Investigating an Emerging

Dietary Paradigm: Saturated Fat
Not the Cause of our Modern
Health Crisis, but Refined
Carbohydrates and Vegetable
Oils Are


Kelly Cassidy
490 – Vernarelli
3/30/2013









Risk Factor Defining Level
Abdominal obesity*
Men
Women
Waist circumference**
>102 cm (>40 in)
>88 cm (>35 in)
Triglycerides 150 mg/dL
HDL cholesterol
Men
Women
<40 mg/dl
<50 mg/dl
blood pressure 130/85 mmHg
Fasting glucose 110. /dL

Metabolic Syndrome Definition and Statistics

• Metabolic syndrome(MetS) is a name for a group of risk factors
that occur together

• It is a highly associated with obesity, CVD, DB, Hxn

• Over 68 million Americans have MetS as of 2012

• It defined as having three or more of the following risk factors:
Saturated fats have been described
as a primary cause of MetS:

“An atherogenic diet, rich in saturated fat (>10%), cholesterol
(>300mg/day), and trans-fatty acids may predispose one to
metabolic syndrome.” (American Heart Association)

 The idea that SF is harmful is present everywhere

However, these claims are being challenged by
top nutrition scientists…







Quotes:

 Dutch Review: “Results and conclusions about saturated fat
intake in relation to cardiovascular disease, from leading
advisory committees do not reflect the available scientific
literature” (Hoenselaar)

 “In 1920, the typical American diet was rich in
saturated fat (and cholesterol), yet contained only one-
third the level of PUFAs consumed today. In that year,
death was seldom attributed to myocardial infarction.
Natural and refined vegetable oils containing high
concentrations of PUFAs were subsequently introduced, and
by 1960 deaths arising from myocardial infarction in the USA
had substantially escalated to a figure of 600,000 per year”
(Grootzfeld)

 “Our meta-analysis showed that there is insufficient
evidence from prospective epidemiologic studies to
conclude that dietary saturated fat is associated with
an increased risk of CHD, stroke, or CVD” (Siri-Tarino)


The Dietary Guidelines Have Not Changed
Much from 1977:

Timeline for Increase in Obesity in
America – Sharp Rise after 1976
Research Question:
Could foods other than saturated fat,
namely oxidized unsaturated vegetable-oils
and foods that cause exaggerated insulin
secretion be the true cause of the modern
health crisis that metabolic syndrome
exemplifies?
Carbohydrates and MetS:
Meta-Analyses:
 Low fat, refined-carbohydrate heavy diets increased small LDL, thereby
increasing the overall heart disease risk (Siri-Tarino)

 CHO-rich diets elicits chronic inflammation resulting from dyslipidemia as well
as insulin resistance, which underlies metabolic syndrome (Kuipers)

Experimental Studies:

 Dietary CHO increases serum SFA due to de novo lipogenesis; increase of
dietary SFA by 2-3x does not increase serum SFA (Forsynthe)

 Low-fat, high-carbohydrate diet increased risk factors for CVD in women with
insulin resistance. The undesirable metabolic effects of low-fat, high-
carbohydrate diets are directly related to degree of insulin resistance.
(Jeppesen)

 In postmenopausal women with low total fat intake, a greater saturated fat
intake is associated with less progression of coronary atherosclerosis in
women with metabolic syndrome, whereas carbohydrate intake is associated
with greater progression (Mozaffarian)
Potential Mechanisms by which
CHO causes Dyslipidemia
 Stimulator of Insulin: MetS may arise from problems
with insulin metabolism
 Dietary CHO raises insulin levels (Tan)

 Glycation: AGEs form cross links between proteins and
glucose via Maillard Reaction
 Glycation of VLDL extends the time VLDL stays in the
serum (Mamo)
PUFA and Metabolic Syndrome
Experimental Studies:

 Commonly used vegetable oils (canola,
sunflower, soybean, corn) were heated to
temperatures typically used during food
preparation showed substantial oxidation and
production of harmful compounds (Halvorsen)

 Typical trans-2-alkenal compounds, known to
exert a range of toxicological effects, are
produced from the thermally induced
autoxidation of PUFAs are readily absorbed from
the gut into the systemic circulation.
(Grootveld)

 In women given daily soybean oil, HDL level
decreased significantly, while the levels of total
cholesterol, LDL, and the LDL: HDL ratio were
increased significantly.
 In the coconut oil group waist circumference
decreased and HDL was increased while the
LDL:HDL ratio was lower (Asuncion)



