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Dear Jennifer

"I’m afraid I was a bit hasty during our last conversation when I encouraged you to eat more butter without much explanation. Although this is a subject I have visited on the website here and here, I decided it was time again to address the subject of the fats we eat and how they affect our risks for the chronic diseases of our modern world. Make yourself comfortable, this might get long-winded! Or you could just scroll to the very last section and watch an eloquent video that short-cuts my explanations! Here goes."

Humans have historically met their end from trauma or infection up until the last two hundred years, as we have modernized our diet and lifestyles. We now suffer during our lives and succumb at our deaths to what have been called “the Western diseases” or the “diseases of modern civilization,” namely heart disease, diabetes, and cancer.  Common to all three is a high degree of inflammation, which also contributes to hypertension, arthritis, autoimmune disease, and more. Despite the advice and treatments of science, our modern epidemics are largely getting worse rather than better, and a lot of it has to do with our blind spots about food.

Patients report to me they have heard two common attitudes about food from their doctors. Either “Food has nothing to do with your disease,” even to diseases of the digestive tract, incredible! Or if the doctor acknowledges the importance of food, the advice is largely mired in the conventions we adopted in the 1970’s: lower the fat, eliminate the red meat, and eat lots of fruits and vegetables and whole grains. Let’s look more closely for a different understanding of food that might reverse our trends of epidemic chronic illness.

A dentist’s view

Dr. Weston A Price was the first to observe that the foods associated with modern civilization (refined grains and sugars) effectively displaced foods eaten traditionally and set of a chain of events that could be observed in the sequential appearance of dental caries, orthodontal problems, and ultimately chronic metabolic disease (obesity, diabetes, and heart disease.) He and his wife, intrepid travelers, roamed the world in the early 1900’s and observed cultures that ate primarily meat and fat (the Inuit in Alaska and the Masai in Africa), as well as people that relied heavily on fish (my Scottish ancestors) or sourdough bread and dairy (the Swiss.) What all the cultures shared was that they had been eating the same food as their ancestors enjoyed for previous centuries and that none of them ate white foods. He was also the first to observe that there appeared to be no (zero, absolutely none) naturally vegan civilizations and that the only vegetarian traditions were religious rather than rooted in history. All traditional societies valued animal products, particularly organ meat, animal fat, and eggs from poultry and fish.

And all the traditional societies had far better health than we do now, until they began enjoying white bread, white flour, and added sugars.

Scientific literature

Current research and writing has taken two main directions from questions raised by the work of Dr. Price. Scientists interested in lessons from our ancestors -- the fields of evolutionary health and medicine, the Paleo world -- first published in 2011 an article on “The western diet and lifestyle and diseases of civilization,” by five authors, the two most famous being Staffan Lindeberg and Loren Cordain.  The full article is available for download here

These authors claim that we must look farther back than the view of Dr. Price, and look instead at the hunter-gatherer populations that preceded the change to agriculture. They were able to study some contemporary hunter-gatherer societies as well as archaeological records. Folks that hunted and gathered their food, rather than raising it, were taller, leaner, and had better bones than modern folks. Their lifespan was on average shorter than ours (shortened by premature death from infection or trauma) but once they survived youth, they tended to live to about 70 years of age. The process of evolution determined that those best suited to their environment and life choices provided the genes for future generations. We are all descendants of these hunter-gatherers and share a genetic heritage, within which it makes sense to make similar life choices—as possible—as those which allowed our ancestors to survive.

Cordain, Lindeberg, et al., inspired research and writings that fit into the Paleo or ancestral movement now. Within a Paleo framework, the avoidance of grains, legumes and dairy offer an introductory test period that eliminates the modern foods. During a month or more of reliance on meat, fish, eggs, vegetables and fruit, you can see if you have any particular reactions to the modern foods: breads, pasta, milk, beans, rice and others. Although the Paleo movement started by embracing “lean meat,” they gradually shifted (a story in itself) to include fatty choices, both fatty muscle meat and the fatty meat of organs.

From an evolutionary point of view, we need not fear the fat nor the red meat of animals. However, our hunter-gatherer ancestors were not animal keepers, so the butter I recommended you eat would not have been on their menu!

Modern science wonders about diet

In the mid-1900’s for a variety of reasons (improved techniques of scientific measurement, increased rates of heart disease and diabetes), modern science felt compelled to protect public health by purifying water, recommending good sanitation and evaluating the quality of our diets. Here’s where it gets very political and argumentative. Mid-twentieth century we developed the ability to measure cholesterol in the blood. We knew that the heart is full of cholesterol and scientists postulated that cholesterol might be the cause of a heart becoming diseased. Once able to measure cholesterol, we looked for ways to modify it and hoped that changing cholesterol levels would change heart disease. The most recent disappointment was a new cholesterol-lowering drug that markedly lowered cholesterol but did nothing for heart disease risk, suggesting that just "fixing" cholesterol levels is no way to guarantee good heart health.

