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Saturated fat in the dock: ‘Our nutritional courts tried and convicted the wrong man’

By Elaine WATSON , 01-Apr-2014
Last updated on 01-Apr-2014 at 18:25 GMT

Stephen T. Sinatra MD, FACN: 'It was never saturated fat that was killing us, it's been sugar all the time'
Stephen T. Sinatra MD, FACN: 'It was never saturated fat that was killing us, it's been sugar all the time'

As the debate over the role of saturated fat in cardiovascular disease intensifies, the authors of a new commentary claim that the “real villains” in the American diet are trans fat, sugar, and high-GI foods that rapidly convert to sugar.

In a commentary published in the Journal of the American College of Nutrition, Stephen T. Sinatra MD, FACN; Beverly B. Teter PhD, MACN; Jonny Bowden PhD, CNS; Mark C. Houston MD, FACN; and Miguel A. Martinez-Gonzalez MD, PhD, MPH; argue that the “nutritional courts tried and convicted the wrong man".

They add: “It was never saturated fat that was killing us, it's been sugar all the time and we’re consuming record amounts of it, unprecedented in human history. Replacing processed carbs with proteins and healthy fats (saturated, polyunsaturated and monounsaturated), is a step in the right direction.”

Dr Sinatra  - who co-wrote the best-selling book The Great Cholesterol Myth with Bowden -  is assistant clinical professor of medicine at the University of Connecticut School of Medicine, and believes saturated fat is mostly neutral and may even have some health benefits.

The commentary was published just before the meta-analysis in the Annals of Internal Medicine , which concluded that "current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats”.

While sections of this meta-analysis have been amended since its initial publication, and some scientists have challenged its conclusions , it has re-ignited the whole debate over the relationship between saturated fat and heart disease.

It was never saturated fat that was killing us, it's been sugar all the time

According to Dr Sinatra et al, there is no single cause of heart disease, but there are a number of “major promoters” including inflammation and oxidative damage.

“Without inflammation, there is no plaque, which is, after all, an attempt by the body to “patch up” an injury,” add the authors, who acknowledge that saturated fat increases total cholesterol, but question whether cholesterol is a major cause of heart disease.

They also argue that protecting LDL cholesterol from oxidation is more important than just reducing total LDL levels.

“Is cholesterol lowering really the gold standard for treating patients with cardiovascular risk and disease? Current evidence would say no... Oxidized LDL cholesterol, particle size and number and especially Lp(a) are also potent factors causing inflammation at the endothelial level.”

The problem is excessive sugar, trans fatty acids and overzealous use of omega-6 oils

Fixating on LDL “will detract from other inflammatory etiologies resulting from excessive sugar/insulin relationships, trans fatty acids and overzealous use of omega-6 oils”, they argue.

“Inflammation is becoming accepted as an important process in the development of cardiovascular disease, mitochondrial dysfunction and ROS (reactive oxygen species) produced from excess dietary carbohydrates and polyunsaturated fats such as vegetable oils.

“Trans fatty acids have been shown to be involved in cardiac dysfunction and blood lipid abnormalities causing significant cardiac pathology. Many of these factors are because of the types of fat in the diet but none of them involve the saturated fats."

A balanced ratio of omega-6 to omega-3 is vital for cardiovascular health

Meanwhile, the over-consumption of vegetable oils [high in omega-6] and the under-consumption of omega-3 fatty acids is “a much bigger problem than saturated fat intake because that imbalance is a substantial factor in creating inflammation”, they claim.

“The ratio of omega-6 to omega-3 is turning out to be an important metric for health, possibly more important than cholesterol ever was… A balanced ratio of omega-6 to omega-3 is vital for cardiovascular health because when more omega-6 than omega-3 is consumed, more inflammatory cytokines and other bioactive compounds with adverse effects will be formed.”

The Sugar Association: Sugar consumption is significantly lower than it used to be

Not surprisingly, The Sugar Association takes issue with the authors' claims that we should point the finger at sugar instead of saturated fat in our search for nutritional 'villains'.

President and CEO Andy Briscoe told FoodNavigator-USA: "We have not yet fully reviewed the commentary, and thus cannot provide a complete response, however, we would like to note this is not peer-reviewed science.  Sound nutrition guidance must be based on the preponderance of peer-reviewed, published science. 

"In response to your question [about whether we are consuming 'record' amounts of sugar, as Dr Sinatra et al claim], however, according to independent U.S. Department of Agriculture data, American per capita consumption of real sugar (sucrose) is lower now than it was 40 years ago by approximately one-third (34%). So of all the things we need to worry about, "higher" consumption of sugar is not among them."

Click HERE to read more on the debate over the role of saturated fat in cardiovascular disease.

Source: Journal of the American College of Nutrition     DOI:10.1080/07315724.2014.878633

'The Saturated Fat, Cholesterol, and Statin Controversy: A Commentary'

Authors: Stephen T. Sinatra MD, FACN, Beverly B. Teter PhD, MACN, Jonny Bowden CNS, Mark C. Houston MD, FACN, and Miguel A. Martinez-Gonzalez MD, PhD, MPH.

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