys was an idiot, and he doesn't know what he's talking about.
And this is also where we've had clips on the show before about how the dietary guidelines should be ashamed of how they've misled people.
I think of Gary Taubes as being a big spokesperson for how the dietary guidelines have actively killed people from heart attacks.
And so, how do we make sense of all of these people who are basically saying that we've been lied to for years?
I think that's a great question.
And I think there's going to be a couple of things that we need to do a deep dive into because there is a lot of nuance here.
This is when nuance in research really matters.
And so the first thing that I think we need to say is that when we're thinking about the relationship between saturated fat intake and cardiovascular disease risk, we have to think about dose.
And what I mean by that, Matt, is that we have a good amount of evidence that suggests that when our intake of saturated fat exceeds 10%, right around 10% of our total energy intake, there seems to be an increased risk of cardiovascular disease.
My guess is that some people listening may have heard this 10% number before.
This is something that the AHA used to say, kind of try to keep your calories from saturated fat to 10% or less, and that is because the risk of cardiovascular disease in relation to saturated fat intake seems to kind of happen right around this 10% mark.
Okay, interesting.
So that's the dose is if you exceed a certain dose, which represents about 10% of or maybe exactly 10% of your total energy intake, that's where things get more risky.
And so that's the nuance here is we're not talking about saturated fat, yes or no, we're talking about a specific threshold.
So you can be under that or over that.
And I would imagine that that nuance makes it easy for people to hold up studies and say, look, there's no difference between a high saturated fat and a moderate saturated fat intake on cardiovascular disease risk.
And that's because both of those numbers were actually above that threshold of 10%.
Yeah, that's correct.
I think another way to think about this is that the relationship between saturated fat intake and heart disease risk is not linear.
And what that means is that our risk of cardiovascular disease doesn't just keep going up and up and up.
The more saturated fat we eat, there seems to be this spike in CVD risk right around that 10% threshold, and then risk just kind of levels off.
So it's very, very common, like you said, Matt, for like, again, like the pro-saturated fat groups to, you know, pick two studies that are kind of above this 10% threshold, compare them to each other, and then say, look, you know, this group ate 20% of their calories from saturated fat, this group ate 12%.
And look, there was no difference in cardiovascular risk.
But that makes sense, because those are kind of both above that 10% threshold, where risk kind of levels off and stays constant.
Yeah, so it sounds like dose is really important to keep in mind.
And you know, I know everybody listening, including us, we don't think about our food in terms of the percentage of our energy coming from specific types of dietary fat or any nutrient for that matter.
So this really gets translated into trying to choose more of these unsaturated fat sources to sort of hedge your bets that you're winding up at that under 10% number, right?
Yeah, exactly.
And we heard Paul Saladino talk about the importance of saturated fat, you know, in terms of its function in the human body.
That's also true what he's saying, right?
We need saturated fat.
We just want to make sure that it doesn't rise above a threshold where it's going to significantly increase our risk of heart disease based on the research we have thus far.
Correct.
I mean, I don't actually love, you know, on the show, we never love the language good or bad.
I don't think we need to say saturated fat is bad because yeah, I would agree with Paul Saladino, saturated fat can be used to make hormones.
It can be used for energy.
It's just that we want to be like, kind of gently cognizant of our intake.
Gently cognizant.
I love that.
And how could you do better than that because saturated fat is in everything.
I mean, most foods are sort of this fractionated dietary fat intake, like peanut butter we think of as a source of unsaturated fat, but it has saturated fat in it, right?
Correct.
Correct.
Yeah, absolutely.
Yeah.
So it's not necessarily an all or nothing.
The goal here is not just completely try to avoid saturated fat forever.
It's just kind of like I said, gently cognizant.
The other thing that we have to say is that replacement really matters.
I cannot underscore this enough.
And so let me explain what I mean by that.
