The death knell for "artery clogging saturated fat"?

[agoraphobe]

The saturated fat myth busting is finally reaching the mainstream:


http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1


ABSTRACT

Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.

Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.

Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.

Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

[Wise Guy]

Nice find.

[cpeil2]

The saturated fat myth busting is finally reaching the mainstream:


http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1


ABSTRACT

Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.

Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.

Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.

Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.


Too many lipidologists continue to think otherwise for me to feel comfortable eating a lot of marbled steak and dousing my vegetables with butter.

[JanSz]

Too many lipidologists continue to think otherwise for me to feel comfortable eating a lot of marbled steak and dousing my vegetables with butter.

I would love to see breakdown of different fat contents in butter and marbled steak.

Something similar to this:

http://musclechatroom.com/forum/showpost.php?p=23193&postcount=2

with more info.

..

[LowT]

Too many lipidologists continue to think otherwise for me to feel comfortable eating a lot of marbled steak and dousing my vegetables with butter.

I'll take marbled steak and butter over microwave dinners and margarine any day. ;)

[agoraphobe]

Too many lipidologists continue to think otherwise for me to feel comfortable eating a lot of marbled steak and dousing my vegetables with butter.

yeah but what's the evidence they're basing it on?

http://www.npr.org/templates/story/story.php?storyId=15886898

if you click the audio link the american heart association affiliated doctor who discovered LDL particles agrees saturated fat is all bunk.

[LeanGuy]

Bring out the bacon... just balance with enough fish & olive oils

[cpeil2]

yeah but what's the evidence they're basing it on?

http://www.npr.org/templates/story/story.php?storyId=15886898

if you click the audio link the american heart association affiliated doctor who discovered LDL particles agrees saturated fat is all bunk.

How about this:

http://www.bmj.com/cgi/content/full/331/7510/187?ehom


I think you completely misunderstood what Dr. Krauss said.

The newest lipid science downplays the importance of absolute amounts of LDL and focuses instead on particle size and number. Dr. Krauss (and Gary Taubes) said that the more harmful type of LDL is small, dense LDL. Eating refined carbohydrates shifts the LDL particle size distribution toward small particle LDL and increases number of small dense LDL particles. Dr. Krauss (and Gary Taubes) said that eating saturated fats increases numbers of large, fluffy LDL particles. Dr. Krauss (but not Gary Taubes) said that large fluffy LDL is still harmful, just not as harmful as small dense LDL. Dr. Krauss's view is shared by many preventive cardiologists and lipidologists.


Gary Taubes's view is that the large, fluffy LDL is not harmful or dangerous. This view is gaining ground among paleo devotees, who eat platters full of ribs,etc. three times a day and who have very high HDL particle counts and also high LDL counts but think it's OK because Gary Taubes told them that it's OK. Also, the epidemiology still considers a high large particle LDL count a risk factor for CAD. We'll see. As far as I'm concerned, the jury's still out.


I'll continue to to get my protein from fish, lean meats, skinless chicken and eggs and use butter sparingly. I'm so used to it, that it's no sacrifice, and it certainly can't hurt me.

[agoraphobe]

How about this:

http://www.bmj.com/cgi/content/full/331/7510/187?ehom


I think you completely misunderstood what Dr. Krauss said.

The newest lipid science downplays the importance of absolute amounts of LDL and focuses instead on particle size and number. Dr. Krauss (and Gary Taubes) said that the more harmful type of LDL is small, dense LDL. Eating refined carbohydrates shifts the LDL particle size distribution toward small particle LDL and increases number of small dense LDL particles. Dr. Krauss (and Gary Taubes) said that eating saturated fats increases numbers of large, fluffy LDL particles. Dr. Krauss (but not Gary Taubes) said that large fluffy LDL is still harmful, just not as harmful as small dense LDL. Dr. Krauss's view is shared by many preventive cardiologists and lipidologists.


Gary Taubes's view is that the large, fluffy LDL is not harmful or dangerous. This view is gaining ground among paleo devotees, who eat platters full of ribs,etc. three times a day and who have very high HDL particle counts and also high LDL counts but think it's OK because Gary Taubes told them that it's OK. Also, the epidemiology still considers a high large particle LDL count a risk factor for CAD. We'll see. As far as I'm concerned, the jury's still out.