Two controversial journalists have undertaken thorough studies of just how we arrived at our modern recommendations of a low-fat, butter-avoiding, complex grain and minimal meat diet. Gary Taubes in Good Calories, Bad Calories then Why We Get Fat and most recently The Case Against Sugar lays out the science along two major themes. Nina Teicholz in The Big Fat Surprise describes the politics behind our choice of fat as a dietary villain: it was money and personal power that sent us barking up the saturated fat tree. Meanwhile, according to findings of both authors, we missed the main culprit which starts with excess added sugars in the diet, and ends with insulin resistance, inflammation, type 2 diabetes, obesity, and metabolic syndrome.

  • Despite decades of egg-avoiding advice, most nutritional authorities now agree that dietary cholesterol does not raise blood cholesterol.
  • Although dietary fat can affect cholesterol, it does not increase the risk of cardiovascular disease or diabetes. Eggs and shellfish, both high in cholesterol, have too many vital nutrients to minimize them in any way. Saturated fat tends to raise both "good" and "bad" cholesterol (oversimplified!) in such a way that the net effect is a good one.
  • Added sugars (or a largely sugar diet, even if it’s all grains and beans and fruits and vegetables) will raise the level of blood sugar and the consequent risk of diabetes, heart disease, inflammatory diseases and cancer.

From 1999, dietary saturated fats demonstrated no association with cardiovascular disease.  Other research has confirmed this study. Note that this study was published now eighteen years ago (18!!!!) and yet most docs would say the truth is just the opposite. To their credit, there has been some confusion if you don’t read the research carefully.

For many years saturated fats and trans fats were always combined; since trans fats are hazardous, the saturated fats were claimed to be guilty as well, but it was only by association that didn’t hold up when they were separated. For this reason, it is important to only look at studies where trans and saturated fats are listed separately. In such studies, the saturated fats are almost universally harmless, and the trans fats associated with greater risk of multiple metabolic diseases. 

High fat diets when combined with high sugar diets (the modern American diets!) can be hazardous, but when the nutrients are teased apart, it’s the sugars not the fats that are problematic. (Sugars are always more hazardous; fats are only hazardous in the setting of high sugars.)

Bullies have had their way. The second brilliant journalist is Nina Teicholz, author of The Big Fat Lie, who stunningly documents the blowhard tactics of Ancel Keys (the bully), an early believer in fat being problematic. He routinely omitted data that damned sugars and mocked and discounted the work of John Yudkin, a contemporary scientist who did have the insight that sugar was the problem, not fat. Ancel Keys is famous for a Seven Countries Study in which dietary fat and heart disease correlated well: the only problem was that all the data available, from more than twenty countries, showed no such correlation. He focused only on the countries that proved his hypothesis.

Other research that confirms the healthy nature of well-chosen fats include

  • Another AJCN article (a letter) documents that eggs are good for us, not hazardous. 
  • Another letter, referring to several research articles, clarifies that a reduced carbohydrate diet (which necessarily will mean more calories from fat: one must eat something) yields benefits even if there is a slight increase in the so-called “bad” cholesterol, LDL. 

And the latest review

In the interests of wrapping up this way-too-long blog post, let me turn to two outspoken cardiologists. If you are more of a reader, you might enjoy this New York Times summary of the work of British cardiologist Dr. Asheem Malhotra. He encourages his patients to enjoy real food, to eat plenty of vegetables, and to please enjoy them with fatty food such as red meat and melted butter!

February 2017, Heart Health Month: big thanks to Dr. Salim Yusuf, President of the World Heart Federation, for his review of data on 17 countries, 150,000 people. You can watch the full video here, and it's quite straightforward. His bottom line is that when you look at survival statistics of populations at large: increasing dietary carbohydrates is associated with increased morbidity (heart disease, type 2 diabetes) and mortality. "Once you get past 45% of your calories from carbohydrates, you see a sharp increase in the rates of cardiovascular disease."

Increasing dietary fat is associated with decreased morbidity and mortality.  Limiting carbohydrates and allowing fats without restriction usually results in a lower caloric intake. Greater satiety? Boredom? Whatever the reason, the emerging dietary consensus is that healthy proteins and the fats associated with them are all promoters of health. Processed foods and refined carbohydrates are the parts of the modern diet that are problematic.

Or: Skip the sugars, the breads, the excessive amounts of grains or fruits; enjoy meats, vegetables, and healthy fats such as butter, red meat, eggs, fatty fish, avocados. There are individual and genetic reasons why any given individual might modify general dietary recommendations, but for "general recommendations" these simple rules stand up well to scrutiny.

"So, Jennifer, I hope that fills out a big of a very big discussion we could have about butter! And if butter isn't your idea of a perfect addition to any meal, what would you prefer? Bacon? Avocado? So long as it's organic, and grass-fed if related to an animal, enjoy!"