Saturation be damned

Night time reading

I love interacting with this informed and educated community of ours who take responsibility for own health, read and interpret scientific articles, ask intelligent and incredibly tricky questions and look at the world through a prism of human evolution. It’s really really cool. I also don’t own a television or read newspapers. I know, I am missing out on the vital information on the recent exciting advances in the field of laundry detergents, easily foldable exercise equipment and female hygiene products. But I’ll take my chances.

So when I was approached recently by an Australian reporter to comment on why saturated fat might not be as bad as everyone thinks, I was temporarily stunned. Everyone still thinks that? An hour-long lunch outside in the company of co-workers brought me back to reality. Listening to the less-than-lithe lady lecturing a younger employee that “pasta is perfectly healthy as long as you avoid creamy sauces and stick with tomato-based ones and add psyllium husks to increase fibre” plunged me back to earth from the AHS12-induced heights.

Oh boy. On this planet, margarine is still a health food.

So I thought I’d write down some thoughts on fats, why we still need to talk about them, the strength of evidence and where we go from here. The article ended up being published at The Age and I was amused to see our hour-long phone conversation and the exchange of several emails with attached studies reduced to one sentence quoted from me, but I am not complaining since I think the article was quite well-balanced and hopefully gives people some food for thought. Here is the link.

If you are totally new to all this, I recommend that you read my post on fat basics and the slightly more complicated polyunsaturated fat primer.

Don’t all scientists and doctors agree that saturated fat is bad?

My main gripe with conventional advice to reduce saturated fat in the diet is that it makes it sound that everyone in science and medicine agrees that it is the right thing to do. They say “scientists” and you imagine a group of nerdy-looking men and women in lab coats and glasses with clipboards, all nodding in unison: “Saturated fat will kill you”.

Bad cow, bad!

Sorry, no. Far from it. In the year 2012 we still run trials on dietary fat and its effect on mortality, cardiovascular disease and weight. In fact, a Pubmed search on “dietary fat” yields close to 700 article from 2010 to present date.

If “saturated fat will kill you” is a done deal why do all these folks get research grants and waste years of their life on the pointless pursuit of the truth that has long been discovered and incorporated into every government-led nutrition advice?

And yet, the consensus is farther away than ever. Nutrition and Metabolism Society publishes critiques of the American Dietary Guidelines, as well as scores of papers on the subject. Then there is THINCS, The International Network of Cholesterol Skeptics, which really sounds like an evil mad scientist organisation from a Bond movie, but in fact has respected members like a biochemist Dr Mary Enig and a scientific researcher Dr Uffe Ravnskov.

Not to mention a fine gathering of clinicians, scientists, nutritionists, researchers, physiotherapists, bloggers at Harvard Law School this year for 2012 Ancestral Health Symposium, most of whom seemed to think that bacon is rad and margarine is bad.

Can you refute XYZ study and the rest of the body of evidence on saturated fat?

Yawn. I have no intention on memorising every study conducted in the last 50 years, no matter how bad or good they are. We have been eating fat, lard, meat, eggs, butter, ghee, coconut oil for thousands of years. I think the burden of proof lies on those who say that these traditional foods have been our silent killer all along. All I can do is to politely present the vast body of scientific evidence that does not support the lipid hypothesis (YES! IT IS STILL A HYPOTHESIS!)

Sarcasm alert. Lipid Hypothesis 2.0 = we have come to realise that total fat intake has no bearing on heart disease or weight (sorry! Our bad!) But it’s all about the type of fat. There are only 2 types of fat: saturated (=evil, comes from animals, eating animals is bad, you immoral cruel self-serving glutton) and unsaturated (=pure good, comes from vegetables, like cottonseed, soybean, canola and sunflower, botany be damned). Substituting unsaturated for saturated fat is the real reason why we are healthier, thinner and fitter than thousands of generations of traditional cultures because they couldn’t work out how to get 10% of their daily calories from PUFA, suckers.

