Saturated fat: the making and unmaking of a scientific consensus (2022)

The guidelines from 1980 have indeed mentioned reducing satiating saturated fat and since then people have been getting more and more obese.

The problem is that we have, unfortunately, been listening.

Exactly. And we can’t blame nutrition science for that.

>put whole grains specifically

This is false, in the 90s when I grew up there was no such criterion, and the posters of the pyramid prominently depicted sliced white bread.

The worst part of the food pyramid was the indication to use all fats and oils sparingly. There's never been any point in which the evidence suggested that olive oil or other monounsaturated fats should be avoided

The food pyramid makes economic sense.

Grains are cheap and energy dense, if your goal is to feed a large population it makes a lot of sense to put them at the base of the pyramid, that's what will keep you alive, as in, not starving. Higher up are fruits and vegetables, also cheap, they will provide with nutrients that you need to stay healthy on top of the calories that will keep you alive. Higher up are animal products, expensive but rich in proteins and a few other nutrients that are a bit lacking in the base layers, they help you get stronger and more performant in addition to healthy and alive. On top are pleasure foods, not really necessary for your body, but enjoyable.

I take it like a mirror of the "hierarchy of needs" pyramid rather than nutritional advice for people with effectively unlimited resources.

The elephant in the room is that nutrition studies (whose results influence health and economic policy) are frequently funded by dominant players of the food industry, creating a huge conflict of interest. This has to end.

> The food pyramid put whole grains specifically at the base of the food pyramid. Not sure why you consider this objectionable, the body of evidence overwhelmingly points in the direction of benefits for wholegrain consumption.

Citation please or I'm calling extreme bullshit. Everything I've ever read has argued for putting more nutrient dense fruits and vegetables as the basis for a healthy diet.

More importantly, I think the nutrition community was woefully naive to the point of being negligent when they tried to defend the food pyramid. One quote I heard was "When we were recommending lower far intake, we never imagined Snackwells." Well, why TF not??? It should have been blatantly obvious that by demonizing fat and making people feel like carbs were "free" that companies would react appropriately and come up with fat-free, sugar-stuffed replacements that had a huge amount of calories, left you feeling unsatiated, and tasted like sweet cardboard. Probably even worse was frankenfood like Olestra.

I agree with the original point - while I think the field of nutrition science has improved a lot over the past decade, they have a ton to answer for and never did an appropriate "mea culpa" for all the great harm they caused.

> The food pyramid put whole grains specifically at the base of the food pyramid. Not sure why you consider this objectionable, the body of evidence overwhelmingly points in the direction of benefits for wholegrain consumption.

my humble research found that diffs in nutrition between whole grains and refined grains carbs is very small compared to say whole grain to some complex carbs from leaf veggies. The same goes to glycemic index, satiety index, etc.

Let's get real here: the benefits in the USDA Food Pyramid are benefits for agribusiness and the big subsidized food producers. The benefits that the USDA pushes have nothing to do with good nutrition for the average citizen. This is 100% "regulatory capture" as we call it around here. The Food Pyramid is a scam and a hoax, and the more it can be ignored, the better.

When I joined a Christian Health Sharing ministry, they determined that I needed remedial help, due to hypertension and dyslipidemia. They assigned me to monthly virtual meetings with a dietician. The dietician's advice horrified me, because it would've made me sicker, and exacerbated my conditions. I approached the ministry's administrators, requested a replacement dietician, and they replaced her alright. The new dietician had basically the same credentials and the same letters after her name, but she was way more flexible, listened to my reasoning, and supported my choices with encouragement.

My parents followed every "diet fad" in the 1970s-1980s, from 2% milk, to margarine, to yolk-less-egg-whites, to reducing red meat, to low-sodium everythings, to bottled fluoridated water. It was sheer torture and disgusting. My mother didn't know the first thing about flavor or pleasure in cooking, and never used the spices in her rack. Our food was always bland. For breakfast she'd slap down a jug of milk, a box of Chex, a bowl and a spoon, and abandon me to go do housework. I would sit there and read the mendacious lies known as "Nutrition Panel" on the side, and simply stewed in my resentment for the whole thing. It's a travesty.

