Tag Archives: lipids

Saturated Fat: Old Foe, or New Friend?

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IMG_8348rt5x7bwYou may have seen some of the recent media articles that address the debate over saturated fat. This is based on some newly published research that suggests that adults who reduce their intake of saturated fats don’t necessarily reduce the heart risk. Popular media has covered this widely, and even the New York Times declared that “Butter is Back”. So does that mean we now have the green light to load up on red meat, butter, and other sources of saturated fat?

The short answer is – probably not. I recently addressed this topic on the video blogging site Vidoyen.com, which you can view by clicking here. Many nutrition and public health experts, who certainly have more expertise than myself, have also weighed in (one of my favorites, Dr. David Katz, has this video and this excellent article which help rebut the “butter is back” theory). The consensus is that this recent research, which was a pooled analysis of prior research, not new data, has some serious flaws. Here is what the “experts” seem to conclude:

1. Saturated fattty acids (or SFA, such as red meat, cheese, and butter) have long been known to be linked to the development of heart disease.

2. While reducing SFA can reduce heart risk, what is important is how the “bad” fats are replaced – many diets (and people) tend to increase intake of carbohydrates – especially the processed kind, which are probably worse for long term heath. That is why many “low fat” foods really don’t improve your health- they replace the SFA with bad carbs instead.

3. The key seems to be to replace the SFA with “good” fats instead – that is, unsaturated fatty acids such as nuts, olive and other vegetable oils, and fish. When this has been studied, there appears to be a beneficial effect on heart risk and overall health. In fact, this is the exact goal of the Mediterranean Diet, which has been studied extensively and shown to reduce heart risk.

More importantly, think less about the “components” of your diet, and focus more on eating whole foods. For example, butter may actually be better than some of the processed spreads, but not as good as olive or vegetable oil. So the “old foe” is still a “new foe”!

Here are some more links to our articles on diet and nutrition:

Our overall guide to a heart healthy diet

Our top 10 eating tips

Nutrition Counts

The perils of carbohydrates

 

The New Cholesterol Guidelines: What do they mean for you?

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Kanny S Grewal MD 5x7 (4)As you may of heard, some experts created new guidelines for clinicians to treat high cholesterol, and they have generated quite a bit of controversy, since they are a big departure from prior guidelines. The big new difference is that they no longer emphasize having “target” levels of cholesterol, LDL, etc and rather focus on just using statins at low, moderate, or high doses based on the patients level of “risk”, which is calculated from a formula based on age, sex, and various risk factors. This could be a sound approach, since some experts feel that simply being on a statin will reduce heart risk, regardless of how much a patients “numbers” actually change. They also conclude that most other types of cholesterol medications, besides statins, don’t have much impact on heart disease and are not generally recommended. The controversy is that the recommended formula to calculate an individual’s long-tern risk has not been thoroughly tested, and it seems to overestimate risk in many groups of patients.

What messages can we “take home” from these new guidelines? Here are a few:

1. The best treatment for high cholesterol remains lifestyle – diet and exercise.

2. The decision to start medication therapy should be individualized and come from the patient, after a thorough discussion with their clinician about risk.

3. Patients with established heart disease clearly benefit from statin therapy, which clearly reduces future risk of heart attack and stroke.

4. For patients without a history of heart disease or stroke,the benefit may be very negligible, unless they fall in a “high risk” group based on other risk factors such as diabetes. These patients should discuss the pros and cons of medication therapy with their doctor.

4. One way to think of statin therapy: it reduces future risk of heart attack and stroke by one-third in everyone. That means a 300 lbs diabetic who just had a heart attack, and a 30 year old fitness fanatic in perfect shape. The difference is the baseline risk. If you start with a risk of 1 in 100 of a heart attack the next 5 years, is that 1/3 reduction really worth taking a potentially toxic pill every day? Probably not. But 1 in 10, or 1 in 5? Probably yes.

So if you have been recommended therapy, or already on therapy, for high cholesterol, ask your doctor about your cardiovascular risk both with and without medication. And more importantly, stay active, maintain your weight, and focus on your diet!

Here is an some excellent summaries of the debate about the new cholesterol guidelines:

Dr. Krumholtz discussion in New York Times

Experts Reshape Treatment Guide for Cholesterol