What do I mean? Here’s a short list of the bait that draws you in and the inevitably divergent truth reserved for the fine print.

Sugar Is the Problem Now, So Saturated Fat Is Not

I have seen innumerable commentaries propounding this position in all manner of media, yet only a vanishingly small fraction of them even hint at familiarity with the underlying scientific evidence. The mainstay, in this post-truth age of alternative facts, is predictable: citing blogs, blogs, and more blogs in a sequence of those blind to the literature they claim to be invoking being led by those comparably blind to it but ideologically aligned.

While there are many articles that pertain here, including some that have been massively misinterpreted and some subjected to revisionist history—the two most often invoked are meta-analyses from 2010 and 2014. Leaving aside the details that are grist for different mills on different days, what both papers showed is that rates of heart disease were just about identical at the lower and higher end of the saturated fat intake ranges assessed.

Since, to the extent saturated fat in the prevailing modern diet was ever actually replaced by anything, it was replaced by refined carbohydrates and added sugar—not lentils and kale—these studies actually lead to a conclusion all but anathema to the “eat more meat, butter, and cheese” cabal. Diets higher in saturated fat and thus lower in refined carbohydrates and added sugar seem to produce identical rates of heart disease as diets higher in refined carbohydrates and added sugar and lower in saturated fat. If the epidemiology is what’s good for the goose is good for the gander, these papers can only be interpreted to show one thing: Excesses of sugar and saturated fat appear to be all but exactly, commensurately harmful. These studies show that there is more than one way to eat badly—and we, the gullible people, appear committed to exploring them all.

Butter Is Back

This topic has perhaps been whipped to death already, but the simple truth remains elusive. Isolating any specific harms to health over time of butter, per se, is all but impossible for rather obvious reasons: Few diets that are high enough in butter to affect health adversely are “good” in other ways, and few diets that are generally “good” are high enough in butter for it to be very harmful, so whether butter is harmful in and of itself cannot be clearly determined. In some ways, looking for the harms of just butter, or any one food for that matter, is like attempting to indict the culpable snowflake in a deadly avalanche. Every individual snowflake is innocent; but together, they did it!

Diet is the same; it’s the overall dietary pattern that matters. The danger in messages about isolated foods, or nutrients, is that they readily become misleading tales that wag the popular dogma. Saying that “butter is back” implies that eating butter is actually good for health, which further implies that the kinds of diets prone to be high in butter are “good” for health. But the relevant literature shows nothing of the sort.

There is no evidence that butter is beneficial to health. There is some evidence that butter, per se, may increase the risk for some chronic diseases but not others. Contrast this with olive oil, for instance, where there is compelling evidence of actual benefit! So, while we get headlines like “butter is back,” what they actually mean is: butter, by itself, may confer only some of the harms formerly associated with it. That’s right up there with: guilty of negligent homicide, but not first-degree murder. Cue the confetti!

So, fine: Butter is back relative to stick margarine made with trans fat, which one must be living under a rock not to know. Relative to anything actually known to be good for us … not so much.

Full-Fat Dairy Is Better

Claims about dairy fat, like those about butter, beg the oft-neglected question: compared to what? There is evidence in the context of the prevailing American diet, where go-to beverages include Coke, Pepsi, and psychedelic sports drinks incubated in chemistry experiments—that there may be satiety (i.e., appetite control) benefits of full-fat dairy. That makes sense. But is there any evidence that full-fat dairy produces better health outcomes in the context of decent dietary patterns where foods are wholesome and filling and water is the default response to thirst? None that I can find.

The best dairy for those who consume dairy is unresolved once context is considered. But in case you care, here’s my take: We certainly don’t yet know if dairy fat is “good” for us. Rather, we have hints that it may be less harmful than we thought and clearer hints that regular milk is a better choice for the average kid than Coca-Cola. But we have perfectly clear evidence that the fat in nuts, seeds, olives, and avocado is actually good for us. So I get mine there, preferentially.