This is the story as old as time. Much of science is good faith, fairly accurate, and nuanced.

Policy and advocacy is deceptive, dishonest, and lacks nuance.

Not sure why you’re being downvoted, this is one of the best takes here. It sits squarely in the realm of evidence where the majority of these comments are anecdotal and they don’t translate to population level studies.

It’s a shame that our institutions have burned so much good will and credibility that they’ve created an environment for this to thrive.

All metrics I see show faith in these institutions going to zero. Most good science I see is making (and has been making for decades) a really strong case that this loss of faith is deserved.

Credentialism is collapsing under the weight of its own corruption.

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Actually, excessive omega-6 arachidonic acid intake is far more problematic than saturated fats. Dr. Gregor knows about the arachidonic acid problem but doesn't seem to understand it. https://nutritionfacts.org/topics/arachidonic-acid/ Compare what Gregor says to this comment by Norwegian animal science researchers. "Chicken meat is commonly regarded as a healthy type of meat; it is popular, and hence the consumption has increased. Chicken meat is lean, protein-rich and rich also in other important nutrients. However, the fatty acid composition is strongly dependent on the diet fed to the birds. A typical modern poultry diet is rich in cereals having a high ratio between omega-6 and omega-3 fatty acids. This diet is very different from the natural diet for the same species containing more green leaves that are rich in the omega-3 fatty acid alpha-linolenic acid (ALA). It has been shown that a diet rich in ALA gives increased concentrations of ALA, eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in broiler muscle and improved, i.e. reduced ratio between total omega-6 and total omega-3 fatty acids. The utilisation of ALA and linoleic acid (LA) for synthesizing EPA and arachidonic acid (AA) depends on feed concentrations of ALA and LA as well as on other factors. Much AA in the diet may contribute to prostaglandin overproduction in disease situations in humans, but some AA is necessary for virtually every body function. Dietary sources of AA are especially meat, eggs and offal, with smaller amounts coming from milk and fish. https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/ It's likely that the global increase in obesity and diabetes is largely due to increased consumption of grain-fed monogastrics such as poultry and swine. A 2021 paper by Australian zoologist Anthony Hulbert, PhD entitled 'The under-appreciated fats of life' concludes, "As a final comment, I note that we are only beginning to understand the implications of the balance between omega-3 and omega-6 fats in the human diet. Although most animals have a relatively constant diet, we humans are especially diverse (both between individuals and over time) in the types of food we consume. Over the last half-century, the modern human food chain has emphasised omega-6 and diminished omega-3 intake, largely because of: (i) a shift from animal fats to vegetable oils, (ii) an increase in grain-fed meat and dairy, and (iii) a decline in full-fat dairy products from grass-fed livestock (an important source of omega-3). In the opinion of the current author and others, these diet trends are likely to be responsible for the increased incidence of obesity and other modern epidemics of chronic disease, but that is a story for another time." https://journals.biologists.com/jeb/article/224/8/jeb232538/...

I believe the current thinking is to consider the effect on inflammation and bad cholesterol.

If your doctor says your number one priority should be to lower inflammation or lower bad cholesterol, you should consider lowering the amount of red meat.

The issue is that of course we need protein. Older people who tend to lose muscle mass and are at risk of falling should actually increase protein intake and weight resistance exercises. If their stomach tolerates fish legumes nuts, wonderful. If they tolerate red meat better, then they should eat red meat. Like every thing else in life, there are trade offs and nothing is completely healthy or unhealthy.

Sure. The government isn't your mommy, and neither are corporations. People have to take responsibility and look out for their own health. Nobody else is going to do it for you.

> Get a blood lipids panel and see what your ApoB is like!

not sure how this tell me if i have 'unique feedback mechanism' . wtf does that phrase even mean.