Potential Dangers of PUFA/MUFA
 PUFA, MUFA easily break down into oxidative products
in the presence of heat
 Contributes to chronic systemic inflammation

Dyslipidema now better understood:

“We now understand better the mechanisms responsible
for the initiation and development of atherosclerosis.
Inflammation plays a key role, and we view arteries as
highly organized organs comprised of living cells, not as
inanimate conduits” – Vascular Biologist Peter Libby
Saturated Fat and MetS: Positive
Evidence
Experimental Studies:
 Compared with the conventional control diet, serum
TAG concentrations were reduced by feeding a high
saturated fat diet. The low-carb diet also induced a
reduction in the serum cholesterol, as well as reducing
fasting insulin levels (Kim)

 After adjustment for calcium intake, experimental
subjects were over 100% more likely to be struck by
metabolic syndrome, while subjects in who drank full-
fat dairy were 61% less likely to develop MetS (Louie)

Meta-Analysis:
 There was insufficient evidence from all prospective
epidemiologic studies reviewed to conclude that dietary
saturated fat is associated with an increased risk of
CHD, stroke, or CVD (Tarino)



Population-Based Studies:
 Men who ate more dairy fat had a lower
BMI, lower blood pressure, higher physical
workload, and were more frequently
smokers and farmers. Low dairy fat intake
was associated with increased risk and
incidence of CHD (Holmberg)

 In a large study of 10,700 pre-schoolers ,
researchers found that the children who
drank skim (1%) milk were the most obese
of all regardless of of race, ethnicity or
socioeconomic status; 2% milk drinking
children had the next highest BMI followed
by the whole milk drinking children
who were the leanest of all (Scharf)

 The Masai consume the majority of their
diet as saturated animal fat and yet are
protected from unfavorable lipid profiles
and have virtually no CHD/CVD in the
population (Mbalilaki)
SFA and MetS: Negative Evidence
 Early animal studies supported associations between
Satfat and CVD (Anitschkow)
 Fed Rabbits Cholesterol

 Multiple Risk Factor Intervention Trial(MRFIT), compared
mortality rates and eating habits of over 12,000 men;
people who ate a low-saturated fat and low-cholesterol
diet had a marginal reduction in coronary heart disease
 Total mortality was higher in those with low SF/chol intake

 Dietary patterns in seven countries link consumption of
dairy fat to CHD (Keys)



 Following 3 groups were prescribed a hypocaloric high
saturated fat (HSF) and starch avoidant (SA) diet w/use of
dietary logs:
 23 obese patients on various statins in the atherosclerotic
cardiovascular disease (ASCVD) group
 15 women in the polycystic ovarian syndrome (PCOS) group
 116 patients in the reactive hypoglycemia (RH)
 Diet consisted of 1/2 calories as SF such as cheese and red
meat. Was high in cholesterol-containing foods. Fresh fruit
and non-starch vegetables were provided.
 A dietary log was taken; serum lipid fractions were
evaluated at the beginning and end of the study

High SF, No-Starch Diet in Patients with
Documented ASCVD Diseases:

Hays, et. al
Results
 ASCVD, PCOS, RH patients lost 5.2, 14.3, 19.9
% weight
 ASCVD: Previously prescribed a low-SF/chol diet
 Increased SF by 24g and chol by 1000g
 Chol levels did not change; size of both HDL/LDL
increased
 Fasting glucose, insulin, TG decreased
 Most MetS pts became low-profile

 PCOS/RH: serum lipids did not change
substantially
 Authors conclude that long-term adherence to a
HSF-SA diet can result in weight loss with no
adverse or even beneficial effects on serum lipids
Ancel Keys’ The Seven Countries
Study:
 The first to explore associations
among diet, risk, and disease in
contrasting populations

 In the 1950s Keys had already
formulated the hypothesis saturated
fat is an important dietary
determinant of coronary heart
disease

 It became one of the primary
justifications for the hypothesis that
saturated fat is dangerous

 There was, and still is, much
controversy about the validity of
this study
Study Design:

• The 7 Countries Study was a
population-based survey in 16
cohorts of men aged at that time
40–59 years


• Between 1958 and 1964, 12,763
men were examined


• These men were re-examined
after 5 and 10 years of follow-up
and were followed for mortality
for 25 years


