A Primer on Dietary Fats – Part 2

In A Primer on Dietary Fats – Part 1, I looked at some basic concepts related to dietary fat/lipids including the different primary types of lipid (triglycerides, cholesterol and the ‘other stuff’) as well as the difference between triglyceride and cholesterol.  Finally, I looked at the issue of dietary cholesterol and blood cholesterol briefly.

Today I want to finish up by looking at more detail at the issue of dietary triglycerides.  As I mentioned in Part 1, dietary triglycerides (TGs) make up the bulk of the fat that we consume in a day, providing over 90% of our total fat intake.  Therefore, understanding what the different ‘types’ of TG are along with how they affect the body is important.

 

Types of Dietary Triglyceride

As I mentioned in A Primer on Dietary Fats – Part 1, a fat/TG molecule consists of three fatty acid chains bound to a backbone molecule of glycerol.  And while people tend to talk about different types of fats (e.g. saturated fat or unsaturated fat), it’s actually the specific fatty acids that differ in terms of their chemical structure.  For simplicity, I’ll simply refer to the different types of ‘fats’ and leave it at that.

Things such as chain length, degree of saturation and chemical conformation all go into distinguishing one fat from another but I’ll try to avoid boring people with that level of detail.  Fats are pretty much universally subdivided into four primary categories which are

  1. Trans-Fat
  2. Monounsaturated Fat
  3. Saturated Fat
  4. Polyunsaturated fat

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A Primer on Dietary Fats – Part 1

For the past 30 years or so, ever since people started talking about cholesterol and heart disease, there has been a combination of concern and confusion over the topic of dietary fats in the diet.  In this article, I want to take a look at some of the topics involved to see if I can help to clear up some of the confusion.

Today I want to look at some general issues, including the major categories of dietary fats, the difference between cholesterol and triglycerides, and then look briefly at the impact of dietary cholesterol on blood cholesterol levels.  On Friday, in Part 2, I’ll look in some detail at the different types of dietary triglycerides and address some of the current controversy over their effects on health.

 

Triglycerides, Cholesterol and Everything Else

While people tend to throw around the term dietary fat somewhat loosely, the fact is that not all of the fat that we consume on a daily basis is the same.  And here I’m not talking about saturated vs. unsaturated fats.  Quite in fact, dietary fats (more generally known as lipids) come in distinct chemical types.

Now, the primary two that folks eat on a day to day basis are triglycerides (TGs) and dietary cholesterol with dietary triglyceride contributing the bulk (over 90% of the total) of the dietary fat that we consume on a day to day basis.

However, there is also a small amount of lipid that come from sources such as various phospholipids and other fat based compounds; since they tend to make up a very small percentage of the total daily fat intake, I’m not going to spend any time discussing them.

Rather, I want to focus primarily on dietary triglyceride and cholesterol.

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Fish Oil Intake for Inflammation

Q: I read in quite a lot of places that fish oil capsules or cod liver oil are a great supplement for controlling inflammation and improving nutrient partitioning, but no one gives any information about dosing. I have no idea how much of this stuff to ingest. Have you formed any guidelines as a result of your research?

A: A fairly standard dose of fish oil in the studies is the equivalent of 6X1 gram capsules. The average capsule has 180 mg epa and 120 dha so 6 capsules will provide 1020 mg epa and 720mg dha for a total of 1.8 grams of total fish oil. I would consider this basically the minimum daily amount that would be beneficial on any level.

Some work has identified that the body will hit a limit (in terms of plasma saturation) on DHA at 1.2 grams per day which is the equivalent of 10X1 gram fish oil capsules. That would also provide 1.8 grams EPA for a total of 3 grams per day of fish oil. Under most conditions, I think this is more than enough.

A friend who uses fish oiils to control her arthritis will often go as high as 15X1 gram capsules although I haven’t seen that supported in the literature. I’d note that higher doses are not better here (although some are currently recommending absurd amounts). Excessive fish oil can impair the body’s ability to mount a proper immune response, as well as impairing insulin release.