I'll continue to to get my protein from fish, lean meats, skinless chicken and eggs and use butter sparingly. I'm so used to it, that it's no sacrifice, and it certainly can't hurt me.

We've already seen that epidemiology data is virtually worthless for dietary impact. The highest saturated fat intake is in france, where the risk of CHD is also the lowest.

It's actually completely untrue that LDL goes up eating "paleo", LDL almost always goes down, and HDL always goes up. Occasionally someone's LDL will also increase by going paleo, but this is infrequent and not typical, ldl down hdl up has happened in every study on low carb eating in the last decade as well as evidenced by people posting their cholesterol profiles online who follow that way of eating.

As far as LDL as risk factor...

http://download.journals.elsevierhealth.com/pdfs/journals/0002-8703/PIIS0002870308007175.pdf

look at page 3, figure 1

50% of cardiac patients have an LDL of less than 100.

I agree the jury is out, but it seems like all of the assumptions the diet-heart-cholesterol-fat-etc hypothesis is predicated on legitimately are based somewhere between "we have no idea whatsoever and are completely guessing" and "totally wrong and fictitious"

The larger point i wanted to make is krauss didn't object when taubes said at this point it looks like saturated fat is between neutral and healthful and didn't attempt to demonize or caution on saturated fat and essentially backed up the assertion that saturated fat has been overstated and carbohydates are worse in contrast.

[cpeil2]

As far as LDL as risk factor...

[


But, as Taubes and Dr. Krauss were discussing, conventional Friedewald counts are not relevant. Particle size distribution is. And large numbers of large, fluffy LDL particles are a risk factor for CAD. Remember, Friedewald calculations are largely irrelevant as a marker for CAD - that's why people can have heart attacks with low LDL. Also, a Friedewald calculation can be 50% off either way. Somebody with a calculated LDL of 100 can actually be as low as 50 or as high as 150.

[Wise Guy]

But, as Taubes and Dr. Krauss were discussing, conventional Friedewald counts are not relevant. Particle size distribution is. And large numbers of large, fluffy LDL particles are a risk factor for CAD. Remember, Friedewald calculations are largely irrelevant as a marker for CAD - that's why people can have heart attacks with low LDL. Also, a Friedewald calculation can be 50% off either way. Somebody with a calculated LDL of 100 can actually be as low as 50 or as high as 150.

Cpeil,

I was under the impression that "oxidized" and "hydrogenated" fats are the main contributor to large LDL particles.

[cpeil2]

Cpeil,

I was under the impression that "oxidized" and "hydrogenated" fats are the main contributor to large LDL particles.


I don't know. According to Gary Taubes and Dr. Ron Krauss, large LDL particles come mostly from saturated fats. Since the trans fats from hydrogenated vegetable fats are sort of like saturated fats on steroids, it would be reasonable to speculate that they contribute to large particle LDL. When you say "oxidized" fats, do you mean rancid fats? I know they are generally considered to be unhealthful, but I don't know how they affect blood lipids.

[cpeil2]

I'll take marbled steak and butter over microwave dinners and margarine any day. ;)

So would I. Believe me, I don't live on microwave dinners and margarine.

[cpeil2]

.

It's actually completely untrue that LDL goes up eating "paleo", LDL almost always goes down, and HDL always goes up.

I agree. I have never read Cordaine's book, so I don't really know what a strict paleo diet is like. But I follow a quasi-paleo diet - no grains, no tubers, no legumes, no sugar, not much fruit, not much dairy, lots of vegetables, particularly green ones, and lean protein from animal sources. When I started eating this way, in literally only a few weeks, my sdLDL dropped 70% and my HDL increased 20%.


But there are a lot of people out there pounding back, as I said, plattersful of ribs and fatty meats, etc. and calling it "paleo." Since I haven't read what a paleo diet actually is, maybe that actually is paleo. It's true, their HDL does go up. One of these guys has a blog, "Free the animal" I think it's called, whose HDL is over 100. They dismiss their sky-high LDL as irrelevant because Taubes and Jimmy Moore tell them that LDL doesn't matter.


I think it would be really interesting to do coronary calcium scoring and/ or CT angiogram on a bunch of these guys to see what there coronary arteries look like.

