Fat, the much maligned nutrient

by Bryon Ennis

The day I began to see fat in a different light occurred 10 years ago. My companion and I, Ron, a retired chiropractor, and an active yoga instructor, had stopped for breakfast on our way to a day of birding. I knew that Ron had different notions about food than were popular at the time. As a health practitioner and a yoga instructor, he was very current about what nutrition research had been learning about the typical American diet. So when he ordered bacon with his scrambled eggs, whole milk and buttered toast, I commented that I didn’t think he would eat so much fat. To which Ron replied. “Fat is essential in our diet. Our brains need fat to work properly, and so do all the cells in our bodies.”

What! This was blasphemy. As far as I understood, fat was a sort of delicious poison we ate at our own peril. Fat in our diet meant fat on our bodies, not to mention in our arteries. Wasn’t that what cholesterol was after all, fat collecting in our arteries? Well, no. Ron was correct, and as time passes and more research and long-term diet studies are done, fat has nearly taken on a place of honor in our diets, right there with protein, calcium, iron and fiber.

Until the 1940s little concern was expressed regarding fat consumption in the human diet. Prior to that time most people had physically demanding occupations, and the primary concern was getting enough calories, not avoiding them.

However, during World War II, advances in agriculture and food technology, and changes in lifestyle resulted in concerns among medical researchers. One of the major advances in agriculture emerged surprisingly from the munitions industry, which had built up large stockpiles of the potent explosive ammonium nitrate during the war. Searching for possible new markets for this war chemical, the industry found eager consumers on American farms. This synthetically produced explosive/fertilizer not only allowed for the industrialization of agriculture, it also spelled the demise of many small farms where wholesome natural foods had been produced in small quantities using any kind of animal manure as fertilizer. At the same time, many former farm families were leaving rural areas. However their new jobs in cities and their new lives in suburbs did not require the same daily physical exertion from in decades past.

One of the first medical researchers to notice the effects of these changes on the health of men in particular, was physiologist Ancel Keys who witnessed an epidemic of myocardial infarctions (heart attacks) among American business executives. Dr. Keys, then at the University of Minnesota, recruited 286 Minneapolis and St. Paul businessmen between the ages of 45 and 55 to submit to yearly physical examinations starting in 1947, in an attempt to discover the factors involved in “degeneration of the heart.” The only significant predictor (other than smoking) he found in the incidence of future myocardial infarction was a high total cholesterol level. At that time we did not know how to differentiate between HDL (good cholesterol) and LDL (bad cholesterol)

Though Keys was to conduct more diet/heart studies in future years, even these limited studies had considerable appeal among cardiologists at the time. One in particular was Dr. Paul Dudley White, perhaps America’s most prominent cardiologist, who in addition was president of the International Society of Cardiology. From this authoritative position White was able to effectively blunt the protests of a minority of researchers who disagreed with the conclusions reached by Keys. Then, early in the morning of September 24, 1955, an event occurred that would focus the attention of most Americans on a health issue like never before. The 64-year-old president, Dwight Eisenhower, suffered a heart attack in Denver, Colorado. With some fanfare, the Air Force flew Dr. White from Boston to the president’s bedside. Having caught the public’s attention, Dr. White used frequent press conferences, ostensibly about the health of the president, to warn Americans about the disease that had become the great new American epidemic: atherosclerosis, clogging of the body’s arteries.

Employing the basic observation that some fats were liquid at room temperature while others were solid, Dr. Keys simplified the categories of saturated and non-saturated fat for the public in his book Eat Well and Stay Well. Therefore, hard fats such as butter, cheese and lard-based margarine were considered saturated and, according to Dr. Keys, caused high levels of cholesterol in the blood and “probably” those deposits in the coronary arteries. On the other hand, fats that were liquid at room temperature, such as corn and cottonseed oil were unsaturated and thus were relatively benign. Unfortunately we also did not fully understand in the late 1950s, the destructive effect of trans fats on the body, but because trans fats could be commercially produced from hydrogenating the “non-saturated” vegetable oils, some dietary experts actually advocated substituting trans fats for saturated fats. Plus, hydrogenated oils were found to give products a longer “shelf-life.”