> Your diet is by far the most important part of your health.

If it was the case, we wouldn't have an article like this. We would have very obvious results, and we don't. Some claim we do, but if you look closer, it is not obvious at all.

Note that by "it doesn't matter", I don't mean that anything goes. Only eating deep fried donuts is not good, for the same reason eating only apples is not good, you won't get everything you need from a single food source. If you do that, you will get what are now very obvious and easily identified diseases, like scurvy, anemia, etc... Also, eating too little or too many calories is also not good, especially too little, but the effect (starving to death) is even more obvious.

What I meant by "it doesn't matter" is that with a varied diet and the right number of calories, the details don't matter. And I am convinced that a base diet of fried donuts to the appropriate amount of calories, with supplementation (vitamins, ...) to compensate for deficiencies is fine, or at least, not terrible.

And I also believe that "the appropriate number of calories" is the tricky part. Hunger mechanisms are supposed to regulate this, but they are not adapted to modern society, where rich food is plentiful. Hence the psychological aspect, which Ozempic targets.

Did you actually follow up and read the studies she cited in detail, though? Much of what she claims is misrepresentation, such as the insinuation that the Cochrane review found no evidence of SFA consumption being associated with risk.

one is based on an entire industry of people working in so many conflicting fields that it would boggle the mind if they could all be bought, and the other is based on one person who built their fame on being contrarian without a lot of evidence.

I think the question still makes sense, why people are willing to ignore a ton of evidence from a lot of different unaffiliated people and focus on one article by one person that really doesn't add up to much of an argument - I think the answer is just that this is what they want to hear, so it must be right.

If the consensus is evolving, sure. If the consensus is going back and forth for decades, and each time it is presented with the authority of medical or physical science, then it is normal and correct to stop listening at some point.

When scientists have weak theories that they're not sure of, they're not supposed to share those breathlessly with the public, and certainly not try to shape public laws based on the theories they know are weak.

And nutrition science has been guilty of this for over a century. You can find people in the field making confident recommendations and setting dietary standards from the time when they didn't know vitamins were a thing. If you followed the science on nutrition and adjusted your diet accordingly around 150-100 years ago, you could literally get scurvy or other vitamin deficiencies. The field has evolved a little bit, but it's still extremely weak as scientific fields go.

If. What was proclaimed as nutritional facts decades ago turned out to be tainted by industry/lobbying interests.

I don’t believe saturated fat is evil. I believe that consuming more than 10%E from SFA increases risk of CVD, and replacing SFA with PUFA reduces risk of CVD.

And yes, that is my citation in support of that claim. Quote: “There was a 17% reduction in cardiovascular events in people who had reduced SFA compared with those on higher SFA”

and

“When we subgrouped according to replacement for SFA, the PUFA replacement group suggested a 21% reduction in cardiovascular events”

I explain why the null findings on insensitive endpoints aren’t the gotcha some people think they are here: https://news.ycombinator.com/item?id=41960046

They are related, dietary cholesterol does affect serum cholesterol: https://pubmed.ncbi.nlm.nih.gov/30596814/

Experimentally and experientially, saturated fat has no lasting impact on cholesterol levels. Those are genetically determined. https://www.ketogenicforums.com/t/dave-feldman-its-about-ene...

Serum levels of saturated fat are not related to dietary saturated fat intake. https://news.osu.edu/study-doubling-saturated-fat-in-the-die...

What puts a person at risk for chronic inflammatory diseases is excessive polyunsaturated fatty acid intake; in particular, arachidonic acid. Excerpt: "The Mediterranean diet is low in arachidonic acid and rich in healthy fats such as monounsaturated fats found in extra-virgin olive oil (EVOO), nuts and omega-3 fatty acids from fish, which has been shown to lower the risk of inflammation, heart disease, cancer, diabetes and obesity, and other degenerative diseases." https://advancedmolecularlabs.com/blogs/news/new-red-meat-st...

