What’s wrong with saturated fat?

There has been so much media coverage lately about saturated fat, with newspaper and magazine articles, and even peer reviewed journal articles claiming that saturated fat isn’t that bad after all. This news is well received by people who love to hear good news about their bad habits. It allows people to avoid the difficulty of change and to keep eating the foods that are making them sick.

Lurking in the background behind the saturated fat issue are powerful industries whose products are relatively high in saturated fats. Most guides to healthy eating include the advice to eat less saturated fat, but they shy away from naming those foods we should eat less of for fear of offending the meat and dairy industries. So we end up with recommendations that mix food advice, e.g. eat more fruit and vegetables with nutrient advice e.g. eat less saturated fat. Why not just say “eat less cheese”?

The saturated fat/high cholesterol/atherosclerosis/heart disease link is well established. Nothing has changed to refute decades of research which link high fat animal products with heart disease, diabetes, cancer and other diseases. The only real challenge to the ‘saturated fat is bad’ paradigm is whether some of the adverse effects of foods high in saturated fat might be due to other features of these foods such as animal protein, carnitine, choline or haeme iron. For practical purposes it doesn’t really matter whether it’s the saturated fat or something else – it’s still meat and dairy foods that are contributing to chronic disease.

Many of the stories woven to refute the health hazards of saturated fat are based on several key scientific publications:

  1. Chowdhury, R., Warnakula, S., Kunutsor, S., Crowe, F., Ward, H. A., Johnson, L., . . . Di Angelantonio, E. (2014). Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 160(6), 398-406.
  2. Malhotra, A. (2013). Saturated fat is not the major issue. BMJ, 347, f6340. doi: 10.1136/bmj.f6340
  3. Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition, 91(3), 535-546. doi: 10.3945/ajcn.2009.27725 (NB This research was funded by the dairy industry)

It all sounds quite plausible until you actually look at the fine detail of the evidence given, which takes considerable time and skill… few health professionals do this, so what hope has the general public got? We are indebted to people like Plant Positive, Dr John McDougall, Dr Michael Greger, T Colin Campbell and others who invest the time and effort to cut through the smoke and mirrors. Below is an extensive list of resources that will help you understand what’s behind the sensational headlines.


These videos from Dr Michael Greger explain how industry works to confuse the public on the saturated fat issue. The second video presents powerful evidence that saturated fat does indeed raise blood cholesterol and the risk of heart disease:

An extensive analysis of this topic is provided by Plant Positive. His whole website (and YouTube channel) is designed “to correct specific falsehoods and flawed arguments that pervade the popular and academic discussion of nutrition”:

Addressing the Siri-Tarino and Chowdhury Saturated fat articles:

Cholesterol **February 2015 update**

In Feburary 2015 it was reported that the new US dietary guidelines will withdraw their recommendation to limit dietary cholesterol. Below are some responses from plant-based practitioners:

Saturated fat and cardiovascular disease **June 2017 update**

In June 2017 the American Heart Association published a ‘Presidential Advisory’ written by a team of highly experienced researchers who conducted a thorough review of the scientific literature into the effects of dietary saturated fat:

David Katz, MD wrote several articles trying to counter the pushback from low carb/high fat advocates in the days and weeks following publication of the AHA paper:

Other responses:

Ancel Keys’ research:

This white paper was commissioned by the True Health Initiative to explore the historical record and address the popular contentions with primary source material and related work, and in consultation with investigators directly involved. Popular criticisms directed at the study, and the lead investigator, Ancel Keys, turn out to be untrue when the primary source material is examined:


  • Campbell, T. C., & Jacobson, H. (2014). The low-carb fraud. Dallas, Texas: BenBella Books, Inc.

