“Sugar, fat or confusing and inaccurate reporting . . . which is worse for the cardiovascular health of our patients and the population?”
There has been a lot of media attention around saturated fats and health. Lots of sensational headlines and soundbites encouraging us to abandon all our long held beliefs around healthy food and start eating more butter. The net result is that our patients are increasingly confused from the conflicting information about what actually constitutes a healthy diet —not helpful at all! We felt it important to give you a sensible and balanced summary.
Firstly, this is not a new concept. Many of us who are interested in contemporary dietary evidence have for some time been discussing and highlighted that saturated fats per se are not the prime evil they were once considered. Its also clear if you replace saturated fat with worse foods in your diet (transfats from partially hydrogenated vegetable oils, refined carbohydrates or sugars) which did occur as a result of the low fat health and food industry campaigns, then your overall health will be worse. We also agree that the guidelines from the 1980s which have rolled into the modern era without question are outdated and inaccurate—in fact this has clearly caused an increase in cardiovascular disease—one example being that margarine in the 1980s was pure trans fat! Its also clear that a low-fat diet is not healthy, low-fat products are usually bad for you and most of the low-fat focus which remains in mainstream healthcare is outdated. So far we are all in agreement. However, some of the extreme conclusion from the main author of the study which have been lapped up by a story hungry media have been bizarre and this has motivated a closer look at the background.
So, lets analyse the source of all this media attention. The main author of the study (who actually conceived and did most of the work) is not an objective scientist and it’s clear has pursued this project with preconceived intentions (conflicts of interest)—this explains the bizarre and exaggerated conclusions. She comes from a relatively extreme and evangelical anti-sugar (pro fat) background and openly questions the link between cholesterol and cardiovascular disease without much expertise, qualification or pedigree. Cholesterol is a complex issue and poorly understood in general, but an extreme opinion questioning any link with cardiovascular disease should immediately sound alarm bells. The author has no prior publications in scientific journals which is even more worrying considering she reveals being enrolled in a (?remote) PhD examining the evidence base for dietary fat guidelines at the University of West of Scotland since September 2012 — not an institution recognised for academic excellence in this area or cardiovascular research.
The study was published in open heart which is an open access (i.e. free) online only BMJ (British Medical Journal) with relatively low impact —as a result this journal will have a lower overall standard for the type of research published. You may wonder how a free journal can exist? By publishing articles which create impact and can be press-released to generate general interest, debate and penetration in the public and medical arenas, as in this case. I don’t think we can blame the media —it’s their job to sell news. I think the responsibility lies with the medical journals and the credible scientific community to counter ‘bad science’ and guide reporting bias without being seduced by the limelight and publicity. To be fair to openheart they did publish a parallel and much more balanced, credible accompanying editorial (by a Cardiologist) but clearly this balanced view did not get much press attention —not as exciting!
Now the intention is not to bash the authors of the study or publishing journal, but to highlight the complexities of the conclusions we hear summarised via the media and the confounding issues. We should have learnt by now that we cannot blame a single group of foods for health problems (other than the clearly damaging trans fats)—it will be very dangerous to swing from fat to another culprit (presently sugar). Observations of a given nutrient depend mainly on what you compare it to and therefore we should really move away from focusing on a single ingredient and repeating the mistakes of the past.
Saturated fats can be considered (at best) to be a neutral food —they are certainly not good for you but not as bad as once considered, and can be enjoyed in careful moderation— don’t go crazy with the butter. However, the fats in your diet should strongly favour the protective unsaturated fats from marine and plant sources. Your polyunsaturated fats should come from fish, nuts and seeds. We would avoid regular cooking with vegetable oils which are high in polyunsaturated fats (e.g. sunflower oil) and margarines (ultimately a highly processed food) based on recent evidence. The balance of evidence still favours olive oil for most cooking situations.
Back to the Tuna Fajitas — these are an amazing, fresh, tasty and fun meal. Clean Omega-3 rich tuna, combined with monounsaturated fat avocado, zingy and crunchy nitrate-rich salsa, spicy onions and peppers with cooling yogurt dressing. Although there are a number of steps below its also very quick to prepare and cook — ready in under 30 minutes.