Carlson’s fish oil contains roughly the equivalent of 4X1 gram fish oil capsules per tsp., I don’t know the values on cod liver oil offhand.

My current generic recommendation is the middle level, 10X1 gram capsules per day for 3 grams total fish oil. This should provide maximal benefits (in terms of partitioning and health) with minimum negatives. Individuals trying to control a specific excessive inflammatory condition may wish to experiment with higher doses (15X1 grams capsules or 3-4 tsp Carlson’s fish oil per day).

Carbohydrate and Fat Controversies: Part 2

In Carbohydrate and Fat Controversies: Part 1, I begun an examination of the argument over carbohydrate and fat intakes in the human diet, explaining that, contrary to popular argument, most extremist stances in this debate are incorrect. In Part 2, I want to continue addressing the issue by looking at both sides of the debate.

Examining Both Sides of the Debate

As noted, the usual argument goes that high-fat diets cause high-cholesterol, heart disease, cancer, obesity and the rest, as evidenced by the high incidence of those disease in modern diets (which are typically high in fat). But that’s a questionable conclusion to draw.

Modern diets are also high in carbohydrates (and mainly the highly refined, high GI, low-fiber stuff that the body often doesn’t handle well), low in fruits and vegetables, and generally contain the wrong types of fats (an excess of saturated and trans fats with insufficient amounts of healthy fats). Such an intake is typically coupled with inactivity, the folks eating them tend to be overweight/obese, smoking and alcohol play a role, etc. That is, there are a number of inter-related factors at work here.

Pinning the blame entirely on fat intake or expecting only a reduction in fat to fix the problem is disingenuous: there are a lot of variables at work here. Some research suggests that the entirety of the problem rests with excessive saturated fat intake with the other variables (activity, fruits and vegetables, etc.) playing a relatively minor role. It’s awfully hard to tease out all of the relationships when there are this many variables at play.

Similar comments can be made in terms of obesity. Fat is more calorically dense than carbohydrates and studies comparing high-fat (40%) to low-fat (25%) meals find that people tend to eat more in the higher fat conditions; this is usually referred to as passive over-consumption and leads to excess calorie intake. These studies have problems, mind you, but that’s beyond the scope of this article. The point does stand, though, that dietary fat is tasty (giving food mouth feel) and folks do tend to eat more of foods that taste good.

But while it’s common to blame obesity on high-fat diets, not all researchers agree. Some cultures have fairly high fat intakes but have no problems with obesity and researchers are starting to realize that fat isn’t the ONLY problem. Increasing intakes of refined carbohydrates (contributing large numbers of calories to the diet), decreasing activity, increasing portion sizes and other factors all contribute. You can’t dismiss an excessive fat intake as part of the obesity problem; it’s simply not the sole factor. I don’t want to get into a massive discussion of the carb versus fat debate in terms of caloric intake, preferring to focus on the health issues here.

The fact is that not all studies link a high fat intake to an increased risk of disease. For example, recent analyses of our ancestral diet (what we ate during 99.9% of our evolution) suggests a much higher fat intake and much lower daily carbohydrate intake. Exact numbers vary depending on what assumptions you use but carb intakes of 20-40% (most of which came from low GI, high fiber fruits and vegetables; grains were almost non-existent), fat intakes of 28-60% (which had a significantly different quality than our current diet), and protein intakes of 19-35% of total calories are the current best estimates.

Studies of extant hunter-gatherer societies show little incidence of any of the diseases of modern society and it’s thought that our evolutionary diet was NOT atherogenic (promoting heart disease) despite the high fat intake.

The reasons for this are many-fold, of course and that’s the key to keep in mind when you consider fat intakes and potential health problems. In our ancestral diet, fiber intakes were monstrous, averaging 100-150 grams per day. As well, despite the high fat intake, the source of that fat was far, far different than our modern intake. Much higher intakes of polyunsaturated and mono-unsaturated fats and far lower intakes of saturated fat were fairly typical. Activity levels were also much higher and folks generally stayed pretty lean. Alcohol intake was low or non-existent, as was smoking. Although our ancestors dealt with various stresses, they didn’t deal with the kinds of chronic stress that occurs in modern societies.