Low-Fat Diets Fail

To be blunt, the “low fat” rubric doesn’t interest me much. The world’s best diets range from very low fat, to very high; it’s a poor discriminator. That said, “low fat” has commonly served as a convenient flag for plant-predominant and plant-exclusive diets that are, in fact, low in total fat either by design or by the macronutrient happenstance issuing from food choice. Vegetables, fruits, whole grains, beans, and lentils are very low in fat, so diets in which these predominate are apt to be as well.

Almost every study claiming to show the failings of low-fat diets is itself an egregious failure when viewed objectively. As a matter of routine, diets are called “low” fat but are nothing of the sort, and while such diets are “lower” in fat, they may not otherwise be designed to be good diets. In other words, the “low fat” comparison diets are routinely straw men, designed from the outset to go up in smoke. A long-term, randomized comparison of an optimal, plant-exclusive diet that happens to be very low in total fat to an optimal Mediterranean diet quite high in total fat would be extremely interesting, but to date, no such trial has been run. The evidence we do have, from observational epidemiology and the fates of whole populations over generations, indicates that wholesome foods, mostly plants, in sensible combinations produce comparably enviable outcomes whether low in total fat, high in total fat, or in between. Admittedly—that makes for lousy click-bait.

Saturated Fat Is Not the Cause of Heart Disease

There is no single cause of heart disease, of course. The criteria for indictment as “the” cause are rather different from those for “a” cause. Beware conflation of the two.

What do we know? All of the diets most decisively associated with the health outcomes that matter most—longevity and vitality, not just a quick fix, but a lasting solution—are low in saturated fat. That doesn’t prove a diet high in saturated fat can’t produce such outcomes, but it does prove that those who are peddling such diets to you in the absence of evidence are blithely gambling with your life.

We also know that every food decisively associated with reduced risk of heart disease, chronic disease in general, and premature death from all causes—in other words, every food associated with actual benefit—happens to be low in saturated fat (and, of course, in refined carbohydrates and added sugar; as noted, there isn’t just one cause, dietary or otherwise, of bad health outcomes). Maybe this is just a coincidence—but do you want to bet the life of someone you love on that?

The active ingredients in the Mediterranean diet are low in saturated fat. The foods in the portfolio diet are low in saturated fat. The foods in the DASH, Blue Zones, and Tsimane diets are low in saturated fat. Protein sources and fat sources associated with reduction in cardiovascular risk are low in saturated fat. A reduction of saturated fat intake in a North Karelia, Finland, program resulted in an 82 percent decline in rates of heart disease and a 10-year addition to average life expectancy.

So, sure, maybe saturated fat is truly innocent and just happens to be turning up in all the wrong foods and diets coincidentally. If you choose to take that leap of faith, happy landings.

There are many more variations on this theme, but these suffice to show the basic pattern. Those with something to sell—a book, a film, a reputation, or perhaps bacon and burgers—lure you in with enticing bait.

Why should you care? Because diet is now the leading cause of premature death and chronic disease in the United States and in all parts of the modern world where everyone isn’t still smoking. (Where they are, then tobacco tends to be the No. 1 cause of early death, a dubious distinction if ever there was one.) Because optimal diets—any variant on the theme of wholesome, whole, mostly plant foods in sensible and time-honored combinations—are associated with longevity, vitality, and the avoidance of all chronic diseases. Because what each of us eats profoundly impacts the state and course of our health, and what all of us eat profoundly impacts the fate of the planet.

Why should you care? Quite simply: because you are the fish in this scenario, and you know what happens to them when they take the bait.

The post 5 Ways Saturated Fat Defenders Deceive the Public appeared first on Forks Over Knives.

I confess I don’t understand why hypothesizing by several cardiologists who have expressed this opinion before, involving no new research, citing review articles from two and three years ago on the causes of coronary artery disease should be worthy of publication in the peer-reviewed literature. Generally, it requires more than mere speculation, let alone repeating prior speculation, to clear that bar. I further don’t understand why, in light of all the new research coming out weekly, a commentary lacking both novel comments and new research should be newsworthy. But the media picked this one up just the same.

