March 2015 Question #3
The results of both product
and purchase-level analyses indicated that saturated fat density increased in
RTE GBD products during the 2005-2012 timeframe. Systematic reviews and
meta-analyses within the past five years (supplemental article #2 and #3) have
indicated that the evidence linking saturated fat and heart disease may not be
as clear-cut as once thought.
Do you think that we have enough evidence to
clear saturated fat of the charge of killing innocent Americans (remember,
heart disease is the nation’s leading killer)?
If not, what would it take to convince you that there might be other
culprits (e.g. added sugars, physical inactivity, genetic predisposition)
involved?
posted by Unknown @ 2:31 PM
30 comments
30 Comments:
The research with saturated fats is interesting right now, but I think it’s too early to make any judgment calls about changing what we recommend to people. We know that saturated fat is not solely responsible for causing heart disease, but we tend to focus on certain things instead of the big picture. I was actually surprised to see that the American Heart Association lowered the recommendation for saturated fat to 5-6%. Instead of just focusing on one nutrient and demonizing it or condemning it, I would prefer to take the inclusive approach by focusing on what we SHOULD be eating instead of what we SHOULDN’T be eating. We can continue to recommend that people eat fruits and vegetables, whole grains, etc. because we know that these foods have good health benefits. We’ll just have to stay tuned to see what newer research comes out regarding saturated fats.
I like Sammy's perspective on the situation and agree. I find that clients are more receptive of what they can do and get really turned off when told what they can't do. I think the more we can push for what we believe is a healthy lifestyle, maybe that can help create a more well-rounded lifestyle instead of just focusing on one "bad" element. We all know that it's never just one thing that's causing these problems. I also find that recommendations are there but not many people really follow them or even know what they are. I find some patients don't even know what MyPlate is, none the less the RDA for saturated fats.
I do not think there is enough evidence based research to change the recommendation of saturated fat for consumers. There is also not enough evidence to say that saturated fat is the sole factor that causes CVD as other factors come into play (genetics, physical activity, etc.). I think the best approach to take as a dietitian, again, is promoting foods that should be eaten in larger amounts and quantities for good, healthful nutrition benefits as mentioned above (vegetables, fruits, whole grains, lean proteins, low-fat dairy products, etc.). Also, I think another important aspect to consider is educating consumers, clients, and patients on portion sizes and promoting foods in moderation. As Jenn mentioned in another post, some foods such as milk, meats, and cheese do contain saturated fats; however, they also provide important nutrients such as calcium, protein, etc. It is important we do not scare patients or clients into eliminating certain foods from their diets, but rather having them choose healthier versions of these foods that contain saturated fat or limiting/making their portion sizes smaller as well. It is all about learning balance. In addition, overall, I think it is also important that we should promote a healthier lifestyle in general to consumers, clients, and patients. We should encourage daily physical activity, as diet and nutrition are not the only factors that affect the onset of chronic diseases. Being healthy means eating well and exercising. Both are pretty equal in terms of providing good health, and they go hand and hand with each other. Doing one without the other is much less beneficial for a healthy lifestyle.
I certainly agree that there is not yet substantial evidence to make any conclusions in clearing saturated fats for their potential risk in the development of heart disease. Typically the onset of disease is caused by more than one risk factor, and a single nutrient is very unlikely to be solely responsible for the development for heart disease, or any medical diagnosis for that matter. It is our typical dietary intake and physical activity that contribute to the development of disease in addition to genetics and environmental factors. When attempting to improve the overall health of our patients and decrease risk for disease, I believe that it is important to focus on the big picture and aim to set realistic goals for each individual.
Do you think that we have enough evidence to clear saturated fat of the charge of killing innocent Americans (remember, heart disease is the nation’s leading killer)? If not, what would it take to convince you that there might be other culprits (e.g. added sugars, physical inactivity, genetic predisposition) involved?
It wouldn't take anything to convince me that there are other factors to heart disease. I strongly believe that there are multiple factors contributing to heart disease and that saturated fat still may be of concern to individuals who are at risk. Genetics and lack of physical inactivity definitely need to be taken seriously. I also think that the lack of fruits and vegetables in the American diet need to be addressed instead of just focusing on saturated fat. A healthy heart diet should consist of multiple topics such as portion control, increasing produce,decreasing sugar, leaner meats, less salt, using healthy oils etc. I like the SHOULD be eating approach as Sammy said.
