DIETARY FATS AND HEART HEALTH: HERE ARE THE FACTS

The American Heart Association (AHA) has issued a new “Presidential Advisory” on dietary fats and cardiovascular disease to “set the record straight” on the dangers of saturated fats.

The statement by the American Heart Association, June 15, continues to strongly recommend replacing saturated fats with poly- and monounsaturated vegetable oil to help prevent heart disease.

The statement also recommends that the shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern, such as DASH (Dietary Approaches to Stop Hypertension) (http://www.mortontavel.com/2013/05/02/) or the Mediterranean diets, and that “good carbohydrates,” such as whole grains and whole fruits, are other appropriate foods to substitute for saturated fats.

“We want to set the record straight on why well-conducted scientific research overwhelmingly supports limiting saturated fat in the diet,” stated lead author, Frank Sacks, MD, professor of cardiovascular disease prevention at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Outside nutritional experts were fully supportive of the advisory, describing it as “an outstanding paper,” “exacting in its review of the evidence,” and “full of common sense.”

The AHA leadership decided that they needed to put out a new advisory on diet — particularly fats — because of various commentators on nutrition suggesting that saturated fat was innocuous, which has been widely covered in the media, but these comments were not scientifically based.

Unfortunately, a great deal of attention has been paid to controversial new studies that are not scientifically rigorous. A growing trend of media articles focusing on small studies suggests that some saturated fats are “good for you.”  Some people suggest that eating butter and full-fat milk is beneficial. And coconut oil is a fad right now — but it is actually a saturated fat, which raises your LDL [low-density lipoprotein], so the AHA wanted to look at the issue again.

The AHA president issued an advisory identifying this as a key issue that needed attention. Conclusions were based on careful scientific review, organized in a very systematic way, involving experts from a wide range of fields who have looked very carefully at the literature. Then the recommendations were thoroughly vetted and passed through multiple levels of peer review and scientific advisory committees across the entire AHA. This statement focused on fats — what fats should we be eating — and they concluded very strongly that we all should eat less saturated fats, and these can be replaced by polyunsaturated and monounsaturated fats. This recommendation was supported by multiple scientific studies that demonstrated that by lowering intake of saturated fat and replaced it with polyunsaturated vegetable oil, cardiovascular disease is reduced by approximately 30%. In addition, several studies found that coconut oil — which is predominantly saturated fat but widely touted as healthy — raised LDL cholesterol the same way as did other saturated fats found in butter, meat, and palm oil.

Their message is that “polyunsaturated fats are the best fats to eat. They are found mainly in vegetable oils such as soy bean oil, peanut oil, corn oil. Monounsaturated fats, found in sunflower oil, olive oil, nuts, and avocado, are also okay — much better than saturated fats, and may be as healthy as polyunsaturated fats.”

The last few years has seen an increase in knowledge on benefits of polyunsaturated fats. They are associated with a reduction in total mortality and no compensatory increase in death from other causes; they are also associated with a reduction in insulin resistance, helpful in combating diabetes.

   The AHA document is full of common sense. It is not controversial, but saturated fat is scientific code for animal fat. This statement is telling us to eat less meat, but they are not actually using those words, possibly to avoid alienating livestock farmers. There is now a weight of evidence that plant foods — which are very low in saturated fat — are beneficial. It has been shown time and time again that these foods can reduce heart disease.

    Thus here is a clear statement that should allow us all to react sensibly!

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PLAIN OLD BUTTER: WHERE DOES IT STAND NOW?

 

For the past 20 years or so, we medics have been preaching that in order to minimize risk for cardiovascular disease, butter, which contains mostly saturated fat, should be eliminated from the diet. Even worse, one tablespoon of butter contains 100 calories, 11 grams of fat, 7 grams of which are saturated fat (about half the saturated fat you should consume in a day if you’re following a 2,000-calorie-per-day diet). So where do you go if your looking for an alternative butter-like spread? Previously, margarine had been the usual replacement for butter, but since most margarines contain trans-fat (partially dehydrogenated fat), they no longer desirable. In general, the more solid the margarine, the more trans fat it contains. So stick margarines usually have more trans fat than tub margarines. Trans fat, like saturated fat, adversely affects cholesterol levels and the raises the risk for heart disease. So, if you must have margarine, skip the stick and opt for soft or liquid margarine instead. Look for a spread that doesn’t have trans fats and has the least amount of saturated fat. When comparing spreads, be sure to read the Nutrition Facts panel and check the grams of saturated fat and trans fat. To reduce the calories consumed, limit the amount you use.

If you have high cholesterol, you might consider using spreads that are fortified with plant stanols and sterols, such as Benecol and Promise Active, which may actually help to reduce cholesterol levels

Now let’s take a look at some of these alternatives.