In the middle decades of the 20th Century the heart attack rate was extremely high. Much of that mortality is likely attributable to the release of heavy metals into the environment. Heavy metals such as lead tend to cause arterial plaques to rupture. Excerpt: It must be theoretically expected that there will be a synergistic (multiplicative) interaction between low Se intake (leading to undersaturation of the blood plasma with selenoprotein P), large exposure to toxic heavy metals (which may be expected to lead to simultaneous inhibition of selenoprotein P and extracellular thioredoxin reductase), a high dietary LA/oleic acid intake ratio and high rates of superoxide anion radical production from endothelial NADPH oxidase as causes of more rapid LDL oxidation - with a high rate of LDL oxidation leading in turn to high rates of atheromatosis development. Against this background it is not unreasonable to speculate that excessive exposure to a number of toxic metals from a wide range of different sources may have been one of the main causes of the post-war epidemic of coronary heart disease both in North America and Western Europe. These include lead from car exhaust and from drinking water (especially in the British Isles), as well as mercury and silver from dental amalgam fillings and cadmium from acid rain, commercial fertilizers and tobacco smoke...This hypothesis would appear to be in reasonably good agreement with what is known about the historical curves both for coronary heart disease mortality and for the use of lead as an additive in gasoline in Western Europe, compared to North America. The use of lead as an additive in gasoline started earlier and ended earlier in the United States than it did in the countries of Western Europe. And the epidemic of coronary heart disease has followed a similar time course with both its start and its culmination occurring earlier in the United States than in Western Europe." https://pmc.ncbi.nlm.nih.gov/articles/PMC3031257/

>> oxidised, damaged, small, dense LDL

I am so confused. What on earth is a " dense Low-Density-Lipid" ?

Please help me understand whether or not this is an oxymoron?

The problem with the “lbLDL is harmless” argument is that, while it was an interesting theory ten years ago, we have very strong evidence this is not the case now. I could go through exactly why people thought this is the case, and why the hypothesis turned out to be wrong, but this paper does a better job than I could: https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156

Paul Mason is a renowned spreader of misinformation on this topic (and many others). My favourite moment of his is when he tried to teach a clinical research scientist that the lipid hypothesis was false, and in doing so revealed that his entire argument against the lipid hypothesis was based on an undergraduate-level misreading of a study, after which he just ran away from the conversation instead of admitting he was wrong. Absolute chef’s kiss moment, enjoy: https://x.com/avibittmd/status/1335491375073271808?s=46

Technically speaking it does, but only if you’re starting from a point of very low dietary cholesterol intake or you’re genetically predisposed to have high sterol absorption.

So if you’re, say, a vegan with very little cholesterol intake then adding some would result in significantly higher serum cholesterol. However, for most people in western populations, they’re already above the point where the effect tails off, which is why dietary guidelines generally don’t focus on dietary cholesterol anymore.

Shouldn’t that be “sugars and simple carbs” tho?

Don't smoke, keep your blood pressure under control, and don't become insulin resistant.

Generally speaking, decreasing inflammation in your body. Can google how to reduce inflammation.

How do you feel about starting with the opening paragraph on Wikipedia?

Cholesterol is the principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. — https://en.m.wikipedia.org/wiki/Cholesterol

That's a broad question. Let's turn that around. What harm do you think serum cholesterol could be causing? Like which specific mechanism of action are you concerned about here?

Personally (not the parent) I'm vegan for moral reasons, so I'm being vegan despite (not for) it's health effects. As every extreme diet, it requires monitoring nutrition intake and occasional supplementation in order to avoid micro- and macroelement deficiencies and health problems.

In my case, I didn’t cut carbs. Quite the opposite. The diet could be described as high carb.

Did you stop reading at the end of the part you quoted? Their very next words literally say this.

The relative was also taking statins, so it is hard to say.

following the normal course of events leads to subsequent surgical interventions based on the people I've seen...

