Why I’m not worried about saturated fat or cholesterol

A few weeks ago I shared with you my experience with a vegan diet and why I gave it up. Now we’ll cover the next major step in my understanding and practice of nutrition — no longer fearing saturated fat or cholesterol.

From TN to VA and teaching to engineering

Our story left off in early 2011 with me teaching high school in a small city in Tennessee, recently reintroducing animal products into my routine upon realizing that something was off after a few months eating a vegan diet. I’d been struggling with insatiable cravings, anxiety, depression, fatigue, anxiety, and extreme weight loss, and in reading into my symptoms discovered that perhaps a vegan diet wasn’t optimal for me.

I realized also around this time that teaching wasn’t optimal for me, so in May 2011 I left Tennessee and moved back home with parents in Blacksburg, VA (a bit of a pride-swallowing experience) to determine where I would move next to search for jobs in engineering, which is what I studied at Virginia Tech.

By the end of June 2011, I’d narrowed down my choice down to two options — moving to Denver, CO, with an old roommate of mine from Tech, or moving to Northern Virginia (DC metro area) with a dear friend from my childhood.

While the open plains and the mountains tugged at my heart and sense of adventure, the job market in the DC area was too strong to pass up so I chose to move up to Falls Church, VA, find an apartment (Roosevelt Towers FTW) and search for a job.

I spent about 5 weeks searching for and applying to various positions throughout the area, and landed a sweet gig with a small (three people including myself) engineering firm based in Rockville, MD, doing a ton of work Smithsonian Institution.

No fat, no fun

While I’d chosen to forsake my vegan ways, my eating habits were far from that of the enormous carnivores I saw at the National Museum of Natural History each day.

My breakfasts were usually big-ass bowls of oatmeal with some combination of Greek yogurt, peanut butter, mixed nuts, berries, and/or cinnamon; my lunches were almond butter, cheese, or avocado sandwiches on sprouted grain bread; and my dinners were pitas with veggies, tempeh with steamed veggies, or other generally plant-based meals.

I’d eat some fish and chicken breast every once in a while, and crush a burger or two — usually accompanied by a heavy stout or double IPA (or several) — each weekend, but I was still largely avoiding animal products and fat — especially saturated fat.

As was (and is) the case with most Americans, it was my understanding at the time that saturated fat would raise my cholesterol, which would clog my arteries and increase my chances of disease — particularly heart attack or stroke. I didn’t necessarily like the idea of either of these outcomes so I took steps to ensure my eating habits reflected to this aversion to early death.

However, I still wasn’t feeling very good. I was still battling “hanger” pretty much 24/7, binging on the reg, had the sex drive of a eunuch (which I’m not), was dealing with fits of anxiety and depression, and was skinny AF.

Seek and ye shall find

Being a firm believer in the notion that food was a major determinant of how I looked and felt, I continued to seek out as much of an understanding of nutrition as I could to figure out what I might be missing.

I kept reading articles and blogs, I kept watching YouTube videos, and I kept doing “research” (I use that term 90% joking, 10% serious) in search of what I was missing when it came to how my good was affecting how I felt.

Soon enough, I’d learn that there is a lot of B.S. in the nutrition world, that there is no “one size fits all” solution, and that I’d need to continue experimenting to get myself back to the healthy, energetic, dude that I once was.

In the summer of 2012, right around the time of the derecho that caused quite a ruckus across the Mid-Atlantic, I started to learn that my understanding of saturated fat, cholesterol, and health may have been deeply flawed — or at least incomplete.

Public perception of a suspect wrongfully convicted

I came to learn that our current collective views on saturated fat and cholesterol are analogous to a dude who had been wrongly convicted of a heinous crime in the past, vilified for decades, and since been exonerated, but is still feared by the public.

After decades of being told that this individual is guilty and should not be allowed back into society, a few forensic experts have pointed out that the evidence leading to this person’s conviction was deeply flawed. Unfortunately, this individual’s guilt has been so deeply engrained into the public psyche that it will take decades more before they are fully exonerated.

Now released from prison with his record cleared, this individual still has a difficult time finding a job, making friends, and re-entering society in general due to strong public distrust. Alas, while many folks are figuring out this guy is actually pretty fun to hang out, and gets along with most people, prejudices still run deep.

