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 (in particular the dairy industry) 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.

Resources

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:

• The Saturated Fat Studies: Buttering Up the Public – (4 min. video)
•  The Saturated Fat Studies: Set Up to Fail – (8 min. video)

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”:

• PlantPositive: Making the Case for Plant-Based Nutrition (main website)
• How Time Magazine Sacrificed Its Standards to Promote Saturated Fat – This post addresses the June 2014 Time Magazine article ‘Eat Butter’
• Recent articles by Drs Chowdhury and DiNicolantonio – This post addresses the Chowdhury article
• Malhotra’s Major Issues, Part 1 – This post addresses the Malhotra article (see also part 2)
• Siri-Tarino’s Meta-Analysis, Part 1 (Saturated Fat and Heart Disease) – This post addresses the Siri-Tarino/Krauss article (see also part 2)
• Catalyst Corrected 1, The History of Diet-Heart, Part 1 – Plant Positive also addresses the irresponsible claims made on ABC’s Catalyst program in a 6-part series (see also parts 2-6)

Addressing the Siri-Tarino and Chowdhury Saturated fat articles:

• Saturated Fat and Heart Disease Meta-Analyses: Were Scientists Wrong? – Travis H L, 13 December 2014
• Dr. McDougall’s Comments on the National Headline About the March 18, 2014 Annals of Internal Medicine Article Suggesting Saturated Fat (Dairy, Meat, and Eggs) Is OK to Eat
• Saturated Fat: Still Unhealthy After All These Years, Pt 1 – Jeff Novick, RD also Part 2 which addresses saturated fat from the plant-based world: Saturated Fat: Still Unhealthy After All These Years, Pt 2
• Low Carb Hot Air—Again, again and again! – T Colin Campbell, October 2014
• Oversaturation of Fat in the Media – Susan Levin, August 2014
• Time Magazine says “Eat Butter” – Big Food’s Last Ditch Efforts – Dr John McDougall, 18 June 2014
• A Fallacious, Faulty and Foolish Discussion About Saturated Fat – by T Colin Campbell, April 2014
• Clearing Up The Confusion Surrounding Saturated Fat – by Travis H L, March 2014 “This analysis examines some of the serious omissions in several of the widely cited meta-analysis papers & focuses primarily on how saturated fat and low-carb diets influences fatal heart disease, an important end point that is largely ignored by the authors of these meta-analysis papers.”
• A Preliminary Evaluation of Chowdhury Meta-Analysis on the Association of Fatty Acids with Coronary Risk – extensive analysis of the meta-analysis by Fred Pollack, March 2014
• Ronald M. Krauss, MD—The Doctor Who Made Lard-eating Fashionable – Dr John McDougall, March 2014
• Food Poisoning: How Industry Is Killing Americans – Dr John McDougall, 27 March 2014
• Dr. McDougall’s “Is Saturated Fat OK to Eat” – Dr John McDougall, 19 March 2014
• Dietary fat and heart disease study is seriously misleading – Walter Willett et al., March 2014
• Diet-heart: a problematic revisit – Jeremiah Stamler (2010, AJCN)

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:

• Dietary Guidelines, Cholesterol, Something Old & Something New – Jeff Novick, RD
• Cholesterol Confusion: Let’s Make Sense of It ; and Dietary Guidelines: Scientific Evidence for Nina Teicholz – Neal Barnard, MD
• What’s the Daily Required Intake for Cholesterol? – Linda Carney, MD
• Dr. Esselstyn On New Cholesterol Guidelines – Caldwell Esselstyn, Jr, MD

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:

• Sacks, F. M., Lichtenstein, A. H., Wu, J. H. Y., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., . . . American Heart Association. (2017). Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation, June 2017.

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:

• Saturated Fat: Weighed, Measured, and Found Wanting – David Katz, MD
• Chewing, and Choking, on False (Nutritional) Equivalence – David Katz, MD
• 5 Ways Saturated Fat Defenders Deceive the Public – David Katz, MD

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:

• Pett, K. D., Kahn, J., Willett, W. C., & Katz, D. L. (2017). Ancel Keys and the Seven Countries Study: An Evidence-based Response to Revisionist Histories. True Health Initiative.

Books:

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

Related pages:

• Low carbohydrate diets
• Low fat diets for weight loss
• Why do we recommend a low-fat diet?

Page created 4 July 2014
Last updated 8 July 2017

You may argue that humans are omnivores but it is clear that our anatomy and physiology are those of a herbivore.