If you look at just decreasing saturated fat intake without looking at what people are replacing it with, then you don't always see much in terms of cardiovascular risk reduction.
So actually, you know what I'll probably do?
I want to use a study to illustrate what I'm talking about, if that's okay.
Okay, so this is a study that was published in 2015.
It was titled Saturated Fat as Compared with Unsaturated Fats and Sources of Carbohydrates in Relation to Risk.
And the study found that when people replace the energy from saturated fat with refined carbohydrates, there doesn't appear to be much of a benefit in terms of cardiovascular disease risk reduction.
However, if people replace saturated fat with complex carbohydrates like whole grains, or they replace them with unsaturated fats like nuts, seeds, vegetable oils, then we see a significant decrease in the risk of cardiovascular disease.
Again, this is something that is very, very common in pro-saturated fat camps, carnivore camps, et cetera, that they will cite a study or a meta-analysis that looked at decreasing saturated fat without looking at what the saturated fat was replaced with.
Oh, that's such a good point.
This is just a concept in any dietary change or intervention is people need to eat.
So when you take something away, what is going to go fill in that gap?
And so you're saying that the research suggests that replacing saturated fat, at least some of your saturated fat with poly or mono unsaturated fat sources, which we can talk about at the end, I suppose, like what those are, that is going to have a beneficial impact that you won't see if you're swapping your saturated fat intake for refined carbohydrates in this case.
Correct.
And actually, why don't I have you, Matt, go ahead and read, this was, I think, a quote that summarizes what you and I are talking about really well.
So this is from a statement from the American Heart Association in 2017.
So will you read this, please?
Quote, meta-analyses of prospective observational studies aiming to determine the effects on CVD of saturated fat that did not take into consideration the replacement macronutrient have mistakenly concluded that there was no significant effect of saturated fat intake on CVD risk.
In contrast, meta-analyses that specifically evaluated the effect of replacing saturated fat with polyunsaturated fat found significant benefit, whereas replacing saturated fat with carbohydrates, especially refined carbohydrates, yielded no significant benefit to CVD risk.
Thus, again, differences in the effects of the replacement or comparator nutrients, specifically carbohydrates and unsaturated fats, are at the root of the apparent discrepancy among studies and meta-analyses on whether lowering saturated fat reduces the risk of developing CVD.
Yeah, so it's exactly like you said.
We have to consider what we're replacing any nutrient with that we take out.
Exactly.
Exactly.
And so again, dose seems to matter, replacement seems to matter.
And so these are all the things that we have to take into consideration when we're like digging through the body of research that we have.
And I think a lot of the carnivore folks take it to the next level where they say, well, I don't even think that the way we're assessing CVD risk makes sense.
And so they'll say, oh, I don't care if my LDL is a thousand because I don't believe that that's correlated with heart disease risk.
Right.
Or I have an APO-B that's off the charts, but that's fine.
I trust that I'm okay.
And I don't even know how to argue with that.
I wouldn't trust that I'm okay if I see that lipid panel.
Yeah.
I mean, if fundamentally you don't believe that higher LDL cholesterol is associated with higher risk of cardiovascular disease, yeah, I mean, then there's no really point in arguing any of this.
I think it's very well established at this point that higher LDL seems to be associated with increased risk of CVD.
But if you don't believe that, then yeah, I mean, you're absolutely right, then you don't really need to pay attention, I guess.
Yeah.
It's a different fundamental conversation.
I'm interested in having it.
I think it's interesting.
I'm also interested in genetic differences, right?
Like, you know, maybe some people can just genetically tolerate like really high non-HDL cholesterol and be okay, whereas others can't.
And that'll be interesting to find out in a couple of years or decades.
For sure.
And I mean, I think it's great to continue asking questions.
It's great to continue studying saturated fat and keep asking these questions.
But we're just we're making conclusions, at least for right now, based on the evidence we have at this point in time.
Okay, so we've talked about dose, like how much saturated fat we're taking in.