But perhaps we can account for it after all. The authors make a theoretical argument to contend that saturated fat is not a cause of heart disease. There is nothing we seem to like better in the nutrition space than hearing that everything we thought we knew was wrong, and renewing our license to procrastinate and eat whatever we want. This particular scientific journal’s parent has earned a dubious reputation for favoring dietary dissent over consensus, for whatever reasons. As for the media, there is nothing they tend to like better than an endless sequence of comforting the afflicted and afflicting the comfortable, because perpetual confusion means you will need to tune in tomorrow for the newest “truth” populating the most recent 20-minute news cycle.

There’s just one problem with all of this theorizing: there is nothing theoretical about coronary disease. Heart disease remains the leading cause of premature death among men and women alike in the U.S., and increasing portions of the world. Heart disease is not hypothetical—it is an almost entirely unnecessary epidemiological scourge siphoning years from lives and life from years.

The new commentary is, in a word, wrong. It is not necessarily wrong in every particular about saturated fat—there are some legitimate uncertainties there. It is wrong in the whole, because it commits the willful deception, or classic blunder, of conflating the part for the whole.

Saturated Fat and Heart Disease

Whatever the specific, mechanistic involvement of any given saturated fatty acid with atherogenesis and coronary disease, the reliably established fact is that diets high in the foods that are high in saturated fat lead to high rates of heart disease—while many variations on the theme of diets low in saturated fats, whether low high or middling in total fat, are associated with lower rates of heart disease, lower rates of all chronic disease, and lower rates of premature death.

The choice of citations in this commentary is highly selective, very limited, and the interpretation of the studies is flagrantly biased. These authors didn’t ‘happen upon’ this opinion because they just reviewed the literature and found a surprise. They are well established, even famous, for espousing exactly this opinion—so they knew the answer before ever they posed a question. Science tends to be better when the question precedes the answer.

Their conclusion that saturated fat is exonerated is based on straw-man arguments. For one thing, it is very hard to isolate the effects of saturated fat. This is because saturated fat is a diverse class of nutrients with differing effects; because saturated fat is consumed in foods, not by itself; and because more of THESE foods in one’s diet ineluctably means less of THOSE foods. Consequently, the attribution of health effects to just one dietary factor is very difficult. The more enlightened researchers in this space have long shifted their focus to overall dietary patterns, and there—the evidence is nothing short of overwhelming: dietary patterns that produce the best health outcomes overall, including less cardiovascular disease, may be high or low in total fat, but are invariably plant-predominant and low in saturated fat.

Best Diet For Preventing Heart Disease

The best evidence regarding the best diets all points to wholesome foods, predominantly plants, in sensible combinations—but provides no decisive evidence that any one level of total fat is best. What matters are the sources of that fat, with nuts, seeds, olives, extra virgin olive oil, avocado, fish, and seafood favored.

High-fat Mediterranean diets have shown great results, but so have vegan and vegetarian diets, and very low-fat omnivorous diets like that of the Tsimane, so recently in the news. The Tsimane reportedly derive up to 72 percent of their calories from carbohydrate; have very low dietary fat intake; experience inflammation on which the current authors blame coronary disease, but due to infections not eating sugar; and yet have the cleanest coronaries ever studied. Fat level, per se, simply does not appear to be a relevant consideration. But the kind of fat, and the sources of that fat, clearly are. Why would these authors conflate the two?

Why, in particular, would they fail even to mention the Tsimane if their commentary were aiming at illumination on this topic? The answer is—they would not. They failed to mention them, or any studies at odds with their predetermined conclusion, because their goal appears to be self-promotion born of controversy. Controversy sells.

To be fair, there are some valid points in the commentary, but they are so lost in a haze of obfuscation that they are devoid of all value.

Imagine a commentary arguing that, in theory, one particular compound or group of compounds in cigarettes is not responsible for emphysema, or lung cancer. We might already be convinced that these compounds are involved, based on the weight of evidence. We might have meaningful, residual doubts about the specific role of these compounds relative to other constituents of tobacco. But we know for sure that cigarettes, per se, are overwhelmingly linked to both emphysema and lung cancer.