There is a popular fallacy that humans as a species are well adapted to eating meat and wild plants but little carbohydrate. Also that eating more grains and root vegetables results in chronic diseases such as diabetes. It is difficult to reconcile this theory with the fact that there is least diabetes in the populations who consume the most carbohydrate, and most diabetes in the developed countries where meat, dairy and oil has displaced much of the basic starchy (carbohydrate) food from the diet.

The low carbohydrate enthusiasts claim that we evolved on a meat rich diet. A frequently quoted publication on the Paleolithic diet considered the diets of modern day hunter-gatherers and concluded that their diets were rich in foods of animal origin, leading to the conclusion that the natural human diet is meat based. The first major flaw in this publication was that it relied on old data, which was not collected reliably, and underestimated the amount of plant foods that these people gathered. The other flaw was that the last enclaves of hunter-gatherers were often marginalized into land that was not agriculturally productive and therefore provided limited sources of foods. It is likely that the majority of the Paleolithic humans lived in more productive lands abounding in plant sources of food. There is considerable evidence that early humans had diets that were mainly based on high carbohydrate starchy foods such as grains and root vegetables.

The development of a larger brain was not dependent on eating meat or fish. The mother provides the increased needs for omega-3 fats during the most rapid periods of growth in pregnancy and infancy. After weaning, human growth is incredibly slow and the main extra nutritional cost of a big brain is the energy it consumes, about 20% of resting metabolic rate. The brain runs almost exclusively on carbohydrate: “brain food”?

We don’t know how much meat versus plant our ancestors ate over the last couple of hundred thousand years. The advent of fire and cooking enabled our ancestors to eat things that were poorly digested or hazardous when raw, and greatly increased the range of foods we could eat, both plant and animal. Meat was not an ideal health supporting food for our ancestors, but it was energy dense and in hard times, it was better than hunger and starvation.

Evolution does not seem to have endowed us with a meat eating body or metabolism. We have hands that are suited for picking and collecting the edible parts of plants. We lack claws to attack prey and our skin is soft and vulnerable to laceration should we wrestle with another animal. Neither our hands nor our teeth are suited for tearing the flesh off a carcass. To a paleontologist, our teeth and jaw muscles are those of an herbivore, primarily designed for grinding food rather than tearing and chopping. We lack the large stomach of a carnivore and our intestine is long like an herbivore’s. Our large intestine is adapted to ferment plant foods to extract more energy. And we are vulnerable to disease when we eat more meat. Our cholesterol metabolism, like other herbivores, makes us vulnerable to artery disease when we eat more saturated fat and less fibre.

We are better adapted to eating starchy foods than the great apes who live on fruits and leaves in tropical forests. We have more copies of the gene for the starch digesting enzyme, amylase. Amylase mainly works in the small intestine, but we also have a higher concentration of amylase in our saliva. This adaption enabled us to take advantage of grains and roots of plants that store their energy as starch for the next growth season. Starch granules have been retrieved from surfaces of stone tools in Mozambique, dating back to 105,000yr ago, and from the teeth of our Neanderthal cousins in Europe.

The epidemiology overwhelmingly supports a high starch, predominantly plant based diet as being most health supportive. Cancer, heart disease and diabetes are least common in populations that have the most plant strong diets. Within developed nations, those who consume a more plant-based diet are healthier.

The most effective lifestyle intervention programs for reversing heart disease, diabetes and, most recently, prostate cancer all used a mostly plant-based, low fat diet.