We've talked about replacement, like if we're not eating as much saturated fat, what's coming in to fill the gap?
Is there anything else we want to keep in mind here in this conversation?
Well, I think that we need to talk about source, food source of saturated fat.
And I actually really want to make sure we talk about coconut oil, because like, especially a few years ago, I mean, coconut oil was elevated to like this, like super food.
And there was just so much discourse around coconut oil and how, yes, it's high in saturated fat, but it's okay.
And so I want to dig in to source, and I want to start with talking about coconut oil.
Okay, let's do it.
Well, it's an MCT oil, right?
So it doesn't do anything that other saturated fat sources do.
Is that correct?
Well, that is again, some of the thinking on the, I guess, pro coconut oil camp is that because the saturated fat is MCT, or medium chain triglyceride, that it's not going to necessarily affect or impact LDL levels, the same as other saturated fats.
And so I am going to play another clip from the show's favorite chiropractor, Eric Berg, talking about coconut oil.
“Coconut oil is a poison.
Yes, it's very, very dangerous.
I know it's been given to a lot of cultures over the last 2000 years, and they didn't have a problem, but so it's now just been recognized by the experts that it is very, very dangerous.
Okay, guys, coconuts are only dangerous if they're traveling at your head and you don't duck, okay?
That's the only danger in a coconut.
Guys, let me just show you why they, well, I'm just trying to figure who they is, consider coconut oil a poison because it's a saturated fat.
Now, they didn't do studies on having you consume coconut oil and having it cause heart attack.
Now, they just ignored that link and went right to the saturated fats, because everyone knows that consuming saturated fats will clog your arteries and cause coronary heart disease.
I mean, that's a fact, right?
That is an example of false data, okay?
That is false information.
Now, the American Heart Association blasted out there to all the physicians that you need to start replacing the saturated fat type products with the vegetable oils, okay?
So that's kind of like the new thing.
But what they ignored is these three very large studies, the Minnesota Coronary Survey Experiment, the Sydney Study, and the Women's Health Initiative.
I'm gonna put the links down below so you can check them out, because these major studies do not show this link at all.
Okay, they showed that there is not a link there.”
We just got schooled.
Did he just verbally clickbait us?
What was that format where he was like, coconuts will kill you, but they won't kill you.
Let me explain why.
It was very, very strange how he presented that information.
Yeah, and we have to tangent here for a second, because I really need, we're gonna get back to coconut oil, I promise, but I really need to talk about a couple of the studies that he cited.
He talks about the Minnesota and then the Sydney Heart Study, or the Sydney Heart Trial.
And I'm gonna plant a red flag any time somebody sees a, again, like, pro-carnivore, pro-saturated fat, individual using these studies to back up their claims.
I want people to just be very, very wary.
And the reason is because these studies were done in the 1960s, the 1970s.
The Minnesota Trial had a huge loss to follow up.
I mean, I think it ended very, very prematurely, so there's not a lot we can really take from it.
But if we look at specifically the Sydney Trial, this was a study where they had people replace saturated fat with either an unsaturated oil, like safflower oil, or a margarine.
And so Matt, remember how we put margarine on a shelf for a moment?
Yep.
Yeah, so if you think about the type of margarine that people were using in place of saturated fat in the 1960s, 1970s, what do you think the margarine had in it?
Trans fats.
That's right, that's right.
So there is a big confounder in these studies because people were likely replacing saturated fat with at least some or a good amount of trans fat.
And we know that trans fat on its own increases cardiovascular disease risk significantly.
I mean, this is something that pretty much everyone agrees on, which is rare in nutrition world.
Yeah, to the point where it's illegal to include it in your product above a very, very, very small threshold.
And so, yeah, we're pretty, it's well established.
We got to look out for trans fats in our diet.
And thankfully, there's legislation around it.
So we don't have to think too hard about it.
That's right, that's exactly right.