There are so many great vegan protein powders these days. I'm not vegan but enjoy most of them. Soy goes down the best for me.

Maybe try whey isolate?

No I guess there must be some people for whom it isn't obvious. I was kind of assuming the intended audience for the advice was people who are interested enough in diet to look at a book on nutrition, for example, not people who just eat junk without thinking about it.

But yes for those people I do think the "eat food" thing should be emphasised and laid out in more detail, maybe. Hard for me to have an opinion there as I just can't put myself in the shoes of someone who eats that kind of stuff.

If he has his own special meaning of the common word "food", then it's no longer a spiffy quote. And now you need to get into all the nitty gritty of this recommendation to actually take any advice from it.

Even this term "ultra-processed" is highly suspect when you start investigating it more deeply. Plenty of traditional foods are quite processed - bread being one of the oldest. Is it better to eat 200g of bread (artisanal, wood fired, using traditionally-milled non-GMO pesticide free grains), or a steak?

The definition I've heard of his for "food" in this sentence was "things your grandparents would recognise", although by this point it might be "your great-grandparents".

It's not a misquote unless he misquoted himself

https://www.nytimes.com/2007/01/28/magazine/28nutritionism.t...

In what way am I shutting down discussion? I’m just participating in it. There’s a great deal of misinformation on this thread that could lead people to make lifestyle decisions that would put them at risk. Don’t see why there’d be an issue in discussing the evidence behind this misinformation so people can come to their own, hopefully informed, decision instead of a misinformed one.

I’m not interested in poor attempts at mind reading (“this subject makes you desperate to call yourself a specialist”) but I’m happy to discuss the evidence on this subject if you’d like.

A null finding in a study does not mean it “doesn’t matter”. Let’s take an extreme example: we want to know if exercise reduces mortality, so we randomise one arm of a cohort of 20 people to an exercise regime, while the other arm does nothing. After four weeks, we compare the death rate in each group. There’s no significant difference.

Does this mean exercise “doesn’t matter” for mortality, or it’s in the “doesn’t affect category”? No, of course not - the finding was null because the timescale was too short and even then, the statistical power from a cohort of 20 is going to be very low.

Likewise, if you look at the study characteristics, most of the studies were too short to find a significant outcome on an insensitive endpoint like CVD mortality or ACM. FWIW, Dayton 1967 had a followup of 8 years and did find significant increases in mortality endpoints in the SFA group, but those results are pulled towards null in the meta summation by the other, shorter studies.

CVD events are more sensitive because they don’t require the participants to die of a heart attack in order to register as a data point.

So no, there’s no lying or cherry picking going on here. In order for that to be the case, you’d have to argue that angina and non-fatal heart attacks are not negative health outcomes. If they are, then it’s demonstrably the case that SFA consumption is associated with negative health outcomes, and Nina is telling porkies.

As for your accusation that I’m lying - what false claim did I make? Be specific.

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Tbh the evidence in the literature on seed oils is actually overwhelmingly in their favour. Studies that find in the opposite direction are few and far between, comparatively.

So then we’re just left with “lots of people on the internet believe a thing to be true, surely there’s something in it.”

Hopefully I don’t need to come up with a counter example here, you can just see how poor an argument this is.

And the author of the article has a long history of misrepresenting science and has direct financial incentive to push her specific view.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

The BMJ got in trouble for believing her and had to issue retractions because of it:

https://www.theverge.com/2015/10/26/9616122/bmj-nina-teichol...

There is no evidence that Nina Teicholz should be given the benefit of the doubt when it comes to her arguments and plenty of evidence that she should be treated with skepticism.

> There's no way that someone today could take a plant that naturally produces a useful but toxic industrial lubricant, modify it to be less toxic, and then start feeding it to humans. But in the 1970s you could still get away with stuff like that.

Why? I am not seeing the causation. Tomatoes came from a family of plants that are not edible, and now they are consumed worldwide.