 

He needs to be told how unhealthy he is from his 40% SAFA intake. Those coconuts will kill you, buddy! (Source: http://www.thatpaleoguy.com)

Several studies have shown improvement in CV markers and mortality when saturated fats were replaced with PUFA. Regardless of how good/bad sat fats are, shouldn’t we make the substitution just in case anyway?

This is a very common reasoning from many educated doctors and academics. They are now aware that sat fats are not much of a problem. Great. But what’s the harm in tinkering our diets if all we have is improvement, right?

Wrong.

I have a real problem with a blanket advice to increase PUFA in general as if they are all the same. PUFA are not all created equal, they have different physiological functions and effects on the body! (go back to basics). At the very least they should be differentiated into omega-3 and omega-6. However, even that’s too simplistic.

If you are planning on dividing fats on the basis of the biochemical structure and biological function, you have just only scratched the surface. Behold! All saturated fats are actually not the same either. Lauric fatty acid is metabolised differently and has different effects on serum lipid profiles than stearic. Even omega-3 are not a homogenous group (gasp!). The intake of the shorter-chained ALA (alpha-linolenic acid) does not come close to providing the same benefit as the long-chained DHA due to inefficient conversion.

Jacobsen’s analysis of 11 cohort studies, quoted in the article as the final proof of the miracle qualities of PUFA,  showed that substituting PUFA for SAFA seemed to reduce CV events and mortality. However, simplification, as usual, can only take you this far. The analysis lumped omega-3 and omega-6 PUFA together and did not take into account the deleterious effect of trans fatty acids separately from SAFA.

“Linoleic acid selective PUFA interventions produced no indication of benefit but rather a fairly consistent, but non-significant, signal toward increased risk of coronary heart disease and death. ” (Kuipers ER al, 2011, hyperlinked above)

That’s what happens when you simplify a complex concept. Why? Because the public are so dumb they won’t get it? Because 2 types of fat is quite enough to remember? And to make things even more visually and conceptually appealing let’s represent them as ying and yang, bad and good, dark and light?

So you have some studies, “they” have some studies. How do lay people know who to trust?

As much as I respect Evidence Based Medicine, I am well aware of its limitations. You can pull apart every study, point out the confounders, small sample size, confirmation bias, lack of double-blinding, the grant approved by a completely impartial third party with key investments in related area. Let’s not reduce the process to “Mine is bigger than yours.”

Nothing in biology makes sense except in the light of evolution“. Repeat this 5 times before going to bed every night.

How much omega-6 was available in our diet as Homo sapiens for 2 million years up to the advent of industrial processing? How much oil can you get out of a soybean without the benefit of extraction chemicals?

Aaaaaaah! Would you just tell me how much PUFA/SAFA/Carbs I should be eating?

Talking about macronutrients (fatty acids, carbs, etc) is useless unless it applies to food. If the advice to increase PUFA translates into “eat more fish” I will be the first one to shout it from the rooftops! But what if it translates into “eat more peanut butter”? Still PUFA! But are you going to get the same benefits? You don’t need to read an insightful review by Christopher Ramsden on omega-3 vs omega-6 to know that peanut butter ain’t gonna make you healthier than salmon. But sometimes we really really want to believe it. And deluding ourselves is oh so easy when somebody in a position of authority gives you the green light.

Yum

Focusing too much on macronutrients is what allowed abominations like “low fat banana bread” to become a healthy morning tea snack. The “reductionism” approach has successfully indicted natural foods such as eggs, coconut, avocado, butter. At the same time we have low fat sausage rolls, sugary cereal, margarine and other foods devoid of any nutrition, riding on the coat tails of the lipid hypothesis 2.0.

One of the benefits of using the evolutionary approach is that it allows you to make rational decisions about your life choices without having to double-check them with Pubmed. And it doesn’t involve re-enactment of Paleolithic times, although heaven knows, I find some modern social conventions really tedious (like people requesting to know how I am going on a Monday morning prior to my first cup of coffee). As the opponents of the Paleo approach correctly point out, we don’t really know what our ancestors ate. But I sure as hell know what they DIDN’T eat: excessive amounts of sugar, grains, seed oils and other industrially produced food-like substances. Not even almond flour cupcakes. Sorry.