The early 1960s marked the real beginning of the “cholesterol wars.” The wars were fought very much in the public arena by one side, “the lipophobes” as the anti-fat side was labeled. They included the U.S. government, Time Magazine, Newsweek, Wesson Oil, Nucoa and Fleischmann’s Margarine, General Mills, the American Heart Association, the American Medical Association, and many prominent researchers at major American universities.

On the opposing side, though not necessarily “lipophiles” because they were not yet advocating for fat in the diet, were a small knot of dedicated doctors and researchers who were simply unconvinced that that Keys’ conclusions were scientifically valid. With the first reports of Keys’ “Seven Countries Study” ostensibly linking fat-rich diets and heart disease, Jacob Yerashalmy of UC Berkley, launched a challenge. Yerashalmy pointed out that while six of the seven countries Keys examined in his study seemed to support the diet-heart hypothesis, statistics were actually available for 22 countries. When all 22 countries were analyzed, the apparent link between fat consumption and heart disease disappeared.

In the 1960s, Vanderbilt University scientist George Mann studied nomadic Maasi in Kenya and Tanzania. These populations consumed a very high saturated fat diet, including drinking the blood of their cattle. Skeptical scientists argued they must have some hereditary protection against heart disease. Yet when the Maasi men moved to cities and began to consume a modern diet, they developed high cholesterol levels. Similar studies were conducted with the Inuit tribes of the polar regions whose diets included large quantities of animal fat seemingly without contributing significantly to high serum cholesterol counts.

Both sides of the diet/heart debate continued through the 1960s to argue vehemently—some say, past each other—with the public siding with the low-fat diet side. Yet, as early as 1957, distinguished pioneer in lipids (fat/protein) research, Edward H. “Pete” Ahrends Jr. warned of oversimplifying the problem of diet and heart disease, saying the cause could be fat and cholesterol, or it could be carbohydrates and triglycerides.

In 1965, an important shift in the public’s attitude about the diet/heart link occurred with the introduction of the Atkins Diet. Dr. Robert Atkins had himself been overweight after beginning his medical practice. But rather than turning to a diet that counted calories and avoided fats, he was attracted to one that followed the recommendations of researcher Dr. Alfred Pennington. Described in an article of the Journal of the American Medical Association titled, “A New Concept in the Treatment of Obesity,” the diet advocated the complete elimination of sugar, and a marked increase in both fat and protein. Following this diet advice, Dr. Atkins lost weight and kept it off.

Impressed by the results he had experienced, Dr. Atkins began to share the beneficial affects with his patients. While working as a medical consultant for American Telephone and Telegraph, he managed to help 65 patients reach their ideal weight. News of Dr. Atkins’ successful diet regimen reached the producers of the popular “The Tonight Show” with Johnny Carson, where Atkins was interviewed. Subsequently Vogue Magazine published the diet plan Dr. Atkins recommended. This changed the arena of the “fat wars.” Whereas the lipophobes previously had the major media on their side, now there was erupting a small public awareness of the possible benefits of fat in the diet.

At the same time a landmark study of heart and vascular health was taking place in Massachusetts. The Framingham Heart Study was the first epidemiological study of what caused people to have heart attacks, cardiovascular disease and hypertension (high blood pressure). Prior to the study it was generally believed, even by physicians, that all three of these conditions were an inevitable part of aging. Before Framingham, the notion that scientists could identify, and individuals could modify risk factors tied to heart disease, stroke and other diseases was not part of standard medical treatment. One of the key risks for fatal heart attacks The Framingham Study absolutely identified was smoking. In fact it was established in the study that those who quit smoking cut in half their risk of fatal heart attack. Other risk factors were found to be faulty diet, sedentary lifestyle and unrestrained weight gain. During the era of the Framingham study researchers progressed from identifying all cholesterol as a risk factor in developing heart disease, to distinguishing the unique biologic characteristics of LDL versus HDL. At this point it could be shown that all cholesterol was not necessarily bad. There was both “good cholesterol” and “bad cholesterol.”