[JanSz]

But, as Taubes and Dr. Krauss were discussing, conventional Friedewald counts are not relevant. Particle size distribution is. And large numbers of large, fluffy LDL particles are a risk factor for CAD. Remember, Friedewald calculations are largely irrelevant as a marker for CAD - that's why people can have heart attacks with low LDL. Also, a Friedewald calculation can be 50% off either way. Somebody with a calculated LDL of 100 can actually be as low as 50 or as high as 150.

Spectracell gives particle size distribution.

Is there another test that would do similar or better evaluation job?

..

[cpeil2]

Spectracell gives particle size distribution.

Is there another test that would do similar or better evaluation job?

..

It certainly provides the right data, but I don't know how reliable the Spectracell analysis is.

The most common advanced lipid analyses are the Liposcience NMR lipoprofile and the VAP. Either of these can be self-ordered for less than $100. The Cadillac of advanced lipid analyses is the Berkeley Heart Lab series, which, at one time, cost about $500. That was years ago when I first read about them. They probably cost way more now. They have to be ordered by a physician and they are usually covered, at least partly, by insurance. I can't say whether Medicare pays for the Berkeley or not. I haven't had a Berkeley or a VAP done, but I have had the NMR lipoprofile done several times.

[agoraphobe]

It's true, their HDL does go up. One of these guys has a blog, "Free the animal" I think it's called, whose HDL is over 100. They dismiss their sky-high LDL as irrelevant because Taubes and Jimmy Moore tell them that LDL doesn't matter.


i don't know about jimmy moore because i find him so annoying i can't really read anything he does or says, even his face just creeps me out to look at which he plasters everywhere, but richard @ free the animal has an ldl of around 40 and triglycerides of around 40 and hdl of 133.

very few of these people have normal ldl much less sky-high ldl, despite eating giant plate fulls of ribs and steaks the size of mount rushmore bathed in half a can of coconut milk (all saturated fat), even the people eating the most extreme paleo 80% red meat and saturated fat diet mostly maintain a very low ldl

[cpeil2]

i don't know about jimmy moore because i find him so annoying i can't really read anything he does or says, even his face just creeps me out to look at which he plasters everywhere, but richard @ free the animal has an ldl of around 40 and triglycerides of around 40 and hdl of 133.

very few of these people have normal ldl much less sky-high ldl, despite eating giant plate fulls of ribs and steaks the size of mount rushmore bathed in half a can of coconut milk (all saturated fat), even the people eating the most extreme paleo 80% red meat and saturated fat diet mostly maintain a very low ldl


As I said, a CACS or a CT angiogram doesn't lie. It would be really interesting to see what their coronary arteries look like after a few years of a regimen like that.

[GirlyMan]

Too many lipidologists continue to think otherwise for me to feel comfortable eating a lot of marbled steak and dousing my vegetables with butter.
Ditto.


I'll continue to to get my protein from fish, lean meats, skinless chicken and eggs and use butter sparingly. I'm so used to it, that it's no sacrifice, and it certainly can't hurt me.

Ditto.


I'll take marbled steak and butter over microwave dinners and margarine any day. ;)
Ditto.


So would I. Believe me, I don't live on microwave dinners and margarine.
And Ditto.

Much as I have lost my "sweet tooth" after eliminating sugar, I have also lost my "fat tooth" after substantially reducing it. I get most of my fats now from nuts, nut butters, and "good" oils. A big fat steak, cheeseburger, or platter of ribs just doesn't get me salivating the way it used to. I'll still eat 'em occasionally without feeling guilty, but I won't kill for 'em anymore ... or even go out of my way ... or even choose 'em it if I've got a fish or poultry option instead.

Dudes at work talked me into a FiveGuys cheeseburger and Cajun fries the other day for lunch. Said it was heaven. And it was delicious. I had to wipe the grease off my hand after every bite. Delectable. But I felt like I had been poisoned for the rest of the day and into the next. Not worth it to me.

[agoraphobe]

As I said, a CACS or a CT angiogram doesn't lie. It would be really interesting to see what their coronary arteries look like after a few years of a regimen like that.

i agree, even though all the markers of inflamation drop and the numbers on paper move in the right directions, i'd really like to see the actual blood vessels, it sucks that its such an uncommon procedure. i don't really "trust the numbers" either, going in either direction, as being indicative of anything.