           Healthier Butter Substitutes

Land O’ Lakes Spreadable Butter with Canola Oil tastes like real butter.  It contains about half the saturated fat of butter but a similar calorie load and total fat count. A main advantage is that the taste is indistinguishable from real butter. Thus it’s slightly better than regular butter.

          Spreads with More Benefits

        Some spreads are lower in calories, fat, and saturated fat than butter or margarine. Although some brands boast that they’re made with olive oil or canola oil, that doesn’t mean they have the same nutritional profile as the oils themselves. Most are a blend of the featured oil and other vegetable oils. And all spreads—even those made with olive oil (such as Olivio) or yogurt (Brummel & Brown)—contain trans or saturated fat. For instance, Brummel & Brown 35% Vegetable Oil Spread contains partially hydrogenated soybean oil,  and I Can’t Believe It’s Not Butter Light palm and palm kernel oils, contain 45 calories, 5 grams of fat, and 1.5 grams of saturated fat.

Smart Balance produces a variety of spreads, but is vague in listing contents, especially beneficial stanols/sterols. Heart Right Light has a mild flavor that is acceptable to most people. Smart Balance Buttery Spread with Calcium, which has 100 milligrams of calcium and 200 international units of vitamin D, has a hint of dairy flavor and melts well, but it is rather salty. Smart Balance Buttery Spread with Omega 3 offers questionably more health benefits but is saltier and artificial tasting compared with original Smart Balance.

In general, spreads containing cholesterol-lowering sterols/stanols possess extra heart health benefits. Two grams a day—the amount in 4 tablespoons of a fortified stanol spread—might lower LDL (bad) cholesterol by about 10 percent. At 50 to 70 calories per tablespoon, it also can reduce your calorie intake. But watch the labels, for some products contain far less than 2 grams of these helpful components.

         Coconut spread

Earth Balance Organic Coconut Spread melts well and is lightly salted.

Trendy coconut-oil spreads contain coconut oil blended with other vegetable oils. They have 3.5 to 5 grams of saturated fat, 50 to 100 calories, and 7 to 11 grams of total fat per tablespoon. You may have heard that coconut oil contains a “healthy” saturated fat called medium-chain triglycerides. But it contains other types of saturated fat as well, meaning that it is not the best choice. The brands Melt Organic and Earth Balance Organic Coconut spreads are tasty, but tend to have a strong coconut flavor.

                 More Alternatives to Butter

.  You may get more health benefits if you keep an open mind about what to spread on your bread. A great choice is extra virgin olive oil, a common offering in upscale restaurants. Nut and seed butters, such as almond or sunflower, are naturally rich in heart-healthy oils and also contain fiber and protein, which are not found in most butter substitutes. You can also try mashed avocado, or hummus. All have a better-than-butter fat mix.

Peanut Butter
With 180 to 210 calories per serving, peanut butter may seem averse to dieting. But it has the enviable combination of fiber (2 g per serving) and protein (8 g per serving) that fills you up and keeps you feeling full longer, so you eat less overall. Moreover, a serving of peanut butter contains 208 mg of potassium and significant amounts of vitamin E, magnesium, and vitamin B6. Research shows that eating peanuts can decrease your risk of heart disease, diabetes, and other chronic health conditions.

When shopping for peanut butter, look for a natural style product with little to no added fat or sugar. Some companies add partially hydrogenated oils to the regular type of peanut butter, which should be avoided. A typical 2-tablespoon serving of peanut butter has 3.3 grams of saturated fat and 12.3 grams of unsaturated fat, which puts it up there with olive oil in terms of the ratio of unsaturated to saturated fat. In moderation, however, some saturated fat is okay. Unsalted peanut butter has a terrific potassium-to-sodium ratio, which counters the harmful cardiovascular effects of sodium surplus. And even salted peanut butter still has about twice as much potassium as sodium.

The Big Picture

According to a new large study, people who replace saturated fat (mainly found in meats and dairy foods) in their diets with refined carbohydrates do not lower their risk of heart disease.  On the other hand, those who replace saturated fats with unsaturated fats (found in vegetable oils and nuts) or whole grains, lower their heart disease risk. Many people fall back on carbs, especially refined carbs like white bread, when they reduce saturated fat in their diets. This may in part explain findings from a controversial 2014 paper that called into question recommendations for limiting saturated fat for heart health, and led to headlines promoting the return of butter. But in terms of heart disease risk, saturated fat and refined carbohydrates appear to be similarly unhealthful. The most recent study was the first large prospective analysis to directly compare saturated fat with other types of fats and different types of carbohydrates in relation to heart disease risk.

From this data, I conclude that individuals should not replace saturated fat with refined carbs. Dietary recommendations to reduce saturated fats should specify their replacement with unsaturated fats or with healthy carbohydrates, such as whole grains. The various butter-substitutes described above can help in this endeavor.

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