America was in the midst of an epidemic of heart attacks back then. Lacking any effective drug treatment for prevention – indeed, lacking any real model for risk factors – and without the emergency room trauma care that we now take for granted, medicine scrambled to find answers to the sudden upsurge in heart attacks and strokes. A consensus built around cholesterol as the primary villain, and so a vast public campaign went forth that hasn’t subsided ever since.
Cholesterol: The Real StoryThe problem with the cholesterol story is that it complicated matters far more than it clarified them. To begin with, high cholesterol in the diet was never a strong correlation with premature heart attacks. The strongest correlation had to do with psychological factors, in fact, but these were considered too “soft” to present to the public. Cholesterol was simpler and easy to communicate. But there was another major problem. The cholesterol you eat isn’t the same as the cholesterol that winds up in your bloodstream, so-called serum cholesterol. In between eating a fatty food and raising your serum cholesterol, there’s the process of digestion. In particular, fats are processed in the liver, and it’s the liver ability to select various fats that determines how high or low your serum cholesterol is.
In their zeal to deliver a simple story, however, heart experts demonized basic foods like eggs and milk when there was no evidence that either leads to increased heart attacks. Fifty years on, the anti-cholesterol campaign has become a billion-dollar juggernaut, thanks to the involvement of drugs that are supposed to correct imbalance in blood fats. We’ve been indoctrinated to think in terms of LDLs, HDLs, and triglycerides, yet the actual cause of heart disease is unknown. In addition, the simple formula that the “good” HDLs will rise as a drug lowers the “bad” LDLs has been proven wrong.
As with all disorders, the story of heart disease involves all the messages being sent to and from every cell in your body. Invisible factors like stress are just as important, if not more so, than the fats you eat, along with psychological factors like the difference between tense, perfectionist Type A personalities and relaxed, easy-going Type Bs. The only natural way that is proven to reduce the risk of heart attack combines meditation, exercise, and a low-fat diet.
Wellness Principles for Fat in Your DietTo really know what causes heart attacks and strokes, we would have to discover why the tiny cracks develop inside the smooth, slick lining of blood vessels. An answer to that mystery is far from clear. So for the time being wellness in terms of the fat you eat encompasses some basic principles, as follows:
- Eliminate the hydrogenated fats or trans fats and reduce saturated fats in our diet, preferring fats like vegetable oil, omega-3 oils in fish, and olive oil.
- Whatever fat you eat, don’t demonize it. Fear isn’t part of wellness.
- Don’t rely on drugs to change your serum cholesterol until you have given prevention a chance.
- Forget so-called diet foods and processed foods with reduced fats. You don’t need the added chemicals. In addition, it has never been shown that eating diet foods helps reduce obesity.
- If you are overweight, make it a top priority to get your weight back in control. Reducing total calories is more important than fine-tuning the kind of fat you eat.
- Body fat appears to be more active in a harmful way than we used to think. To offset the hormonal effect of body fat, the easiest counter is regular, moderate exercise.
I’ve deliberately avoided going into detail about the war over dietary fat, because singling out one factor misses the holistic point: wellness is never about one villain who needs to be vanquished. It’s about changing the entire mind-body picture. There will always be fads and controversy swirling around America’s weight problem. One year the magic bullet is a high-protein, high-fat diet, while the next year it’s gluten allergies or switching to a vegan lifestyle. For healthy adults, these fads are harmless. In the end, they offer short-term benefits to almost everyone who flirts with them and long-term benefits to a very small minority. There is no replacement for holistic wellness.
For readers who want to hear about the technical details, however, here’s a brief rundown about the physiological nature of fats.
Not All Fats Are EqualFrom bananas to bacon, there is fat in virtually every food, differing in amount and type. And whether we eat a burger, a sardine, or an avocado, we are eating a mixture of fats, both “good” and “bad.” According to the USDA, a stick of butter, for example, contains 51% saturated fat, 21% monounsaturated fat, 3% polyunsaturated fat. Olive oil has 14% saturated fat, 73% monounsaturated fat, and 11% polyunsaturated fat.
How much fat should you eat? The Institute of Medicine says fats should be 30-40% of total daily calories for children ages 1-3, and 20-35% of total daily calories for older kids and adults.
“Good” FatsDietary fats can be classified into two categories: unsaturated (the “good” fats) and saturated (the “bad” fats). Unsaturated fats come in two types: monounsaturated and polyunsaturated. Replacing saturated fats in the diet with unsaturated fats lowers blood cholesterol and the risk of cardiovascular disease. Desirable sources of these fats are healthy oils, nuts, seeds, fish and avocados.
Saturated fats are risky because they raise LDL (“bad” cholesterol) levels. As we touched upon, elevated LDL levels contribute to arterial plaque and increase the risk of diabetes, heart attacks, and stroke. Among the most common dietary sources of saturated fats are fatty meats and dairy products. The US population currently gets 11-12% of its energy from saturated fats and that hasn’t changed much over 15 years. It is generally recommended that saturated fat not exceed 10% of the daily fat intake, but some experts suggest getting it down to 5% would be healthier target.
The roles and benefits of omega-3 and omega-6 fatty acids are controversial and confusing. Both are essential fatty acids, which must come from our diet because our bodies cannot make them. They play key roles in every system in the body and are important in the regulation of many physiological processes and are crucial for the health of cell membranes and the neurological development.
There is growing evidence that most Western diets have too little omega-3 and this may affect immune system function and cause inflammation. Some scientists believe that the natural ratio of omega-3 to omega-6 fatty acids in the human diet is 1:1. In the typical modern Western diet, however, the ratio is about 1:16. That’s a big difference. Good sources of omega-3s include fatty fish, flaxseed oil, walnuts, and walnut oil.
Trans fats, artificially modified vegetable oils widely used in fried and processed foods, are undeniably bad guys. Trans fats are considered more harmful to your health—and especially your heart—than saturated fats. They have been shown to raise LDL-cholesterol, lower HDL-cholesterol (the “good” cholesterol), increase triglycerides, and contribute to inflammation, heart disease, stroke, and diabetes. Even a small amount—say 5 g, about the amount found in a serving of fast-food French fries—is enough to increase inflammation.
Body fat is complex
Body fat is getting more complicated. It was once thought of as basically inert; fat cells were like microscopic oil tankers that took on a small or expanding load of fat. Now we realize that fat is a very sophisticated and complex tissue. Fat in fact functions as an organ. Rather than just a passive or inert storage depot, fat is metabolically active and constantly communicating with other organs, including the brain, through a variety of hormones and chemical messengers.
The brain is the fattiest organ in the body. More than 50% of the dry weight of the human brain is fat. It is structural fat contained in the membranes of neural cells and a key component of the synapses, or connections, between neural cells.
Reading Your Fats Is Not So Tough
According to the American Heart Association, everyone over 20 years of age, regardless of their previous high cholesterol history, should have a blood cholesterol test at least every 5 years. If you’ve been diagnosed with high cholesterol, and are controlling it with diet, you should be tested every year. People who take prescription medications to control cholesterol levels, like statin drugs, may need to get their cholesterol tested at least twice a year to not only check cholesterol levels, but to also check liver function.
Today, many people know their cholesterol and triglyceride levels, just as they know their blood pressure. The theory is that the more thoroughly you understand these numbers and are able to put them to use, the more you’ll be able to maintain cardiovascular health. Frankly, ruling your life by the numbers makes for a miserable existence. Keeping vigilance over yourself tends to be a combination of prison guard and prisoner at the same time. No one reaches wellness by being statistically perfect. True wellness is beyond statistics, and even if medical markers are helpful, as of course they can be, the core of wellness lies elsewhere.