This dude’s name is Saturated Fat.

This is a blog, not a doctor’s office

Before we proceed, I should make it crystal clear that I am not a doctor. I’m just a dude sharing my own experiences with food, training, and life. Anything I write or share on this blog to is not a substitute for the advice of a qualified physician and is not intended to diagnose, treat, prevent, or cure any illness or disease.

We are still learning a ton about how different foods and nutrients interact with our bodies, and much of what I’m going to share below may or may not apply to you depending on your specific circumstances.

Since I’m not qualified to determine the strengths, flaws, and relevance of specific studies, I will not do you the disservice of providing links to such articles that support the ideas and concepts I’m about to share. All studies are flawed, statistics can be “massaged”, and I’m not keen enough to identify which specific studies are or are not the strongest relative to other studies.

Most of what you’ll read below is a synopsis of concepts I’ve learned from the work of Denise Minger, Dr. Peter Attia, Dr. Rhonda Patrick, Dr. Jonny Bowden, Dr. Chris Masterjohn, Dr. Sarah Ballantyne, Chris Kresser, Mark Sisson, Nina Teicholz, and a few other people I’ve chosen to trust (you may or may not do the same).

At the end of this article I’ll provide links to articles and videos from them and others, and implore you to explore these concepts in further detail than I’m able to provide.

Saturated fat, cholesterol, and heath

Let’s kick this off by briefly touching on the positive roles that saturated fat and cholesterol play in promoting optimal health and wellness.

Saturated fat plays an important role in the health of our cell membranes, vitamin absorption, and is a readily available source of fuel for our bodies. It’s also resistant to oxidation, which can lead to inflammation in the body, and typically has a high smoke point, making it a great option for cooking. Our bodies like saturated fat as a fuel source so much, that it’s what we store reserve energy

Cholesterol also plays an important role in the health of our cell membranes and vitamin absorption, as well as insulating neurons (nervous system cells) and producing hormones. As a matter of fact, our livers produce much more cholesterol than we get from our diets, and the more cholesterol we eat, the less our livers make, while the less cholesterol we eat, the more our livers make.

For most of us, dietary cholesterol is not a major contributor to baseline blood cholesterol levels. There are some folks who seem to see their blood cholesterol increase in response to dietary cholesterol more than others, or may have conditions preventing them from metabolizing cholesterol as effectively as the rest of us, but whether this presents a problem in terms of negative outcomes doesn’t seem to be clear.

So, if saturated fat and cholesterol are so important, how did they come to be so vilified?

Saturated fat, cholesterol, and heart attacks

The prevailing idea behind diet and heart disease is that more saturated fat in the diet leads to more cholesterol in the blood, and that more cholesterol in the blood leads to higher risk of plaque accumulation, which results in higher risk of cardiovascular (heart and blood vessels) disease.

In short, the idea is that higher levels of saturated fat in the diet increase risk of cardiovascular disease.

The first part of this hypothesis — that increased saturated fat in the diet does appear to raise cholesterol in the blood — is widely understood to be true. However, the second part of the hypothesis — the idea that higher cholesterol in the blood contributes to cardiovascular disease — is the part we seem to have wrong.

The Seven Countries Study, ice cream, and drowning

One of the earliest scientists to really take the idea that saturated fat contributes to heart disease and run with it was a dude named Ancel Keys. Back in the 1950’s, Keys implemented a study called “The Seven Countries Study”, the data from which he eventually presented as strong evidence in support of the lipid hypothesis.

In a nutshell, Keys went around to a bunch of countries, assessed what they were eating, read about why they died, and then looked for patterns. The pattern he presented was that the countries that ate more saturated fat also had higher rates of death from cardiovascular disease.

The thing about The Seven Countries Study is that the data actually involved quite a few more than seven countries. It just so happens that the seven countries to be included in the final study happened to be those that fit Keys’ hypothesis the best — a practice we call “cherry picking”.

Oh, and there were a few other confounding factors involved in Keys’ observations that weren’t accounted for in the published study either. For example, some of the populations Keys observed were practicing Lent at the time — abstaining from many animal products that include saturated fat.

