Saturated Fat, Diets, and Diatribe: Nutrition Science Meets “Whac-a-Mole”

David L. Katz, MD, MPH, FACPM, FACP, FACLM
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I hope, my fellow Americans, that in spite of it all, you have a good holiday weekend. This is a hard time to “celebrate” America, both practically and in principle. Practically, the customary expressions of celebration are much obviated during a pandemic surge – by restrictions, regulations, cancellations, and lock-down extensions.
Close up of a grill with 4 hamburgers and 2 hotdogs

In principle, as the legacy of institutionalized racism roils us, as inept management of the pandemic foils our progress toward normalcy, and as the beacon of our global leadership in matters of ideals is much dimmed– we have far more cause for corrective toil, than celebration. This is a sad, bad national birthday.

But I hope we find ways nonetheless to navigate past that, and celebrate in whatever patches of love and solidarity and friendship we can cobble together. Let’s celebrate the idea of our ideals, and how we may better honor them. Let’s celebrate the indomitable, if capricious, character of hope. Let’s peer around the next bend and celebrate the view as we recall that the best way to predict the future, is to create it. Let’s honor the opportunity in crisis.

With that, I will leave the high-minded matters of existential reorientation to philosophers, political commentators, historians, and the past echoes of John Philip Sousa. Let’s talk food.

Whatever passes for celebration this weekend, food will figure prominently in it, as ever it does. Tradition suggests hamburgers and hotdogs on backyard grills as a popular choice- with perhaps some inchoate concessions to plant-based alternatives. I salute, and encourage those substitutions– for the sake of people and planet alike.

But just as our national debate about the right pandemic response devolved into competing dogma propounding “lock it all down until there’s a vaccine,” versus “liberate my state, and let the nursing home residents fend for themselves” – we have altogether too much diatribe where the benefit of wholesome, balanced, sustainable dietary patterns nurturing both health and pleasure ought to prevail.

Specifically, where simple clarity about wholesome foods in sensible, and often time-honored assemblies could put a permanent end to the notion that nutrition guidance should change with every news cycle and its hyperbolized distortion of some new study of nominal consequence- we have, instead, a never-ending game of nutrition-whac-a-mole.

Nothing better epitomizes this than what passes for scholarly contribution on the topic of saturated fat, and nothing better represents the liabilities of such distractions than a paper now in press at the Journal of the American College of Cardiology entitled “Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review.”

There is an irony- if not the graver matter of a hypocrisy- in the very title of this paper, leaving aside whatever justifies the “state-of-the-art” contention. How can a paper assert in the same headline that it is about the health effects of a specific nutrient class, while advocating for food-based recommendations? If recommendations are food-based, then a focus on any given nutrient is no longer warranted. If the focus is on a nutrient and conclusions about it, then that directly undermines the proposition that recommendations should be food based.

Lest there be any doubt, I will hasten to evince my own view: dietary recommendations absolutely ought to be food-based.

Getting the foods right will sort out all of the nutrients, whereas fixation on any given nutrient still invites innumerable ways to get diet wrong. Diets high or low in fat or carbohydrate can be good, or bad. Diets can be low in sugar yet bad; low in salt, yet bad; high in calcium, yet bad. There are many ways to eat badly, and under the ever-shifting halo of some nutrient fixation, Americans have been exploring them all for decades– aiding and abetting the invention of new varieties of junk food with each misguided, fleeting infatuation; propagating epidemics of obesity, heart disease, and diabetes– to name just a salient few.

Yes, by all means- let’s focus on foods at last; let’s get dietary patterns right, based on science, sense, and the well-established global consensus of diverse experts. By and large, that means ignoring this new paper, which is an invitation to perpetuate the substitution of diet science whac-a-mole for anything more constructive.

Whatever your gathering’s culinary inclinations, we can be pretty confident about items unlikely to make the menu. Chances are very good you will not be serving saturated fat sandwiches for lunch. A saturated fat smoothie probably won’t be featured for the family breakfast. There will be no seared saturated fat kebabs for dinner.

No one “eats” saturated fat, any more than we drink oxygen. Yes, there is oxygen in water- famously, in every molecule of H20. But it’s water we drink, and the oxygen is just along for the ride.

So, too, saturated fat- or any other fat for that matter. The closest we ever get to eating a “fat” is with use of cooking oils. But even here, we do not eat “saturated” or “unsaturated” fat. Oils are all mixes of various fatty acids. None is one variety of fat in isolation. Olive oil, for instance, famously high in monounsaturated fat, is more than 20% other varieties of fat, including…some saturated fat.

You don’t eat saturated fat. No one does. You eat food (or what passes for food in modern cultures, and all too often doesn’t truly deserve the designation). Either way, there is no snacking on saturated fat anywhere in sight.

So why, then, do research papers talk about our intake of saturated fat as if it were something we ate? Personally, I think it is a willful attempt to keep nutrition research mired where it generates doubt and pseudoconfusion in the place of understanding.

The perpetual pseudoconfusion that emanates when nutrients people do not eat are substituted for the foods people do- is enormously profitable for some. It allows for horrible exploitations- such as the willful engineering of addictive junk food– to hide in plain sight. And, it underlies the stark reality that while we know, reliably, how to eat to eliminate 80% or more of premature death and chronic disease- we don’t do it.

