Saturated fat vs. heart disease: current state of the science
Despite recent publications finding no correlation between intake of saturated fat and coronary heart disease (CHD) – see, for example, the recent meta-analysis in the American Journal of Clinical Nutrition – the debates over the role of saturated fat continue.
In that same issue of the Journal, another study says that reducing saturated fat only works if you replace it with something better. If you replace saturated fat with carbohydrates, the effects on heart disease will be worse.
The fat story is not simple (in What to Eat, I explain the biochemistry of food fats in the chapter on fats and oils and in an appendix). The main reason for the complexity is that different kinds of fats do not occur separately in foods.
Without exception, food fats are mixtures of three kinds of fatty acids: saturated (no double bonds and solid at room temperature), monounsaturated (one double bond), and polyunsaturated (two or more double bonds and liquid at room temperature). Food fats just differ in proportions of the three kinds.
Meat, dairy, and egg fats generally are more saturated. Plant fats and oils are generally more unsaturated.
How to make sense of the saturated fat story? An expert panel from WHO and FAO just produced a new review of the evidence. The panel evaluated CHD morbidity and mortality data from epidemiological studies and controlled clinical trials. It found:
- Convincing evidence that replacing saturated fat with polyunsaturated decreases the risk of CHD.
- Probable evidence that replacing saturated fat with largely refined carbohydrates (starch and sugar) has no benefit and even may increase the risk of CHD.
- Insufficient evidence relating to the effect on the risk of CHD of replacing saturated fat with monounsaturated fats or whole grain carbohydrates, but a trend suggesting that these might decrease CHD risk.
- Possible positive relationship between saturated fat and increased risk of diabetes.
- Insufficient evidence for establishing any relationship of saturated fat with cancer.
The panel’s recommendations: (1) Replace saturated fat with polyunsaturated fats (omega-3 and omega-6) in the diet, and (2) Limit saturated fat to 10% of daily calories or less.
Translation: Eat less animal fat and replace it with vegetable fats.
Historical note: These are precisely the same recommendations that have been standard in the U.S. for at least fifty years. This was good advice in the late 1950s. It is still good advice.
UPDATE, March 22,2011: Another major review has just come to precisely the same conclusions, this one from an international expert panel. It also suggests areas for future research. See American Journal of Clinical Nutrition 2011;93:684-88.

Comments
Thanks once again for the clarity on this issue. One reads a lot of claims about the role of fats (usually unsubstantiated) and even though I read “What to Eat”, I appreciate the timely review.
I may be off on this, but I thought the gov’t recommendations since the 50s have included reducing total fat content. So wouldn’t that lead to a lot of replacing saturated fats with carbohydrates?
I’ve put my money on Gary Taubes: nutrtition “science” is a mess. I don’t take any of these studies very seriously. My bet is the true culprit in heart disease–as well as obesity, hypertension, atherosclerosis, diabetes–is too many cheap carbs. The food pyramid–and government food policy–is killing us.
I’m with Ed: the nutritional advice was wrong back then, and it’s still wrong now. Don’t wait another twenty years until the “experts” admit their mistake.
I’m certainly not going to trust the WHO. They are probably more corrupt than the FDA, if that’s possible. How about someone who isn’t connected with Big Pharma?
You said:
“Historical note: These are precisely the same recommendations that have been standard in the U.S. for at least fifty years. This was good advice in the late 1950s. It is still good advice.”
Yes, and look how well it has served us. A lot of the fat ideas are old information cascades. That is part of what the meta data analysis data was all about.
What’s your take on the ratio of omega 3′s to 6′s…is this a huge unbalanced problem?
“Convincing evidence that replacing saturated fat with polyunsaturated decreases the risk of CHD.”
Actually what the report states is LDL and total/HDL values change. You would have to believe in the flawed lipid hypothesis to make the connection from here to CHD.
Has anyone looked at what’s stored in the fat? Lipid-soluble compounds (such as herbicides and pesticides and steroid-type hormones) are stored in fatty tissue. It makes sense that the plant-based oils are less harmful because they would have less “toxins” stored in them than the animals (the bio-accumulation effect – the herbicides from the plants they eat, plus the pesticides and perhaps hormones used on the animals). I think we are looking at the wrong factor – the culprit is most likely the chemicals stored in these fats, not the fats themselves. Looking at it this way, the conflicting studies make sense. Those cultures that eat a lot of meat, but have excellent health – their meat is not industrially processed like ours. Contrast that with the industrially processed meats and other food-products where these studies show diets high in saturated fats are bad for heath.
When my husband was diagnosed with diabtes five years ago, his cholesterol was over 300, his tryglicerides were 1300 and his blood sugar was 390. With a low carb diet, pretty heavy in animal fats (eggs, cheese, butter, red meat) he lost 70 pounds and his cholesterol is now under 200, his tryglicerides are around 150 and his blood sugar is under 100. He gets most of his carbs from fruits and vegetables. What he does not eat are processed foods and vegetable oil. I’m with Staub all the way.
@ Joseph: you’re presuming that people have actually followed the guidelines for the past 50 years. As Marion demonstrates in her books, the problem has always been that the issues are extremely politicized, so when the actual advice from nutritionists was “Eat less meat and dairy,” it became “eat less saturated fat,” and then “eat more lean meat.” The consistent message from the reputable nutrition community has consistenly been the same: eat less and make most of that relatively unprocessed plants. The problem is that we’re very good at ignoring wisdom in favor of a quick fix. “Eat less meat & dairy” magically becomes “Eat more white pasta,” which obviously doesn’t help anything.