Resources

• Deconstructing the Paleo Diet – Brenda Davis, RD (1hr 43 min. video). In this excellent presentation Brenda presents the evidence of what our Paleo ancestors actually ate. It looks nothing like the modern ‘Paleo’ diet.
• Milton Mills, MD: Are Humans Designed to Eat Meat? – (1 hr 18 min. video) from the Feb. 2016 McDougall Advanced Study Weekend
• The “Paleo” Phenomena: Facing Facts – Brenda Davis
• Brenda Davis: Defeating Diabetes and Debunking Paleo – podcast interview by Howard Jacobson
• The Paleo Diet Is Uncivilized (And Unhealthy and Untrue) – In his June 2012 Newsletter, Dr John McDougall has written an extensive critique of the Paleo diet where he describes it as uncivilized, unhealthy and untrue.
• Nathaniel Dominy PhD. and the True Human Diet – (video, 10 mins.) Anthropologist Dominy talks about his research and why he believes the true human diet is one based on starch.
• The Paleo Diet Is a Paleo Fantasy – Alison George reviews evolutionary biologist Marlene Zuk’s book Paleofantasy.
• Paleofantasy: What Evolution Really Tells Us about Sex, Diet, and How We Live – (book) Marlene Zuk, 2013.
• Richard Wrangham, PhD author of the best-selling book is Catching Fire: How Cooking Made Us Human – (7 min. video) Anthropologist Dr Wrangham has been researching for many years the role of cooking in human evolution. He cautions people about “raw foodism” saying all the evidence shows humans thrive on cooked foods. He has recently published a book Catching Fire: How Cooking Made Us Human.
• The Diet Wars – (54 min. video) In an entertaining lecture, Dr McDougall debunks the myth of the low-carb diet and presents evidence that humans are starchivores, not carnivores.
• Are We Designed to Eat Meat? – (1 hr 26 min. video, 2007) Dr. Milton Mills discusses human anatomy in relation to other animals that are carnivores, omnivores or herbivores.
• Human Ancestors Were Nearly All Vegetarians  – A recent guest blog in Scientific American discusses the structure of the human gut in relation to diet and concludes that, although there are some small differences,  “our guts do not seem to be specialized hominid guts; they are, instead, relatively generalized monkey/ape guts”.
• Even Our Ancestors Never Really Ate the “Paleo Diet” – Researchers are just beginning to understand what ancient humans ate, and these recent studies show that grasses and grains have been part of the human diet for millions of years.

Low carbohydrate diets have been around for decades and were epitomised and popularised by the Atkins Diet. So much evidence condemning these diets has been published that you would expect them to be of historical interest only. But strangely the fad continues with its latest reincarnation being the Paleo Diet and the Keto Diet. Let us make one thing clear: a low carbohydrate diet is a high fat, high protein, low fibre diet. This is explained on the Energy Pie page.

Related pages

• Energy pie
• Gut health
• Humans are herbivores
• Low fat diets for weight loss
• Weight management
• Why do we recommend a low-fat diet?
• What’s wrong with saturated fat?

Resources

• What’s Wrong With The Keto Diet? – Kim Williams, MD (video)
• Vegan cardiologist says a keto diet is ‘suitable for no one’ – (March 2019) includes a quote from Dr Kim Williams
• John McDougall, MD Criticizes Low-Carb Diets And Reveals Why a Low-Fat High-Carb Diet is Best – (1hr 3 min video)
• The Skeleton in The Ketogenic Diet Closet: What Virta Health, Mark Sisson, Joseph Mercola and Others Leave Out – Joel Kahn, MD (February 2018) takes a close look at the science behind low-carb diets
• Plant-based vs. ketosis: diet wars with cardiologist Joel Kahn, MD – (2hr podcast) Rich Roll interviews Dr Joel Kahn.
• Ketosis and the Ketogenic Diet: Debunking 7 Misleading Statements – Cyrus Khambatta, PhD, Mastering Diabetes
• Nina Teicholz, Integrity and The Big Fat Disguise – Joel Kahn, MD
• The Paleo Diet Is Uncivilized (And Unhealthy and Untrue) – Dr John McDougall demolishes the credibility of the Paleo Diet. It includes many links for those wanting more information.
• High Protein & Other Fad Diets  – Dr John McDougall
• This One Graph Single Handedly Explains The Obesity Epidemic (And The Low-Carb Lies) – addresses the narrative propagated by low carb advocates that we actually ate less fat after being told to go low-fat a few decades ago
• Low-Carb Fraud (2014, book) – T Colin Campbell.
• Carbophobia: The Scary Truth about America’s Low-Carb Craze – Michael Greger, M.D.
• Low-Carb Diets & Coronary Blood Flow – (video) Michael Greger, M.D.
• Atkins Diet: Trouble Keeping It Up – (video) Michael Greger, M.D. linking erectile dysfunction to the Atkins diet
• Low Carb vs. Plant-Based Diet – This video links the personal appearance of diet experts with the diets they promote. WARNING – some viewers may find such personal attacks offensive. But it makes a point. “Low-carb diets make people fat and sick. The personal appearance of overweight diet experts speak volumes about these diets”.

Peer reviewed articles

• Noto, H., Goto, A., Tsujimoto, T., & Noda, M. (2013). Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS One, 8(1), e55030.
• Song, M., Fung, T. T., Hu, F. B., Willett, W. C., Longo, V. D., Chan, A. T., & Giovannucci, E. L. (2016). Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Internal Medicine, 176(10), 1453-1463.