Related pages:

Page created 4 July 2014
Last updated 8 July 2017

Atherosclerosis and Heart Attacks

Atherosclerosis is the thick cholesterol laden plaque that builds up on the inside of our arteries when we eat the typical Australian diet. Arteries do not simply gradually block up like a rusting water pipe. Heart attacks are most often the result of a sudden blockage in an artery that is only partially blocked with plaque. A whole foods plant based diet rapidly reduces the risk of heart attack.

The current paradigm of heart disease* views arteries as if they were water pipes. Factors such as high cholesterol, diabetes and smoking causes a gradual build-up of cholesterol on the inside of the artery like scale in a pipe. Eventually the pipe becomes blocked and blood supply is interrupted.

*There are many diseases that can affect the heart muscle and the heart valves. In this discussion we are using the term “heart disease” to refer to the diseases caused by narrowing or obstruction of the coronary arteries that supply the heart muscle. There are various terms that are used to label this type of heart disease: coronary artery disease (CAD), coronary heart disease (CHD), ischaemic heart disease (IHD), and myocardial ischemia. The processes which occur in the arteries of the heart can and do occur elsewhere in the body.


Atherosclerosis is the end result of the complex process that leads to the accumulation of cholesterol and scar tissue within the artery wall. It is an insidious process that produces few if any symptoms until it is advanced enough to slow or block the flow of blood. In the early stages, fatty streaks develop inside the arteries as cholesterol builds up in the lining of the artery. The primary cause is the unnaturally high levels of LDL cholesterol associated with a diet rich in meat, dairy and processed foods and deficient in whole plant foods. The cholesterol deposited within the artery wall triggers an inflammatory response in which white blood cells invade the diseased artery wall, ingest the cholesterol and release further inflammatory chemicals. Eventually the interior of the artery becomes narrowed by a thick layer of cholesterol-laden scar tissue – this is atherosclerosis.

Arteries are not just water pipes and atherosclerosis has more consequences than just progressively reducing blood flow. The large arteries of the body are more like rubber tubes than hard pipes and they stretch with each heart beat and bounce back between beats, giving the smaller vessels a more steady blood flow. Atherosclerosis makes these arteries stiffer (“hardening of the arteries”) so that they no longer absorb the shock wave that each heartbeat produces. The smaller vessels further down the line then get pounded by the water hammer like shock wave of each heartbeat. These smaller vessels then become diseased more quickly resulting in damage the organs such as the brain and kidneys.

The paradigm of heart disease that views arteries as water pipes has an upgrade that describes how heart attacks occur.

Heart attacks

The gradual reduction in blood supply by atherosclerosis can cause the heart muscle to become weak and baggy so that it cannot pump effectively. The result is heart failure. Other organs in the body can also become progressively impaired. But heart attacks and most strokes happen when blood supply is suddenly cut off, resulting in death by asphyxiation to the cells downstream from the blockage. Atherosclerosis is an uneven process and forms localised lumps on the inside of arteries are called plaques. These plaques can burst open like a pimple on the inside of the artery. The material in the plaque causes the blood to clot immediately completely blocking the artery and obstructing blood flow to everything downstream. This can happen in arteries that are only partially blocked with plaque. Therefore an exercise ECG stress test can remain normal right up until the moment of the heart attack.

Cholesterol plaques that are actively growing are cauldrons of inflammation, and this inflammation causes the “cap” over the plaque to become thinner, increasing the risk of plaque rupture and heart attack – these are “unstable plaques”. It has been observed that rapidly reducing blood cholesterol stabilises plaques in just a few weeks, far quicker than the length of time it takes for a plaque to regress as demonstrated by angiograms. A plant based diet is much better than cholesterol tablets alone for stabilising plaques as it not only reduces fasting cholesterol, but also deals with the inflammatory storm that follows every fatty meat-based meal.

Heart disease in women may follow a slightly different course to men. It is the same disease process but plaque formation tends to be more diffuse. Diffuse plaque leads to relatively more diffuse heart damage (heart failure) than localised events (heart attacks).

