Dr. Jim Painter PhD, RD The Fat Theory of Heart Disease Etiology Total fat isn’t the issue Saturated fat doesn’t seem to always be harmful 1. Replacing saturated with linoleic acid may not work 2. Replacing saturated fat with omega-3 may provide the benefit Saturated at within the whole food complex may be neutral Coconut oil Dairy fat within dairy foods
2015 Dietary Guidelines
The Seven Countries Study is the cornerstone of current cholesterol and fat recommendations and official government policies
Keys had data available from 22 countries----- only used data from 7 countries that supported his hypothesis
Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press. British physician Malcolm Kendrick used same data available to Keys and discovered that by choosing different countries you can prove an inverse relationship Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.
Fat and Risk of cholesterol Heart intake Disease
The Snackwell Phenomenon Food companies rushed to create low-fat versions of all foods and market it as “heart healthy”
Butter was replaced with margarine which is high in trans fat!
Vegetable oils were aggressively promoted as a healthy alternative to saturated fat most vegetable oils are highly processed, pro-inflammatory, and easily damaged when reheated repeatedly
Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.
The US Federal Guidelines recommend for heart health: • Following a Mediterranean style diet • Limiting total fat to 20-35% of total calories Intake of Energy 42 41.5 41.2 41
40 39.4 39.2 39 39
38
37 37
36
35
34 MeDiet + EVOO MedDiet + Nuts Control Diet Baseline End of Trial Primary End Point (Acute Myocardial Infarction, Stroke, or Death from Cardiovascular Causes 2015 Heart Disease Risk Factors Perceptions- Total Dietary Fat Dietary Fat as a Major Contributor of Heart Disease 100% 90% 80% 70% 60% 50% Dietary Fat as a Major 40% Contributor of Heart Disease 30% 20% 10% 0% Consumers Students (n=40) Faculty (n=17) (n=39) Are they really the villains everyone says?
Nurses Health Study 1.4
1.2
Trans 1 Sats Mono 0.8 Poly
0.6 Change in risk(lowest to highest) to risk(lowest in Change 1 2 3 4 5 Intake (lowest to highest) 2003 Saturated fat improves good cholesterol more than other fatty aids, suggesting it may reduce risk of heart disease. Change in: Bad Cholesterol: LDL Good Cholesterol: HDL
Total HDL Cholesterol Change 2010
Changes in Total Cholesterol: HDL-C Ratio for Consumption of SFA, MUFA, PUFA, and TFA 2016 Linoleic Acid and Saturated Fat Composition of MCE Control and Intervention Group Diets
Baseline Control Intervention Changes in Serum Cholesterol in Intervention and Control Groups
Meta-analysis for mortality from coronary heart disease in trials testing replacement of saturated fat with vegetable oils rich in linoleic acid I. Balance Omega-3 and Omega-6 Fatty Acids Effects: Reduction of high blood pressure Prevents vascular clotting Lowers triglyceride levels Reduction of atherosclerosis Anti-inflammatory effects Process of Inflammation Omega-6 Omega-3
Arachidonic Acid EPA/DHA
Cyclooxygenase pathway
PGE2 PGE3 Pro-inflammatory anti-inflammatory Omega-3 Intervention Studies
Study N Treatment Results Gissi et al. 11,324 0.850-0.882 g/d Decreased CVD death of EPA + DHA and non-fatal MI 1999 for 3.5 years Von 223 6 g/d fish oil; 3 Decreased CVD death, Schacky et months fatal and non-fatal MI al. 3g/d fish oil; 21 months 1999 Singh et 360 1.8 g/d EPA + Decreased cardiac al. DHA for 1 year deaths and non-fatal MI 1997 Burr et al. 227 3 g/d fish oil for Decreased CHD deaths 2 years 1994
Sources: Omega-3 Fatty Acids Common sources: Fatty fish and fish oil Marine plants Canola oil Flaxseed Soybeans Many nuts and seeds
Sources: Fish and Seafood Omega-3’s in 3.5oz, raw Sardines (in oil, cooked) 3.3g Mackerel, Atlantic 2.5g Trout, lake 1.6g Salmon, pink 1.0g Oysters, Pacific 0.6g Tuna 0.5g Shrimp 0.3g Lobster 0.2g Coconut oil 92% saturated fat 50% form MCT Most past studies used hydrogenated coconut, which contains trans fats Helps increase absorption of calcium and magnesium Also contains short chain fatty acids
Impact of Coconut Milk and Soy Milk on Lipid Profile....
HDL LDL 50 165 45 160 40 155 35 30 150 25 Coconut Milk 145 Coconut Milk 20 Soy Milk 140 Soy Milk 15 135 10 5 130 0 125 Baseline Final Baseline Final
Dairy Fat Dairy Foods and Milk Fat on Heart Disease
2009 Dairy Foods and Milk Fat on Heart Disease Dairy Fat and Heart Disease
Dairy Fat and Heart Disease Conclusions: …there is no clear evidence that diary food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce diary food consumption irrespective of the nature of the dairy product should be made with caution.
German, et al. 2009 2010
Conclusions: Milk fat biomarkers were associated with a lower risk of developing a first MI, especially in women. 2011
Conclusion: This ..meta-analysis of prospective studies indicates that milk intake is not associated with total mortality but may be inversely associated with overall CVD risk...
Symposia of: Eurofed Lipids Congress (2014) –France) Dairy Nutrition Annual Symposium (2014- Canada) American Society for Nutrition (2015 –USA) Experimental Biology (2015 –USA) Federation of European Nutrition Societies (2015 –Germany)
“The emerging scientific evidence indicates that the consumption of regular fat dairy foods is not associated with an increased risk of cardiovascular disease”
October 28, 2015
Conclusions: Total and especially full-fat dairy food intakes are inversely and independently associated with metabolic syndrome in middle-aged and older adults, associations that seem to be mediated by dairy saturated fatty acids. Dietary recommendations to avoid full-fat dairy intake are not supported by our findings. 2015
Dairy’s Role in Cardiovascular and Metabolic Health Recognized by DGA’s Advisory Committees 2010 and 2015
“Moderate evidence also indicates “Consumption of dairy foods that intake of milk and milk products provides numerous health is associated with a reduced risk of benefits, including lower risk of cardiovascular disease and type 2 diabetes, metabolic syndrome, diabetes and with lower blood cardiovascular disease and pressure in adults.” obesity.”
-2010 Dietary Guidelines Advisory -2015 Dietary Guidelines Advisory Committee Report Committee Report Here is the answer When someone asks if ______is good for me to eat.
Compared to what? Conclusion saturated fat! Saturated fat may not be the main cause of CVD Replacing sat fat with linoleic acid isn’t effective Omega-3s may be the effective substitute for saturated fat Coconut oil may be neutral or beneficial Full fat milk is back No more ice milk. Eat Haagen-Dazs! Remember the power of cheese!!
Thank You! Thank you!