Here’s an analogy to help you understand confounding factors.

If we were to look at a graph plotting levels of ice cream consumption along with levels of drowning deaths, we might see a correlation. That is, at times when ice cream consumption rises and falls, rates of drown deaths might also rise and fall. However, this might not necessarily mean that ice cream consumption leads to drowning deaths, but instead that during the summer months people are eating more ice cream, while also swimming more often, thus presenting more opportunities for death of drowning.

Further, there have been multiple studies since the time of The Seven Countries Study that do not support the hypothesis that saturated fat or total blood cholesterol cause heart disease. Unfortunately, these studies often fall on deaf ears or, in the case of at least one, were swept under the rug for years. It would also be negligent of me not to mention that research is a game of statistics, that none of the mentioned studies on either side of the debate are flawless, and numbers can nearly always be “massaged” to support a given hypothesis.

To summarize, The Seven Countries Study as published didn’t include all of the data that was collected (or available) and didn’t account for confounding factors like the lifestyles and other dietary patterns of those studied. Many studies have since come out since The Seven Countries Study that vindicate saturated fat and cholesterol with respect to cardiovascular disease, but they have been slow to gain traction and make significant change in the public perception and policy.

Lipids, plaque, and firemen

Since it’s apparent that relying solely on studies to give us a definitive answer on the issue, perhaps a discussion on the mechanism behind arterial plaque accumulation would be of benefit. I’ll keep this part short and sweet, as I’d prefer not to tread too far into “outside my wheelhouse” waters.

The idea that cholesterol in the blood causes heart disease is mainly based on the idea that higher levels of blood cholesterol lead to cholesterol accumulating on (clogging) the walls of our arteries in the form of “plaque”.

However, although cholesterol is present in plaque, it does not seem to be the cause of plaque. Rather, the accumulation of cholesterol in plaque is actually part of an immune response linked to chronic inflammation.

You might think of blaming cholesterol for arterial plaque as you would blaming firemen for fires — cholesterol is always on the scene, but it may just be helping to “put out the fire”.

HDL, LDL, and proxies

Another idea that warrants a bit more discussion is the idea of HDL and LDL.

I’ll admit before proceeding that I don’t fully understand everything I’ve read regarding the roles of these two guys in heart disease. That said, what I will share with you should be at a general enough level that I won’t get too much wrong (alas, that is pretty much an inevitability when it comes to diet and disease).

Basically, HDL and LDL are two types of lipoproteins that carry cholesterol through the blood. It’s generally accepted that HDL is “good” (protective of heart disease) and LDL is “bad” (contributed to heart disease). However, as our ability to better measure and classify these particles improves, our understanding of their function and what role(s) they play in heart disease becomes a bit more nuanced.

For example, there are a couple different types of LDL — large, fluffy LDL and small, dense LDL. The large, fluffy LDL are thought to be benign, whereas the small, dense LDL are those that are thought to be the particles found in plaque (remember the firemen analogy).

Additionally, we’re starting to understand that it’s not necessarily the total amount of LDL in our blood that matters, but the number of LDL particles that matter. That is, for a given volume of LDL (what is typically measured) in the blood, a higher particle count (what is typically not measured) would indicate more small, dense, LDL particles.

Finally, it should be noted that however we measure cholesterol, HDL, or LDL, we’re really just using them as “proxies”.

This means that when we measure HDL, we aren’t directly measuring healthy outcomes (long life free of heart disease) and when we measure LDL, we aren’t directly measuring negative outcomes (deaths from heart disease). Rather, we’re measuring markers that we associate with positive and negative health outcomes — regardless of whether that association is right or wrong.

That is, high LDL in and of itself might not necessarily be contributing to heart disease, but might instead be a result of the other factors that do contribute to heart disease.

“A leads to B” plus “A leads to C” does not mean “A leads to B, which leads to C”.

Remember ice cream and drowning?

Similar concept.

Healthy vs. unhealthy fats

Before wrapping this up, I’d like to touch briefly on the idea that there are still fats that many of us are eating regularly that do appear to contribute to disease through inflammation and insulin resistance. These fats are mainly processed trans fats and oils found in vegetable and seed oils like margarine, corn oil, soybean oil, rapeseed oil, vegetable oil, and the likes.