And so these studies that are often cited by pro-saturated fat folks definitely ignore that.
Again, replacement really matters, and we have to really take into consideration that saturated fat was likely replaced with at least some trans fat, which could be a confounder.
I also think that even if these studies were somehow very, very high quality, and there weren't these potential confounders with these studies, we still have a whole huge amount of research that actually demonstrates the opposite.
So even if these two or three studies that Eric Berg pointed out were well designed and they weren't problematic at all, should we consider them?
Then of course.
But it still wouldn't negate the fact that we have a lot of evidence that seems to suggest that there really is a link between higher intakes of saturated fat and cardiovascular disease.
Yeah, that's a really good point.
Every time I hear you say pro-saturated fat, I kind of bristle because I'm pro-saturated fat.
Like I love saturated fat.
Butter's the best, right?
But I know what you're saying.
The people who are like, it is absolutely been a conspiracy theory since the days of Ansel Keys, and I'm telling you the truth.
Those are the folks we're talking about here.
And maybe we'll get around a little bit more to our opinions here later on, but I want to take you back to coconut oil.
So tell me how I should be feeling about coconut oil.
Is it different than red meat and full fat dairy and all that stuff?
So there was a recent meta-analysis that was done in 2020 that looked at 16 different randomized control trials that compared the impact of both coconut oil and non-tropical oils on LDL.
And the results of that found that coconut oil consumption does significantly increase LDL compared to non-tropical vegetable oils.
So while coconut oil might not increase LDL as much as the saturated fat from red meat or butter or things like that, it is going to impact lipid levels.
Even compared to seed oils, those pro-inflammatory seed oils they're comparing it to?
I know, I know.
How dare they?
I'm telling you, I know.
But I do also want to say, Matt, that there is nuance within nuance because we're learning more about saturated fat and particularly we're learning more about the different types of saturated fat that are found in some foods and different food sources of saturated fat.
And so one example is that there have been quite a few studies that seem to have found that consuming full fat dairy like yogurt doesn't seem to raise LDL as much as other saturated fat rich foods and therefore may not increase risk of cardiovascular disease.
Likewise, there is a type of fat found in like dark chocolate, steric acid.
This is a type of saturated fat that also doesn't seem to increase LDL or therefore risk of cardiovascular disease.
So I think what's cool is that I think we're going to continue to learn more about different types of saturated fat and different food sources of saturated fat.
I think different sources of saturated fat do tend to matter, but that doesn't necessarily negate the fact that consuming higher levels of saturated fat from animal sources like red meat does seem to be linked to an increased risk of cardiovascular disease.
Yeah, that's a really important point to make.
So there's nuances within nuances here.
The source matters when we're thinking about saturated fat.
Some of the sources are going to have different risk profiles for CVD than others.
And even within something like dairy, we can think about there's some dairy that has probiotics like yogurt, right?
Is that going to be different?
Or with chocolate, that's actually a fermented food in a sense too, right?
There's a fermentation step when we make chocolate.
And so I wonder what the effects of processing, culturing or fermenting does to the ultimate impact on health outcomes.
There's a lot we're still learning, which is really interesting.
Yeah, and that's what's so great about science is that we keep asking questions, we keep exploring hypotheses.
And like I said, I think we're gonna keep learning more about saturated fat, about fats in general.
And like I'll be super interested to see what we continue to learn.
But at this time, it does not sound like you are ready to go carnivore, Jen.
I mean, honestly, it's like giving up coffee.
Even if I heard like the best things in the world would happen to me if I went purely carnivore, I would not want to, because it would just, I don't want to eat that much meat.
I would not do it.
So yes, that is correct.
That is a hot take of this episode that Jen is not going carnivore.
So are we going to talk about Jordan Peterson in this episode?
I act like I know him.
No, we're not, because I figured we could only bring in so many voices into the show.
We've already brought Paul Saladino.
We brought Eric Berg.