Instead, in part under the cover of pseudoconfusion and doubt-for-the-profit of Big Food, Big Pharma, Big Media, and big egos- diet is the single leading cause of premature death in America, and much of the modern world, today. Again, despite all of the simple, clear, reliable, stood-the-test-of-time, works-at-the-level-of-entire-populations truths about food we know- the pseudoconfusion that issues from where exploitation meets gullibility makes our diets actually lethal to us. Let me repeat this: diet is the single leading cause of premature death in America today. Full stop.

That was true before the pandemic; will be true after the pandemic; and remains true even during the pandemic. The pandemic toll is much compounded by our poor diets. They contribute- both directly, and via the chronic maladies they cause– to the COVID hospitalizations, complications, and fatalities.

I hope you are horrified, because this confluence isn’t just preying on you- it is preying on your children, too. The stuff we call “kid food,” and blithely feed our kids and grandkids, would constitute abuse if you tossed it to a zoo animal. Multicolored marshmallows are an acceptable part of a child’s “complete breakfast” here; thrown to the dolphins, otters, or spider monkeys- they would constitute assault, and rightly so. Feed a wild animal what we routinely feed our own offspring, and we’d be subject to criminal charges.

OK, so, back to saturated fat.

Saturated fats are diverse, so speaking of them all together- those from meat, those from dairy, those from dark chocolate- leads to meaningless conclusions. Let’s use oxygen as an analogy again: is oxygen good or bad for us? Well, there is oxygen in Earth’s atmosphere (good for us; essential to our minute-by-minute survival); there is pure oxygen (can be good in the short term, but lethal in a span of hours or days); there is oxygen in water (again, essential for survival); there is oxygen in carbon dioxide (tolerable within strict limits, and a gas we need to breathe out rather than in); and there is oxygen in carbon monoxide (a rapid-acting, lethal poison to us). So, is oxygen good or bad? Yes. The question? Bad, pointless, distracting, and vapid.

So, too, any such question about “saturated fat.”

But, of course, there’s more. Just as 100% oxygen, though lethal over time, might be life-saving in the short-term for someone with hypoxemia (low blood levels of blood oxygen), so, too, food sources of saturated fat may be lifesaving in populations that are prone to overt nutrient deficiency and starvation. But just as you would not recommend 100% oxygen to everyone all the time because it can benefit a select population, so, too, you cannot advise to a population prone to dietary excess, obesity, diabetes, and heart disease- what is beneficial to those prone to famine. If you are barely scraping by on a diet of white rice, any other food will do you some good.

The new JACC paper, which draws selectively rather than systematically on data sources, invokes the PURE study prominently to justify the view that saturated fat is “not harmful.” Leaving aside the incongruity in a conclusion about saturated fat in a paper that professes to favor foods over nutrients, this conclusion is a non sequitur for modern, industrialized countries. Much of the PURE study population is from poor, developing countries prone to famine. The health effects of meat and dairy, let alone saturated fat, are monumentally a matter of context. For those prone to starvation and protein deficiency, these foods offer obvious, decisive benefit. For those prone to obesity and type 2 diabetes, quite the opposite. Conflating the two is either a willful distortion, or profound epidemiologic ineptitude.

There are two other rather damning indictments of this paper and the doubt it is obviously designed to subtend, and neither is at all nutrient-specific.

First, how can the health effects of any food, let alone nutrient, be interpreted without dedicated attention to: instead of what? The profound importance of these three words to nutritional epidemiology has been well and repeatedly established. If you eat cheese instead of jelly beans, you are almost certainly improving your diet quality. If you eat cheese instead of garbanzo beans, you are almost certainly doing the exact opposite. Every judgment about the health effects of a food, food group, or nutrient source must run the “instead of what” gauntlet to reach anything resembling sense.

Studies have shown the direct relevance of this robust concept to saturated fat. Substitute added sugar for saturated fat, and diet quality and health move sideways to “just as bad, by alternative means.” Substitute whole grains, nuts, seeds, and/or legumes for saturated fat sources instead, and health improves markedly.

Second, note the standard the new paper assigns: not harmful. Since when did “not harmful” become the measure of healthful food or diet? By such a metric, we are all granted license to eat cardboard. It will not do us any good, but it is not known to be harmful.

This is an absurd standard when the “baseline” to which harms are being compared is an overall diet quality that kills 500,000 prematurely each year in the United States. This is a preposterous standard when optimal dietary patterns- emphasizing whole vegetables, fruits, grains, legumes, nuts, seeds, and plain water for thirst- have been known for decades to help reduce the risk of premature death and all major chronic diseases by 80% or more. More years in life, more life in years is the luminous prize we are throwing away- for our children as well as ourselves- if “not demonstrably harmful compared to the egregiously bad diet that prevails in America” becomes the new standard of nutritional quality. I can see why Big Food and Big Pharma might love that; but if you love a child, you really need to hate it.

Sure, it makes sense for scientists in biochemistry, cell biology, and metabolism to study saturated fat, and to go further- and study the specific saturated fatty acids, which differ quite markedly from one another.  But when it’s time to convene your loved ones around the holiday picnic table, you will be serving foods- not fatty acids. More importantly, you will do that every other day, year round.

Whatever adorns your table, I hope you and your family have a good holiday weekend in spite of it all. I wish you good food, good health, and some much-needed good fun. If the games happen to include whac-a-mole, try not to eat it.

-fin

This article was first published on LinkedIn.

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