Related to this, studies of the Mediterranean diet have found few problems in terms of heart disease and all the rest despite a relatively high fat intake (40% of total calories). Although the reasons are, as always, multi-factorial some of the contributing factors are that the fat intake is primarily from mono-unsaturated sources (e.g. olive oil).

As well, a tremendous amount of fresh vegetables are typically consumed (with far less reliance on refined carbohydrates). Other factors such as activity, bodyweight, moderate alcohol intake and lowered stress levels probably play a role. Studies of the Alaskan Inuit show similar results, despite an extremely high-fat intake, heart disease is almost unheard of. This has typically been attributed to the high intake of fish oils but there may be genetic adaptations as well.

Of course, some studies on low-carbohydrates diets (which are typically high in fat) will show a big improvement in blood lipid levels; this is especially true for individuals with insulin resistance. I’d note that this effect primarily occurs when weight is lost; in studies of very low-carbohydrate diets where weight is gained, blood lipid levels often get much much worse.

Thus, whether or not you’re gaining or losing weight probably impacts on whether or not dietary fat is a health risk. I’d note that studies in cyclists find that high intakes of saturated fat don’t pose a health problem as long as the athletes are in calorie balance. As I mentioned above, activity (which will affect whether ingested dietary fat is stored or burned off) plays a big role here.

Studies in diabetics are finding that higher mono-unsaturated fat intakes (and lowered carbohydrate) intakes may be healthier than the converse. This, of course, only holds if calories are strictly monitored and controlled to avoid weight gain. When weight is gained, from nearly any dietary approach, blood sugar control in diabetics worsens.

Of course, there’s a flip side to the anti-fat dogma and reducing fat to extreme levels can cause its own set of problems. First and foremost, most people find extremely low-fat diets to be tasteless and this tends to limit adherence in the long-term (as I mentioned above, high-fat diets tend to be very tasty and people frequently eat too much).

And while caloric intake typically goes down in the short-term, folks frequently end up increasing caloric intake because they are hungry all the time. Dietary fat slows gastric emptying (keeping food in the gut longer) although some work suggests that this effect is lost with chronically high-fat diets. Extremely low-fat diets tend to leave people hungrier for this reason.

There is also evidence that the fat-soluble vitamin absorption may be impaired when fat intake is taken too low. And while total cholesterol typically decreases when fat intake is lowered, the decrease occurs in both the good (HDL) and bad (LDL) sub-fractions so overall health risk may not be improved. From a body recomposition or performance standpoint, some studies show a lowering of testosterone with very low fat diets.

There is another set of issues that crops up as well. Again, it relates to the simple fact that people have to eat something. In reducing fat intake, most people increase carbohydrate intake. Most researchers would say that this is just fine as long as the increase comes in the form of unrefined, high fiber, complex carbohydrates. I would say that most researchers need to get out of the lab and look at the real world for a while.

The simple fact is that the majority of people who reduce fat do NOT increase carbohydrate intake from unrefined, high-fiber, complex sources. This is especially apparent in the US (I can’t speak for other countries) where companies rapidly jumped on the ‘fat is bad’ bandwagon and brought tons of ‘low-fat’ high-carbohydrate sources that were highly refined to market.

Such foods may have as many, if not more, calories than the same higher-fat items. Even when they don’t, humans play a cute psychological game, tending to eat more of a given food when they are told it’s low or no-fat.

Recent studies are finding that, when carbs are increased from those sources, other problems show up. In addition to the changes in blood cholesterol I mentioned above (both the good and bad subfraction decrease), the increase in refined carbohydrate intake causes an increase in blood triglyceride levels and small LDL particles; both of which are independent risk factors for heart disease and all the rest. The chronically high insulin levels which commonly occur with such a diet cause other problems including insulin resistance and all of the issues that accompany it.