Regulating your fat intake is easy: eat fish, seafood, meat (preferably grass-fed), eggs, some nuts, seasonal fruit and veggies.

Go back to eating food, not labels.

As if you need another AHS wrap up post…

 

There have been a few wrap up posts on AHS already, some complimentary, some provocative. I will try to add my bit which will be purely my opinion on the event I have been looking forward to since last year and my impressions of it.

For those who are in the dark about what I am on about (gasp!) here is a good “AHS for dummies” round up. Also Beth has put together quite a list of AHS wrap ups for all your evolutionary medicine science and gossip needs.

Boston Gardens

To start with, I went this year in a purely observatory capacity. If you wondering why anyone would endure 24 hr flying time plus layover in 3 cities, here is my main reason. Evolutionary medicine in Australia is still for weird hippies and charlatans, not for Sydney University-trained doctors. Being in a group of passionate people, some including distinguished scientists, medical professionals and clinicians, was gratifying and encouraging.

*And before I get accused of ignoring minorities and lay folk: I see AHS as a primarily academic event designed to open the doors to new hypotheses, share scientific research and help move evolutionary medicine into mainstream consciousness. I think PaleoFX and its organisers, Keith and Michelle Norris, filled the niche of taking theory to practice very efficiently, and if I can ever afford 2 trips to the US a year (poor medical resident here) I would not hesitate to go. I think it’s fantastic that AHS is open to the lay public (let’s face it, the discerning Paleo “lay public” keep everyone on their toes) but I wouldn’t want for the conference to lose its academic edge. And if I ever want a Paleo group hug I will go to a Paleo meet up.*

Recalling my inability to sit through University lectures, I knew I couldn’t attend every talk so I tried to hedge my bets and pick from the program. Some I got right, some I didn’t. A few times, I opted to hear the “big names” only to miss out on a fascinating talk from a less known figure in the other room. I have already marked the ones I would like to download to watch on video.

The dairy debate continued in the ice-cream parlour

Rating on some memorable talks I saw in no particular order:

1. Dan Lieberman on evolutionary principles. A great talk to open up the symposium and a must-see for anyone as an Evolution 101 refresher. It set a nice tone to the event, steering it away from the romanticised hunter-gatherer image.

2. Dr Peter Attia gave an awesome lecture on cholesterol. This was probably the most sciency talk of the whole seminar and in my opinion the best. I wish I had a lecture like this in medical school! I will definitely re-watch this one on video, this time taking thorough notes. Highly recommend regardless of your knowledge level, you will learn something anyway.

3. Jamie Scott spoke about using evolutionary principles for endurance training. He effectively melted a few brains by stating a strong case for low intensity work performed in glycogen-depleted state. For the crowd largely indoctrinated enthusiastically involved in Crossfit it was a hard sell but I think he got a few converts.

4.  Dr O’Keefe on the effects of prolonged endurance exercise on cardiovascular system. He described exercise-induced cardiomyopathy in ultra-endurance athletes. As a runner himself, his position was a little biased toward running and in my view his recommended dosages (45-60 min 5 times a week) were still too high. Also he didn’t mention the significant degenerative joint effects and chronic inflammation on the body. Overall, the talk was very interesting and definitely something that running-obsessed Americans need to see (OMG, do you, people, do anything else other than run???)

5. Chris Kresser on iron overload. Chris gave a good view of haemachromatosis, its diagnosis, manifestations and treatment. Most of this material had been extensively covered in my medical school lectures (yes, believe it or not, they DO teach us something). I would have liked to hear a theory on the evolutionary explanation of haemachromatosis and Seth Roberts, I think, asked Chris that question but I didn’t gleam much from the response. Worth watching if you think that Paleo is a free pass to eat meat like it’s going out of fashion.