While healthy fats from olive oil, avocado oil, nuts, wild caught cold water fish, and healthy, pastured animals (including butter, tallow, lard, and that which comes along with meat) seem to be rather benign, the other vegetable and seed oils listed above are probably best avoided.

Oh, and my advocation for consumption of butter and oil is not the same as me telling you to dump butter and coconut oil into your coffee every day. Sure, this might “work” for some people in the context of their overall eating habits, preferences, and goals, but for some of us it might be problematic for a variety of reasons beyond the scope of this blog post.

What to do with all of this information

In conclusion, the study that really kicked off the whole “saturated fat, cholesterol, heart disease” idea was deeply flawed, and there have since been additional studies that seem to have vindicated saturated fat and cholesterol, but changing the direction of our current dietary guidelines and public perception has been much like trying to steer a big ship with a tiny rudder.

We do appear to be making some progress, as cholesterol was recently (quietly) removed from the Dietary Guidelines for Americans as being a nutrient of concern, which is a big step in the right direction. However, a majority of doctors, dietitians, and other professionals have been taught that saturated fat causes cardiovascular disease for so long that it will take time for this idea to be cleared from practice and policy.

Also, we’re still learning so much about the factors involved in disease, that we’re far from really having a firm grasp on what steps we might take to live long, healthy, happy lives. As we learn more about genetics and the microbiome, we may learn that some people might benefit from eating diets lower or higher in saturated fat than others, but not for the reasons that many of us currently might choose to do so.

My intent is not to tell you what to or not to eat, what does or does not contribute to disease. I also won’t pretend to know what markers you should or should not be looking at on your next blood panel. I consider focusing on specific nutrients or blood markers without regard for our overall eating habits and lifestyles to be akin to mowing our lawns while our houses are on fire (got that phrase from Precision Nutrition).

Get some sunlight. Nurture your relationships. Drink water. Eat a variety of protein, veggies, minimally processed carbs like fruit and tubers, and healthy fats from nuts, avocados, olive oil, wild caught fish, and pastured animals. Manage stress. Sleep. Move often. Have fun.

Do all of this consistently, and you’ll likely be turning your personal dial much further towards “health” than “disease”.

Most importantly, keep learning, keep asking questions, and keep figuring out what works best for you — not somebody else.

You are your best advocate.

“Question everything. Learn something. Answer nothing.” — Euripedes

Learn more:

I’d implore you to explore the resources below, as they are the bases from which I’ve formed my own perspective on saturated fat, cholesterol, and health. None of them get everything “right” or include all of the nuances involved in how specific nutrients affect our health. You might consider each of these resources to be individual puzzle pieces that you might put together to form your own picture of what roles saturated fat and cholesterol might play in your diet.

The Truth About Ancel Keys: We’ve Got It All Wrong, Denise Minger

Dr. Rhonda Patrick Explains the Cause of Heart Disease (video)

Readdressing Dietary Guidelines, Dr. Peter Attia (video)

The Straight Dope on Cholesterol, Dr. Peter Attia (video)

The Cholesterol Conundrum — and Root Cause Solution, Ivor Cummins (video)

Dr. Jonny Bowden “The Great Cholesterol Myth” (video)

Dr. Chris Masterjohn’s Blog “Cholesterol and Health”

A world renowned cardiologist THE DIETARY GUIDELINES ARE A LIE! Salim Yusuf full speech 2017 (video)
***Please don’t let the extreme video title, or channel name, chosen by the person who posted this video keep you from considering the information presented. The original version of this video that I watched, posted in less… hostile… contexts, is no longer available.

Why Has the American Approach to Heart Disease Failed?, Chris Kresser

Nina Teicholz at TedxEast: The Big Fat Surprise (video)

The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet, Nina Teicholz (book)

The Definitive Guide to Saturated Fat, Mark Sisson

The Definitive Guide to Cholesterol, Mark Sisson

All About Healthy Fats, Precision Nutrition

Why Vegetable Oils are Bad, Dr. Sarah Ballantyne

Originally published at https://coachroba.com on February 1, 2018.