I should probably note, and this could certainly be an entirely separate article, that the new scapegoat for obesity and all of the health problems in the world is excessive carbohydrate intake, with a lot of the focus on insulin release. I don’t have space here to address that side of the argument, a future topic for another day.

Sufficed to say that while there is certainly an element of truth to this (in that excessive intakes of any nutrient, and that includes refined carbohydrates, is bad), it’s still true that simplistically arguing that ‘fat is good and carbs are bad’ is just as moronic as arguing that ‘carbs are good and fat is bad’. Again, it depends on the context.

Summing Up

Now, I want to make it very clear that I’m not trying to make this either a pro-fat or anti-carbohydrate article or trying to make a low-carbohydrate diet the default choice for anybody. My point is simply that the idea that ‘fat is bad’ and ‘carbs are good’ (or the opposite) is too simplistic to be meaningful.

Not all fat is bad and not all carbs are good. The source, the composition of the rest of the diet, the total amounts you’re eating of each, your activity level and other variables all factor in. Whether you’re talking about health risk or obesity, you can’t simply pin the blame on one factor or the other.

So, under conditions of high caloric intake, with a high intake of refined carbohydrates (meaning chronically high insulin levels), poor quality fat choices (too much saturated fat and/or too little unsaturated fats), little activity, minimal fruit and vegetable intake, etc. a high-fat intake is probably very detrimental from a health standpoint. Sadly, this describes a fairly typical diet in the modern world (especially the US).

In contrast, with reduced or even controlled caloric intake (such that bodyweight goes down or is maintained) and most of the fat coming from unsaturated sources (note: excessive polyunsaturated fats has its own set of problems), a high fruit and vegetable intake, reasonable activity levels, keeping body fat levels down, etc. higher fat intakes may be no problem at all. In some situations, an increased fat intake (again, from healthy sources within the context of activity and a high fruit and vegetable intake) may be beneficial compared to the alternatives (e.g. increasing carbohydrate intake).

Carbohydrate and Fat Controversies: Part 1

Although there are still many Protein Controversies (usually regarding kidney health, bone health, etc.), nowhere in the dietary world is there quite as much controversy as over carbohydrate versus fat intakes.

In this article, I want to look at carbohydrate and fat intake in terms of the various arguments and debates that tend to surround them.

The main controversy here revolves around what amounts of carbohydrates and/or fat are ideal, healthy, recommended, etc. and that’s what I’ll focus on. I’m not going to deal with body composition explicitly in this article, I’ll save that for another day.

Two (or Three) Dietary Camps

Generally, folks fall into one of two camps regarding whether they think carbohydrates or fats are good or bad. For a couple of decades now, the mainstream of dietary advice has been more or less stuck in the mindset of ‘fat is evil and ‘carbohydrate is good’.

Various attempts to promote so-called ‘high-fat’ or ‘low-carb’ diets have usually been shot down as fads although there is increasing research evidence that, at least for some individuals (usually those with insulin resistance) higher fat intakes and lowered carbohydrates may be both beneficial and preferred.

However, for the most part, I’d say that mainstream dietitians are still on the carbs = good, fat = bad bandwagon with higher fat/lower carbohydrate diets being relegated to the diet ‘fringe’.

Both groups can bring impressive (or at least impressive looking) data to the table but, as usual, extreme stances are invariably incorrect and the truth lies somewhere in the middle; this particularly debate is no different.

The third group (and the one I put myself in) recognizes that whether or not carbohydrates or fats are ‘good’ or ‘bad’ depends on the context. The source of the carb or fat, the rest of the diet, the goal of the individual, genetics, activity, etc. all factor into this issue. So while it may be convenient to give simplistic recommendations of the ‘X is bad, Y is good’ variety, simple in this case tends to be incorrect.

Perhaps the most succinct way of describing what I’m going to detail is that there are no good or bad foods only good or bad diets. That is, within the context of one type of diet or individual situation, a specific food may be excellent; under other conditions it may be a poor choice.