6. J. Stanton on hunger. JS presented very convincing evidence that hunger is a normal physiological response to the lack of nutrients to the cells (who would’ve thunk it, huh?) rather than a massive character flaw possessed universally by the fatties. It was a great complement to his series of posts on hunger (which are excellent to read). JS is, ahem, an unusual personality with a brainpower that makes the rest of us feel like schoolchildren. He was openly critical of the food reward theory during his presentation, however, when we all went out for dinner that night, he was extremely gracious and kept saying that he felt very honoured that people like Stephan (Guyenet) attended his talk. You can read Stephan’s review of this talk here.

7. Dr Terry Wahls gave an inspiring talk about managing own multiple sclerosis with MS. However, I was already familiar with her very excellent TED talk (which you should definitely see if you have been under a rock somewhere) and not sure I got much more out of this presentation.

8. Robb Wolf‘s talk about implementing Paleo diet principles at Reno municipality is inspiring to watch especially if you are interested in public policy and how to bridge the gap between a Paleo community, often seen as alternative and (let’s face it) weird, and real world. Big picture stuff.

9. Dr Emily Deans have a presentation on food and mental health. She gave a good overview of how fructose and trans fats affect us not only metabolically but also psychologically. It was fascinating to see the diametrically opposed views on sugar and mental health: does it make you happy or not?

10. Dr Andreas Eenfeld was a surprise to me. Even though he presented on carbohydrate controversy (yawn) he managed to make it entertaining (yes, really) and light-hearted. I thoroughly enjoyed it.

Watching squirrels was somewhat more entertaining than a safe starch debate

By the way, I think the whole audience was tweeting. It was absolutely surreal to listen to one talk and read tweets from the next room with people raving about the speaker I was missing.

Talks I cannot wait to see on video:

1. Peter Gray on the role play in the development of social and emotional competence. Here is a great example of his work and if I knew he was in the next room I would have dumped Stephan Guyenet in a heartbeat (sorry!)
2. Ubuntu: a paleolithic perspective on human community and health by Frank Foresich
3. Oxidative stress and CHO intolerance by Chris Masterjohn
4. Paleo nutrition and the brain by David Pendergrass.

Overall impression:
It was disappointing to see a few negative posts from attendees, in particular some who felt not included due to their age, appearance, weight, or some other factor. I was not aware of any such tension during the conference, except to note that people were quite naturally gravitating towards their friends and acquaintances, and of course “Paleo celebrities”. I find this community remarkably inclusive but then I am not an idealist and generally do not expect much of people. I certainly would never anticipate Robb Wolf to come up to me and strike up a conversation. Being quite introverted, I spoke to people who approached me or were introduced by others, and relaxed in the courtyard when the crowds got too much.

I would love to come back next year and reconnect with some new and old friends.

A few thanks:
To Ann and Dave Wendell – for making the most of the Aussie-Kiwi rivalry and teasing the hell out of us.
To Victoria Prince – for feeding us home cooked meals, taking us berry picking and showing us the green and luscious part of New Jersey
To J Stanton – for challenging our brain cells and being a very exciting dinner guest
To Jude – for her Aussie accent, sense of humour and constant and inappropriate swearing
To Melissa and Dallas Hartwig – for great conversations, amazing (very well organised!) meals, unwavering support and a hefty dose of inspiration

Many more Twitter names came alive (hey, these people do actually exist) and I fear I’ll miss someone if I start naming them but I enjoyed meeting all of you.

See you all next year.

Big jet plane

I hate packing and always leave it till the last moment. But I finally conquered my procrastination and now (kind of) ready to jump on the plane to head off to Boston. As excited as I am to be in the midst of the biggest gathering of primal and ancestral health minded people in the world, I don’t think I will have it in me to write long Oscar-worthy reviews. Hopefully I’ll still have my Twitter and Facebook to share the overall buzz with those of you who are eagerly following the event. I was doing it last year so I hear ya!

See you after the AHS12!