Butter is back! That’s the gist of recent headlines suggesting that scientists have been wrong all along—that you now can cut loose and consume all the butter, sour cream and lard-fried chicken that you’ve been craving all these years.
A high-profile study concluding that saturated fat does not increase the risk for heart disease, as we’ve been told for years. Researchers based their analysis on about 80 top-flight studies and published it in Annals of Internal Medicine.
Despite the titillating headlines, scientists have not concluded that you can eat saturated fat with abandon. The more nuanced—and accurate—message is that fat and other food components are less important than the totality of your diet. To get the real story on saturated fat, Bottom Line/Health spoke with Dariush Mozaffarian, MD, DrPH, a cardiologist who studies the effects of diet on heart health.
We have long been told that high cholesterol causes heart disease and that saturated fat fuels high cholesterol. Not true? Saturated fat does increase blood levels of LDL, the so-called “bad” cholesterol. But concentrations of LDL are not the only important risk factor for heart disease. We also have learned that saturated fat increases HDL (a beneficial carrier of cholesterol) and reduces harmful blood fats called triglycerides. Compared with carbohydrates, saturated fat has little effect on the ratio of total cholesterol to HDL cholesterol, probably the best simple lipid marker of overall risk for atherosclerosis.
You seem to be saying that pasta and bread cause heart disease…while ice cream and racks of ribs don’t. Is this true? I would tell people to stop counting every gram of saturated fat. You have to take a look at the bigger picture.
For example, low-fat foods, such as certain yogurts and cookies—and ice cream—are frequently advertised as being healthier than their full-fat counterparts. But if these low-fat foods are loaded with sugar—a refined carbohydrate—they might be worse for your heart than a buttery croissant.
Saturated fat by itself does not make a food healthy or unhealthy. It depends on the overall diet. Someone who eats red meat a few times a week, for example, might have a healthier diet overall than someone who eats no meat but consumes trans fat, sodium, refined grains, starches and/or sugars. Research has shown that people who consume the most saturated fat have about the same rates of heart disease as those who consume less.
What have been the consequences of our national focus on saturated fat? Americans have been encouraged to scrutinize food labels and buy foods that meet certain guidelines, such as being low in saturated fat. Manufacturers then exploit this and produce foods that seem to be healthy but really are not.
Turkey sausage is marketed as a low-fat alternative to beef sausage. It’s not healthier. But people think it is because they focus on the fat content. They do not realize that processed meats cause more diabetes and heart disease than natural meats regardless of the fat content.
The same thing has happened with carbs. People who cut back on saturated fat have to replace it with something. They often choose packaged foods that are low in fat but high in refined carbohydrates, sugar and sodium—all of which are bad for you when consumed in large amounts.
Isn’t weight loss a good argument for cutting back on fat? Even though fats have more than twice as many calories by weight as carbohydrates or protein, they’re not any more likely to cause weight gain. You’re far more likely to gain weight if you eat a lot of refined carbohydrates, such as white rice, white bread and potatoes.
Shouldn’t we be consuming more olive oil and less saturated fat? Polyunsaturated fats (such as soybean oil and canola oil) are good for the heart, and extra-virgin olive oil also lowers heart disease risk. These fats are better than saturated fat, but they’re also better than carbohydrates. Because carbs are about 50% of our diets, increasing these healthy vegetable oils (which also have small amounts of saturated fat) should be the priority—not reducing saturated fat per se.
Are some of these types of fat better than others? If I were making a choice about which oils to use for most of my salad dressings and cooking, I’d pick soybean, canola or extra-virgin olive oil.
There is also preliminary evidence that dairy, in particular yogurt and perhaps cheese, may lower diabetes risk. I would suggest two to three servings per day of dairy, including unsweetened yogurt and unprocessed cheese. Currently, there is little evidence indicating whether low-fat or full-fat is more beneficial, so I advise people to choose whichever they prefer.
Will the new research change the Mediterranean diet’s reputation for being healthful? What people may not realize is that a Mediterranean diet is also a high-fat diet—traditionally about 40% of total calories come from fat, a much higher percentage than the typical US diet. Much of the fat comes from olive oil, vegetable oil and other unsaturated fats, with small amounts from dairy and meats.
In a recent study published in The New England Journal of Medicine, eating a Mediterranean diet lowered risk for cardiovascular events and diabetes without any changes in saturated fat. The diet is good because it includes so many wholesome, minimally processed foods, such as fruits, vegetables, high-fiber grains, fish and nuts. The second benefit is what it does not include—an excess of refined carbohydrates (including sugars and starches) and sodium.
If someone has a reasonably good diet, is it OK to enjoy without reservation a good steak, a pat or two of butter or a dollop of sour cream? Yes. If you have an otherwise healthy diet, eating these foods a few times a week or less won’t hurt you.