Dr Michael Gregor describes the process of plaque formation and plaque rupture as analogous to pimples in his video Arterial Acne:

“Atherosclerotic plaques in coronary arteries may be more aptly described as pimples, initiated by the infiltration of cholesterol into the lining of our arteries. The ending, should blood flow to our heart muscle be cut off by a clot formed by the rupture of one of these inflamed pockets of pus in our arterial lining, is a heart attack”.

In this 8 minute video, Dr Esselstyn discusses how cholesterol accumulates in the coronary arteries, provoking an inflammatory reaction which can lead to plaque rupture. This is the main cause of heart attacks and mostly occurs in arteries that are not badly enough blocked to be treated with stents or bypasses. Fortunately plaques become more stable after only a few weeks on a whole foods plant based diet.

Caldwell Esselstyn, MD — “No More Heart Attacks — Ever”

Our current paradigm of artery disease, even with the ruptured plaque upgrade, is still too much of a water pipe analogy. Only by giving the endothelium centre stage can we understand how dietary factors cause atherosclerosis, high blood pressure and erectile dysfunction. See Endothelium, also Heart Health – Resources


Hypertension (high blood pressure) is a leading cause of heart disease and death worldwide. It is so common in older people in Australia and other developed countries that it has been considered a normal part of aging – but it need not be so. Blood pressure actually goes down slightly in old age in communities which subsist on minimally processed plant-based diets.

High blood pressure damages blood vessels, greatly increasing the risk of stroke and heart attack. It also damages the filtration units in the kidneys further compounding the condition. Larger blood vessels eventually become hardened and no longer absorb the pressure pulse of each heartbeat, leading to damage to smaller vessels further down the line. Vessels can even blow out causing a haemorrhagic stroke (not the most common type).

It has been suggested that hypertension is an attempt by the body to provide adequate blood supply to the tissues, raising the pressure to overcome resistance and sludgy blood flow.

Our diet and lifestyle can work to worsen or normalise blood pressure in many ways:

  • High salt intake results in the fluid retention
  • Every animal protein based meal puts the kidneys into a ‘hyperfiltration’ state, leading to reduced function in the long term.
  • Cholesterol plaque in arteries causes them to harden and narrow. Flexible arteries maintain blood flow between heart beats.
  • Ongoing damage to the endothelium (lining of the arteries) and a lack of nutrients from plants reduces the capacity of arteries to relax and dilate, resulting in a subtle increase in resistance throughout the body.
  • Diets rich in animal products and oils vs minimally processed plants cause red blood cells to become sticky and sludgy as they flow through capillaries, depriving sensitive tissues of oxygen and nutrients.

There is little doubt that a whole foods, plant-based diet with a reasonably healthy lifestyle will prevent hypertension but what about reversing it? There have been many clinical trials in which vegan or WFPB diets have been proven to reduce high blood pressure. The DASH diet was designed to get some of benefits of a plant-based diet without going vegetarian.

The bottom line is that a whole foods, plant-based diet – high in whole grains, tubers, legumes, vegetables and fruits – will improve your blood pressure. Virtually all people with hypertension will improve and most will be able to reduce or cease their medication. Some individuals will need a high degree of dietary compliance to get full benefits – minimal salt, absolutely no oil and avoidance of fat-rich plants as well as coffee. Some particular plant foods such as leafy green vegetables, high in nitrates, actively reduce blood pressure. Regular exercise will further reduce blood pressure.

Let’s temper our optimism with the following consideration. Not everyone will be able to get off all  of their blood pressure medications. You may have spent decades unwittingly damaging your kidneys, hardening your arteries, degrading your endothelium and growing thick muscular arteries – some of this is not reversible. But rather than be disappointed consider the bigger picture – lower cholesterol and rapid reduction in heart attack and stroke risk, preservation of kidney function and broad range of other health benefits.

NB Do not stop your blood pressure medications without medical supervision.