But—not so fast!—our commenting theorists tell us. They remind us of the want of randomized controlled trials. They focus their discussion on this one compound, and point out the uncertainties and methodologic challenges in linking this particular moiety to lung cancer. They espouse theories about general mechanisms—random mutations and the inflammatory effects of psychological stress. They cite very impressive sounding work, such as papers in Science telling us that random mutations occur routinely. They systematically avoid citing any impressive research addressing less comfortable areas, such as the paper in Nature indicating that the majority of all cancer is preventable by modifying lifestyle, with avoidance of tobacco at the top of the list. And, they avoid any mention of staggering volumes of evidence establishing the association not between one chemical, but tobacco itself—with emphysema, lung cancer, and other highly undesirable fates.

Such an argument would be almost exactly analogous to the one now making news. The commentary is mostly wrong, but even when it isn’t wrong, it is profoundly misleading—unless you think uncertainties about which chemical in cigarettes is guilty of tobacco’s crimes against humanity, as a license to go back to smoking until the experts sort it all out.

In a paragraph in the middle of the new commentary, the authors all but declare their profound bias, and commitment to finding and citing only evidence in line with the opinion they owned at the start. They contrast a “low fat” diet deriving 37 percent of calories from fat, with a healthy Mediterranean diet deriving 41 percent of calories from fat, and use the favorable outcomes in the Mediterranean diet arm to dismiss and disparage “low fat” diets, and by insinuated extension, diets generously comprised of mostly vegetables, fruits, whole grains, beans, and lentils.

What isn’t preposterous about this reasoning is just plain mendacious. First, 37 percent of calories from fat is higher than the typical American diet; calling it low-fat is truly bewildering. This is like contrasting 37 cigarettes a day to 41 cigarettes a day. If you think lack of decisive benefit from those four fewer daily cigarettes means it makes no difference whether or how much you smoke, this commentary is for you!

Second, the paper was, as declared in its own title, about saturated fat—what does low total fat (whether described fairly or unfairly) have to do with it? Nutrition experts around the world all but uniformly emphasize the variety and balance of fats over the total quantity, a position formalized in the 2015 Dietary Guidelines Advisory Committee Report in the U.S. Personally, I have long concluded that total fat content is a very poor indicator of diet quality, just as total carbohydrate is. Avocado and wild salmon are high in fat, and so is pepperoni pizza. Lollipops are high in carbohydrate, and so are lentils. A focus on macronutrients is yesterday’s news, was yesterday’s news yesterday, and in the context of the new commentary, is a diversionary tactic.

Speaking of fats and carbohydrates, these authors go on to borrow a page from the playbook of every “it’s all about the carbs” iconoclast preceding them, suggesting that coronary disease is due to inflammation, and that, in turn, is due to refined carbohydrate and added sugar. The problem here is the obvious one: there is no need to choose. Those of us who know that beans are much better for you than bacon-cheeseburgers also know that water is much better for you than Kool-Aid, and steel-cut oats far better than Pop-Tarts. The idea that you need to pick a dietary scapegoat is one of the great boondoggles of modern public health, and only serves the interests of the junk food industry—ever ready to put lipstick on a new pig.

As for the authors’ references to the Mediterranean diet, I can only say I share their enthusiasm. But what the PREDIMED diet showed, and the Lyon Diet Heart Study before it—is the superiority of a diet high in unsaturated fat from olives and avocados, nuts and seeds, and to a lesser extent fish and seafood—to a diet high in sources of saturated fat. THERE WAS NO ‘LOW FAT’ DIET IN THE COMPARISON. That contention is either willfully misleading or an indication of plain ignorance.

I do have one hypothetical provocation of my own. Let’s imagine that a diet rich in beans, and a diet rich in beef, were comparably good for our coronaries.  The evidence indicates that is untrue, but let’s pretend. If we really had such options for health, we would still have no real option for the environment. The environmental argument for plant-predominant diets is, if anything, stronger than the health arguments. For academics in the public health space to offer dietary advice in the age of climate change and ignore the planetary impact of choices made by 8 billion hungry Homo sapiens is a sad abdication of an obvious responsibility we all share.

There is nothing hypothetical about coronary artery disease; it is a real, clear, and omnipresent danger. Its association with dietary patterns and key dietary components is reliably established by staggering volumes of evidence these commentators simply chose to ignore. If you are inclined to buy this misguided and misleading theorizing about diet, keep your credit card handy; I am confident that tobacco industry theorists have something to sell you, too.

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