Two other important studies of this era that had an effect on the diet/heart debate were the Nurses Health Study and the Women’s Heath Initiative Study. The Nurses’ Health Study found that a Mediterranean-type diet including fish, nut and whole grain consumption reduced the risk of coronary heart disease, however it also found that consumption of refined carbohydrates and trans fats increased the risk. Findings of the Women’s Health Initiative Study however, showed that low-fat diets had little effect on the incidence of coronary heart disease

Though progress in the research on blood serum cholesterol was making significant advances, and major longitudinal health studies had provided new insights into the causes of heart and cardiovascular disease, the public had been terribly frightened by the overwhelmingly bad press fat had received in the media, and it was reluctant to quickly reverse diet practices that had been drummed into it by doctors, government, major corporations and popular elements of the media. From 1956 to 1976, per capita butter consumption fell by over half, and egg consumption dropped by over a quarter. Consumption of margarine doubled from 1950 to 1972, and that of vegetable oil (corn, soybean) rose by over 50 percent in the 10 years from 1966 to 1976. But examples of healthy fats such as olive oil, nuts and fatty natural vegetables such as avocados had established a toehold in the diets of some “Iipophile” Americans.

From the mid 1970s to the mid 1980s an unfortunate phenomenon began to be noticed. For many decades, the percentage of obese Americans had been about 14 percent of the population until about 1980, when it jumped to around 20 percent. During the 10 previous years, food producers had been removing fat from their products and crowing about it, but the fact that went unobserved was the number of calories remained the same. In removing fat from commercially produced food products, manufacturers were substituting carbohydrates and other non-natural ingredients. In addition the use of high fructose corn syrup was exploding. This is best illustrated in what is now called the “Snackwell” phenomenon, where fats were removed from foods like the Snackwell cookies, only to have the calories replaced by carbohydrates. Once researchers began to examine the effects of low-fat products on our health, they truly began to understand why fats (at least the good fats) were not so bad for us, and consequently why highly refined carbohydrates (found in cookies, crackers, doughnuts, pasta, etc.) were very bad. This disastrous national experience shot all manner of holes through the low-fat argument. At the same time, a dietary movement was taking place in America, once again among an aware few, which pointed us back to the virtues of wholesome natural foods and home cooking.

By 2014, most large media sources had humbly retracted their original position on low fat diets. Time Magazine’s June cover states, “Eat Butter” “Scientists labeled fat the enemy. Why they were wrong.” On June 10, 2015, the Washington Post stated, “The Nation’s top nutrition advisory panel has decided to drop its caution about eating cholesterol-laden food, a move that could undo almost 40 years of government warnings about its consumption.” In a March 4, 2016, New York Times article, Dr. Mark Hyman, director of Cleveland Clinic’s Center for Functional Medicine, advocates the health benefits of eating fat. Dr. Hyman promotes it on talk shows, educates other doctors, and has even managed to wean his close friend Bill Clinton off his previously low-fat vegan diet.

So, it has taken us over 60 years to come full circle on eating fat. We have seen the public swept up in dietary movements advocated by what we thought were the most reliable and responsible sources of healthy eating. Are we now poised to rush into high fat diets on the most recent recommendations from medical and nutritional experts?

I am drawn instead to the advice of Michael Pollen who advocates for a “food” approach rather than a “nutritional’ approach. He hearkens back to a time before the first rumblings of concern over fat. In effect Pollen asks us to consider our food from a historical perspective. Pollan asks, “What did our grandparents or great-grandparents eat?” For thousands of years, people in widely diverse cultures have been determining by trial and observation, what foods were best for them. Perhaps we can relearn what they came to understand.

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