What does the Body Require?

So that some of my comments will make sense, I need to cover a smidgen of nutrient physiology, mainly having to do with the issue of carbohydrate ‘requirements’ (a topic I cover in detail in How Many Carbohydrates Do You Need).

As I think I’ve managed to work into every book I’ve ever written, there is no strict physiological requirement for carbohydrates (this factoid is often used by the low-carb diet groups as part of the rationale for their dietary approach).

Most tissues in the body can readily use fatty acids for fuel just as easily as glucose. There are a few tissues such as the renal medulla, red blood cells and one or two other that can only use glucose. However, those cells essentially make their own glucose by recycling lactate (produced from glucose metabolism) back into glucose.

The brain is in its own weird category. Under most conditions, it relies exclusively on glucose. And while it can’t use fatty acids directly, it can use a fatty acid derived fuel in the form of ketone bodies. After roughly three weeks of adaptation to using ketones, the brain may only need 25 grams/day of glucose or so, which can be made by the body (in the liver and kidney) from sources such as lactate, pyruvate, amino acids and glycerol.

Even the American Dietetic Association bible, the RDA Handbook, states that there is no requirement for dietary carbohydrates. Any decent nutrition or physiology book will state the same. Despite this basic biological fact, many researchers and diet authorities still insist that the majority (50-60% or more) of the human diet should come from carbohydrates.

I’ve seen papers where researchers point out that the body requires no carbohydrates which then go on to say that a proper diet should contain at least 50% carbohydrates. It doesn’t make much sense.

At the same time, outside of a small essential fatty acid requirement (a few grams per day from the fish oils, EPA/DHA), fats aren’t truly required by the body either. All of the tissues I mentioned above will use glucose if you provide it (the heart is an exception, almost exclusively relying on fatty acids for fuel) and the body can make fatty acids out of other sources if need be (this pathway isn’t utilized massively in humans, although a few conditions will make it relevant).

So, outside of the small essential fatty acid requirement, one could make an argument for there being no physiological requirement for fats either.

What does the body then require on a day to day basis if there is no real requirement for either carbohydrates or fats? Well, outside of the basics like water and air, roughly eight amino acids are essential to get from the diet, there’s the small essential fatty acids requirements and of course vitamins and minerals. Everything else, strictly speaking is optional.

I would note that, to avoid starving to death, sufficient calories will be required. Since it’s generally unrealistic to consume your entire daily caloric requirement from protein, that means that carbs, fats, or a combination of the two, will generally be needed to supply sufficient energy to the body.

But, as noted above, most tissues in the body show a great deal of flexibility, using carbs when they are available and fats when carbs aren’t available. Note also that the body has its own store of fuel, primarily in the form of body fat that is mobilized when sufficient amounts of other nutrients aren’t available.

So Why Do Most Argue that Carbs are Good and Fats are Bad?

Despite the fact that there is no physiological requirement for carbohydrates in the human diet, the most common dietary recommendation in modern times is generally to reduce fat intake and increase carbohydrate intake. I’m going to address the issue starting from that standpoint.

A good question might be why is this stance taken. While I can’t read the minds of these folks (and I hate to contribute to grain lobby USDA conspiracy theories), I think the reasons is actually fairly simple: we have to eat something.

There’s usually a limit to how much protein can be reasonably consumed (and most authorities seem to be against ‘high’ protein intakes as well) so that means that the rest of the diet (in terms of energy) must come from either carbohydrate or fat.

In the 70’s, the stigma against dietary fat started to develop and it all pretty much went from there. Fat was implicated as the cause of heart disease, stroke, obesity, you name it and excessive fat intake was blamed.

Since people have to eat something and because of the general stigma against a high fat intake (some of which is warranted, some of which isn’t), policy makers recommend a high-carbohydrate intake by default.

The bigger question is whether or not this is a scientifically defensible position.

I’ll address this issue in more detail in Carbohydrate and Fat Controversies: Part 2