I mean, I think the whole Jordan Peterson carnivore world is another maybe future episode, but I think we got to like take things one step at a time.
Like today, saturated fat, maybe we talk about carnivore at some future date.
Okay, that sounds good.
All right, skipping Jordan Peterson.
Sorry, everybody.
So yeah, so after looking through all the literature here, and I'm sure a lot of it will be shared in our show notes if people want to look at it as well, what are your feelings about saturated fat?
What's your takeaway?
What's kind of coming into your home and your kitchen now that you've done all this thinking?
Well, I am going to say, to kick things off, I will definitely get to my own thoughts around saturated fat.
But you know what I find really interesting about, since I've been living in the saturated fat world of TikTok for the last however many weeks, what I find so interesting is that it really has evolved into a conspiracy theory.
I mean, man, I went down some rabbit holes in the comments sections of certain reels.
People really have strong beliefs, and it really doesn't matter what evidence you show to people.
There are diehards out there that their minds are never gonna be changed.
They will talk about conspiracies by the statin industry or the beef industry.
I mean, it goes on and on and on.
And we always say on the show, you should do whatever you want with food, right?
Ultimately, you wanna eat carnivore, go for it.
You get to do that.
I will just say as a person who is not funded by either the statin industry or the beef checkoff, it really just does seem that best evidence we have right now seems to suggest that being aware and maybe limiting or replacing some saturated fat with non-saturated fat may be helpful in terms of cardiovascular disease risk.
Yeah, and so many of the people you see online, they're like 25-year-old guys who are in the gym talking about their carnivore diet and how they're not scared of heart disease.
It's like, yeah, you're not scared because you're 25.
But people watching this are not 25.
And this is a progressive condition where atherosclerosis develops.
The plaque, the hardening of the arteries develops over time.
And so we tend to see people in their 50s and 60s start to deal with the actual symptoms, like angina, like the symptoms of these conditions, but not when they're 25 typically.
And so you gotta be really careful about what you're sharing if you don't really understand the research.
Absolutely.
Well, I mean, the other thing I'll just say about like the whole conspiracy theory aspect of this is that the US isn't the only part of the world that recommends limiting saturated fat intake.
I mean, the European Commission, the Australian Department of Public Health, the WHO.
So if this is a conspiracy, like the whole world is involved in this conspiracy, right?
It's like if there was data that came out that seemed to suggest that saturated fat wasn't associated with heart disease.
Like you and I, as health professionals, we would shift our thinking, we would shift our recommendations, but we have to go off best data in the moment.
Yeah, no, that's a really great point to make.
We're trying to be research-based here to the best of our ability, and so why would the whole world be on a conspiracy tip?
I'm not really sure.
Yeah, so what else?
What are your other hot takes that you've got on your mind right now?
Well, I think I really don't want people leaving this episode feeling like they need to hyper-focus on that 10% of calories or intake or energy intake from saturated fat.
Really, focusing on a single nutrient can honestly often cause people more stress than anything else.
And so I want people remembering that intake pattern over time matters more than a specific eating event or even a specific nutrient.
But I just, I really want people focused on what they're eating and variety over time versus being hyper-focused on saturated fat.
Yeah, and it's helpful to focus on the replacement side of it, which is how can we get excited about these unsaturated fat sources?
So for me, that's getting excited about avocado and nuts and seeds and chia puddings and getting excited about peanut butter, my favorite food on earth, getting excited about really good olive oil, getting excited about olives and like so many foods that I love that are really good sources of these mono and poly unsaturated fats.
There's so many more I could list.
And when we have that frame of reference, it's quite easy to start shifting that dietary pattern.
And it's harder though, when somebody's got a cultural relationship with coconut oil, for example, right?
And so there are times where it becomes really difficult to make these shifts, and we are doing them in the name of health, right?