Peer-reviewed articles:


Page created 18 December 2014
Page last updated 19 January 2018

Heart Health

“Some people think the ‘plant-based, whole foods diet’ is extreme. Half a million people a year will have their chests opened up and a vein taken from their leg and sewn onto their coronary artery. Some people would call that extreme”
– Dr. Caldwell B. Esselstyn, Jr.

“Normal” blood cholesterol levels in Australia are not normal or supportive of good health. These “normal” levels result in an enormous burden of heart disease and a population in which almost everyone has artery disease by age 65. The national goal of less than 5.5 is well up into the zone in which artery disease develops. The medical profession knows this and the official safe level for cholesterol following a heart attack is less than 3.8 approximately (the target being LDL<1.8). So, we have the situation where you can be reassured by your doctor that your cholesterol level of 5 is OK, suffer a heart attack later that day, and be told the next morning that your cholesterol needs to be less than 4 to prevent further heart attacks. A whole foods plant based diet can lower your cholesterol to a safe level without the inconvenience of having to have a heart attack first. More on Normal Cholesterol


Changing to a whole foods plant based diet results in dramatic falls in blood cholesterol levels. The medical myth that diet has little effect on cholesterol stems from the fact that the current cholesterol lowering diet recommended in Australia is not effective. A diet rich in animal “protein” foods, with or without vegetable oil, will always raise cholesterol. In general, animal products raise blood cholesterol and whole plant foods lower blood cholesterol. More on Diet and Cholesterol


Blood cholesterol is complex. Your blood test results will include measurements of some of the individual lipoproteins, HDL and LDL. But there are further levels of complexity that should make us wary dismissing the risks of elevated blood cholesterol on the basis of “good cholesterol” levels and ratios. More on HDL and LDL


Cholesterol lowering drugs and heart surgery are quick fixes for a complex diet related disease. The drugs only target fasting cholesterol, which although important, is only one part of the cholesterol-diet problem. Stents and surgery are seldom life saving and carry considerable risks. More on Drugs and Surgery


The endothelium is the lining of our arteries and consists of a single layer of tile-like cells. The endothelium is central to artery health and disease. Anything that compromises the health of the endothelium has an immediate effect on the flow of blood to every organ. Atherosclerosis, the obstruction of arteries by cholesterol, is merely the end result of repeated endothelial damage. Every fat and cholesterol laden meal causes an inflammatory storm within the arteries that lasts for many hours and has a measureable effect on endothelial function. More on Endothelium


Atherosclerosis is the thick cholesterol laden plaque that builds up on the inside of our arteries when we eat the typical Australian diet. Arteries do not simply gradually block up like a rusting water pipe. Heart attacks are most often the result of a sudden blockage in an artery that is only partially blocked with plaque. A whole foods plant based diet rapidly reduces the risk of heart attack. More on Atherosclerosis and Heart Attacks


Atherosclerosis is a whole body disease affecting every artery. Therefore any organ can potentially be compromised by impaired blood supply. A partially blocked artery may cause symptoms such leg muscle pain on exertion. A sudden complete blockage may result in a stroke. Diseased small vessels can cause dementia and kidney failure. Even in the absence of artery narrowing, an unhealthy artery may be unable dilate, resulting in erectile dysfunction. More on The Canary and Other Organs



Esselstyn, C. B. (2007). Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. New York: Avery.
Dr Caldwell Esselstyn Jr. MD, author of Prevent and Reverse Heart Disease, carried out the longest and one of the most successful trials of curing heart disease with diet. He describes heart disease as a toothless paper tiger that need never exist. Have a look at a free Excerpt from Chapter One of Prevent and Reverse Heart Disease.

This is his website: Dr Esselstyn’s Prevent & Reverse Heart Disease Program – click on the Video tab to see a links to more videos that present his work, some of which are listed below.


Web resources


Peer-reviewed articles

Success stories


Page created 13th January 2013
Last updated 1st August 2017