• About 1500 men total died from
coronary heart disease
When available data
from 22 total
countries is tabulated,
the correlation
disappears

• Problems with Correlational
Studies
• Mixed results (Tarino)

• Dietary Paradoxes
• French, Spanish, Swiss
• Traditional/hunter-
gatherer societies

• What happened to guidelines
after this study was released
• AHA originally refuted the
study














Limitations:
Confounding
Variables
 Type of saturated fat
 SF Lauric Acid antiatherogenic and
confers immunological benefits

 Quality of saturated fat
 CLA, known to have anti-
carcinogenic and anti-atherosclerotic
effects, is 500% greater in grass-fed
cows

 Saturated fat raises large, fluffy
LDL (benign) cholesterol and not
the atherogenic small, dense LDL
 Only able to distinguish between the
two recently (Krauss)
Conclusions/Implications

 The reviewed evidence calls into question the wisdom of
public health organizations recommending that
Americans should consume less than 7 percent of their
diet as saturated fat.

 Instead of saturated fat being the agent behind
metabolic syndrome, it is possible that foods that
stimulate insulin as well as refined vegetable oils may be
the true culprits

Recommendations
 A limited number of randomized clinical interventions
have been conducted that have evaluated the effects of
saturated fat on risk of CVD; greater emphasis on such
trials needs to occur

 US Dietary Guidelines based on insufficient evidence;
needs to be reexamination of their ability to positively
affect current health crisis

Questions?
References
 Grootveld, et. al. In Vivo Absorption, Metabolism, and Urinary Excretion of a, b-Unsaturated Aldehydes in
Experimental Animals; Relevance to the Development of Cardiovascular Diseases by the Dietary Ingestion
of Thermally Stressed Polyunsaturate-rich Culinary Oils. J. Clin. Invest 1998;101(6)1210–1218


 Mbalilaki JA, Masesa Z, Strømme SB. Daily energy expenditure and cardiovascular risk in Masai, rural and
urban Bantu Tanzanians. Br J Sports Med 2010;44:121-126.


 Louie JC, Flood VM, Rangan AM, Burlutsky G, Gill TP, Gopinath B, Mitchell P. Higher regular fat dairy
consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes. Nutr
Metab Cardiovasc Dis. 2012 Sep 26. pii: S0939-4753(12)00193-7.


 Anitschkow N. A history of experimentation on arterial atherosclerosis in animals. Cowdry’s
arteriosclerosis: a survey of the problem. Springfield, IL: Charles C Thomas, 1967:21–44.. Kato H,
Tillotson J, Nichaman MZ, Rhoads.


 Hays JM, Disabatino A, Gorman RT, Vincent S, Stillabower M. Effect of a High Saturated Fat and No-
Starch Diet on Serum Lipid Subfractions in Patients with Documented Atherosclerotic Cardiovascular
Disease. Mayo Clinic Proceedings 2003;78:1331-1335


 Halvorsen BL, Blomhoff R. Determination of lipid oxidation products in vegetable oils and marine omega-3
supplements. Food & Nutrition Research 2011;55:5792.
References, continued
 Hoenselaar R. Saturated fat and cardiovascular disease: the discrepancy between the scientific literature
and dietary advice. Nutrition 2012 28(2): 118-23.

 Holmberg S, Thelin A, Stiernstrom EL. Food Choices and Coronary Heart Disease: A Population Based
Cohort Study of Rural Swedish Men with 12 Years of Follow-up. International Journal of Environmental
Research and Public Health 2009;6:2626-2638

 Keys AB. Seven countries: a multivariate analysis of death and coronary heart disease. London, England:
Harvard University Press, Cambridge Massachusetts; 1980
 Kuipers, RS, de Graaf DJ, Luxwolda MF, Muskiet MG, Kijck-Crouwer DA< Muskiet FA. Saturated fat,
carbohydrates, and cardiovascular disease. Neth J Med 2011;69:372-8.

 Mozaffarian D, Rimm, EB, Herrington, DM. Dietary fats, carbohydrates, and progression of coronary
atherosclerosis in postmenopausal women. American Society for Clinical Nutrition 2004

 Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor
changes and mortality results. JAMA1982;248:1465–77.

 Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the
association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010;91(3):535-546.

 Scharf RJ, Demmer RT, DeBoer MD. Longitudinal evaluation of milk type consumed and weight status in
preschoolers. Arch Dis Child 2012; 10:1136