And so it kind of is this weird crossover with this intuitive eating conversation where people are saying, well, what my body's telling me is I get a lot of satisfaction when I eat a lot of coconut oil, or if I eat a lot of red meat and have a lot of burgers and steaks, that's what I enjoy the most.
And so how do we balance that and hold those preferences with some of the nutrition information that we have?
This kind of gets into the topic of gentle nutrition and the intuitive eating parlance, which is how do we hold both those things at the same time?
I can't give you an answer on that.
That's something that you explore personally by doing some deep thinking and talking with people or with a registered dietitian.
And so this is interesting stuff, how to integrate this at the personal level.
That's where it gets really fun.
Yeah, that's a great point, Matt.
I mean, is there anything else as we're kind of like wrapping up here?
Is there anything else you want to say?
Yeah, you know, nutrition is just one piece of the puzzle.
So I'm sure one thing I'm confident in is in a hundred years, when we look back, we're going to go, okay, a slice of the pie is nutrition.
And then there's genetic predisposition for heart disease.
There's physical activity.
What type of physical activity?
There's going to be environment and exposures of other kinds.
There's going to be smoking.
There's going to be all of these different sections of that pie.
Nutrition is just one of them.
And so if you're thinking, oh gosh, this rib I ate for dinner is going to give me a heart attack, you're just wrong.
It's not an individual meal-based decision.
It's big picture, and it's just a part of the explanation.
And so we have to have some sense of humbleness here that even though we feel pretty confident telling you today that the research suggests that this conspiracy theory that the carnivore diet is super healthy doesn't make any sense.
What we're not saying is that we need to be hyper worried about saturated fat intake at the day-to-day level.
We just want to make sure that we're taking care of our relationship with food and eating a wide variety of foods.
It's pretty simple.
That's right.
Two dietitians downplaying the importance of nutrition.
Yeah, I think that's probably right, but at the same time, I think that there's just such a weird outsized role of nutrition on social media, especially, where it's like everyone's looking at how they can control every aspect of their eating to dial in the perfect system that's going to lead them to be Brian Johnson living to like 190, looking like a 10-year-old boy.
It's not going to work like this, everybody.
And so that's why we keep having these conversations where we can hopefully remind people that there's a lot of things outside of our control, some things we do have a hand in, and that's exciting.
Let's have fun with it.
Let's make nutrition fun and interesting, but let's keep all the restriction and the chaos out of it because it has no place in a healthy relationship with food, in my opinion.
See, now I'm really caught on 190-year-old Brian Johnson who looks like a 10-year-old.
So thank you for putting that image into my head.
He's like found Never Never Land somehow through his nutrition regimen.
It's very, very cool.
I like how you have been texting me Paul Saladino clips for the last couple of days too.
Yeah, yesterday I sent you that one where Paul Saladino travels on airplanes with like 10 coconuts because that's his source of hydration.
And I was gonna try to work it into the episode, and I couldn't figure out a way to do it because I think that's like the best thing I've ever seen.
Yet here we are talking about it.
I know.
I stick to my response, which is, how do you open coconuts on an airplane?
It makes no sense.
How is he getting into them?
I know, it's just like the best thing I've ever seen.
I literally want to be on an airplane where somebody hands me a whole coconut to hydrate myself.
What are you doing with it?
I don't know.
I don't know how I'm opening it.
That's the problem.
That's why I found it so funny.
It was not only the fact that imagine TSA looking at the big bag of coconuts and just having big question marks above their heads, but also about just busting those out on an airplane and how you're getting into those bad boys.
Next, we're going to see a headline that's like, Shirtless Doctor Dragged Off of Delta Airlines Flight for Smacking Coconuts into the Overhead Department as Hard as He Can.
You gotta laugh, right?
Ah, you really do.
Nutrition For Mortals is a production of Oceanside Nutrition, a real life nutrition counseling practice in beautiful Newburyport, Massachusetts, where we provide individual nutrition counseling, both in person and online via telehealth.
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