[...] in Daily life, Food, Science at 12:11 pm by LeisureGuy Marion Nestle at Food Politics: Despite recent publications finding no correlation between intake of saturated fat and coronary [...]
I agree with Ed Bruske and Gary Taubes. I’d also like to know why vegetarians in India are experiencing skyrocketing rates of diabetes, heart disease, and obesity. They eat few animal products with the exception of yogurt, paneer, and some butter/ghee. Smoking and alcohol consumption are almost nil among Indian women, yet the rate of heart disease, diabetes, and obesity are shooting up. What they do consume is lots of the cheap industrial vegetable oils that Nestle says are healthy. The consumption of refined carbohydrates in India has also increased greatly, in the form of soft drinks and sweets.
I believe the real culprit is huge increase in sugar and refined carbohydrates, along with the industrial oils.
Yeah – it’s not low-fat or high-fat diets. It’s processed food and sugar. Fat studies all contradict each other, but processed food and sugar kill every time!
There are several reasons why the Mediterranean Diet (http://mediterraneandiet.tv) is good for health, but the good fat / bad fat discussion is one of the biggest.
The proof is in the credibility of the numerous prior peer reviewed studies (and Marion’s paper on the topic).
We’ve been replacing saturated fats with polyunsaturated fats for the last half century, but cancer and CHD rates have gone up, not down. They don’t explain why some primitive cultures that eat lots of protein and saturated fats have less CHD and cancer than we do. Personally, I think the mass consumption of cereal grains is the major cause of health problems in the US, not saturated fat-from the right sources ie., grassfed meat, coconut, etc.
Emily says: The consistent message from the reputable nutrition community has consistently been the same: eat less and make most of that relatively unprocessed plants.
So why do processed grains make up the base of the food pyramid instead of vegetables?
This I believe:
Eat meat and vegetables, nuts and seeds,
some fruit, little starch and no sugar. Keep
intake to levels that will support exercise but
not body fat. (from Crossfit.com)
I gotta agree with stan, Tom, and similar. I was also wondering about your take on the omega 3 to omega 6 ratio issue- which certain plant-based oils could really impact?
Wow sorry for the poor grammar above- I was on hold on a phone call and rushed! I meant that increasing plant oils could impact the omega-3 to omega-6 ratio. What is your take on that?
@Emily I am not presuming anything of the kind. This sounds like some of the same old lame excuses for abject failure. In fifty years we need to face failure and not continue with the same old oft failed myths and flawed paradigms.
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[...] This post was mentioned on Twitter by Marion Nestle, Darya Pino, Katie Hobson, Kathryn Elliott, Tomasso Trattoria and others. Tomasso Trattoria said: RT @marionnestle: Saturated fat vs. heart disease: current state of the science: Despite recent publications finding no correlation b… http://cli.gs/y5tdX [...]
Now it can be told: When the composition of human aortic plaques was analyzed, it was mostly polyunsaturated fatty acids (from vegetable oils). No association was found with saturated fatty acids (from animal fat, coconut and palm oils). Hence, it was suggested current trends favoring increased intake of polyunsaturated fatty acids should be reconsidered (Felton C.V. et. al., Lancet, 1994, vol. 344, pp 1195-1196).
I find it odd that they recommend to replace saturated fat with polyunsaturated fat rather than monounsaturated since polyunsaturated fat decreases HDL’s in the blood.
I am with Jaime on that one. For the ordinary man or woman, the main advice since the 1950s seems to have been to reduce consumption of all fats, and to replace them with carbohydrates. I find it more than a bit disingenuous to claim that the official recommendations with regard to fat have been spot on all along.
Tom, your claim that we’ve been replacing saturated fats with polyunsaturated fats over the last 50 years is not supported by the USDA data (available at http://65.216.150.146/NFSdatabase/QueNut.asp). The data show that we’re eating substantially more unsaturated fats, but that our saturated fat intake has remained about the same. On top of that, we’ve substantially increased our carbohydrate intake. Much of this is probably in the form of added sweeteners.
Some people, such as Gary Taubes, like to point out that the percentage of our calories coming from saturated fat has decreased in the last 50 years (see, for example, page xvii of Good Calories, Bad Calories), and use that as evidence that we’re eating conscientiously. But the data show that this decreased percentage is a result of a massive increase in calorie intake (from 3100 calories to 3900 calories from 1960 to 2006), so I can’t help but conclude that Taubes is either disingenuous or hopelessly innumerate. Neither option inspires much confidence in his credibility.
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If this is such good advise, why has CHD steadily increased since the introduction of processed vegetable oils in the U.S.? Why is it in study after study, if you look at the observational data, i.e. who lives and who doesn’t, those who replaced the saturated fats with the “healthier” polyunsaturated fats, died more often. Why is it around the world, cultures who eat a very high percentage of animal fats have virtualy no rate of CHD?
Such as the inuit, 60% plus of there calories come from animal fats. Whale, seals, eggs, ect.
I think the advice is based on what sounds like it should be true, not what actually is true. Satyrated fat intake has declined dramattically in the U.S over the last 50+ years, yet CHD has increased dramatically. As has cancer, diabetese, and many other ailments.
Wake up. The governments good advice is killing us!
People keep saying that the advice has been telling us to replace fats with carbohydrates. That’s not my impression. My interpretation has been that we should reduce saturated fats and replace them with unsaturated fats (where an alternative is appropriate), unrefined carbohydrates and fibre, with an overall reduction in energy content if we have weight problems. And take more exercise. That still seems like good advice. Nobody has been telling us to eat more sugar, have they (except perhaps the sugar companies)?