I like Haley's thought of looking at what American's are lacking in their diet as oppose to what they're over consuming. Maybe, just maybe, if we can get them to eat more fruits and vegetables then they will eat less of other foods. I've found that it's easier to cut down the less healthy foods when my plate still looks full, like when I incorporate more vegetables. It doesn't make me feel deprived of anything and I'll still be full in the end.
I think the reason we always focus on saturated fat being linked to heart disease with clients is that it's an easy starting point. Many of our clients will have multiple "bad" habits, and telling them to change everything at once is very overwhelming. Starting with one nutrient and having them analyze how much of it they are actually consuming is a good place to begin, but there is obviously a lot more that we could and should focus on. I'm not sure the reduced saturated fat, reduced sodium "heart healthy" diet was meant to be explained in one sitting. We really need to be working with these clients over a longer period of time and helping them to make healthier lifestyle changes all around. Making sure the reduced saturated fat calories are not being replaced with simple sugars, promoting activity, and increasing fruits and vegetables is all very important. I don't think that just reducing saturated fat intake in Americans will solve our heart disease problem.
Sammy makes a great point - I think people are much more receptive when we focus on what they can eat vs. what they can't. Using this approach and promoting a healthy, balanced diet should be our goal.
I think its great that researchers are investigating this right now, however if there's anything that past research has taught me it's not to jump to conclusions. I also think there is no doubt that other factors play a role in heart disease. America's dietary guidelines are really screwed up; we focus too much on the numbers instead of just encouraging more fruits, veggies, and whole foods. I agree with Sammy, my style is not to sit people down and lecture them about saturated fats or what is 'bad' for them.
I do not think we have enough evidence to clear the association of saturated fat to heart disease. I think further research needs to be done. Also, just like with other diseases, many risk factors are involved with the etiology of heart disease. Saturated fat may have an impact on heart disease, but many other factors also contribute to someone developing the condition. Lack of physical activity, genetics, and other diet factors all must be considered as contributing factors. To solely blame saturated fats for causing heart disease and for killing many Americans is not accurate. I think it’s second nature for Americans to demonize one problem as the cause of an issue, but it is a synergy of risk factors that generate heart disease.
Sammy,
You made a great point about focusing on what people should eat instead of what they shouldn't eat. If we do this more often, then perhaps the majority of Americans will stop thinking of dietitians as the Food Police!
I can’t say with certainty that we have enough evidence at this point, but that’s because I haven’t read everything on the subject. (Who has??) However, I’m definitely at the point where I feel silly telling patients that saturated fat is a “bad” fat. To provide that advice with complete confidence at this point is out of touch, in my opinion. Also, I don’t need convincing that physical inactivity is a factor. I think that is THE biggest factor. Very large scale, diet and lifestyle-controlled trials comparing high vs low saturated fat intake over lifetimes would go a long way to convince me, but those don’t and won’t exist!
Jessica, you are right about the messages being distracting from the fruits and vegetables and whole foods. If there is one thing we know with certainty as dietitians, it's that a diet centered around fruits and vegetables and whole foods is a darn good thing for your health. If we focus on what we know, we're better off.
Brady,
I completely agree with you about feeling out of touch when talking about saturated fats being a bad fat. I can't say that I would confidently tell them not to worry at all about saturated fat either, though, but I think it's fair to let them know that research is still coming out and we're not completely clear on that yet.
I do not think there is enough evidence out there to completely clear saturated fat of its bad name. However, I also believe that there are other factors involved in the presence of heart disease in the U.S. I might be (or begin to be) convinced that saturated fat is not a "killer of innocent Americans" if more evidence proves that it is not as bad as its rap, along with more evidence that links other facts (like genetic predisposition + influence of diet).
I also agree with Janelle that some of the focus should be taken off of individual food components and placed on the concept of moderation. The spread of nutrition misinformation on the internet has created "bad" and "good" foods ("bad" usually including saturated fat), when the focus should be on correct portion sizes and overall health.
There needs to be an investigation into the types of food eaten overall in the diet, and not just those high in saturated fat. If you look at people who have dyslipidemia, their overall dietary intake is usually (not always) quite poor. If a person has a high saturated fat intake, but it is balanced with a high fiber intake, the consequences of high SAT fat might not be as detrimental. The overall diet approach is a huge factor in this. The way Americans eat, I would not stop telling people to eat diets low in saturated fat for the same reason- these people also most likely have a high caloric intake of low nutrient dense foods and this combination is detrimental. A few research articles is never enough to convince me. I need more data!
I agree with Tina when she says people are turned off when told what they cannot do. It personally makes me want to do the opposite of what someone says. We should focus on what they should do more often to outweigh the unhealthful habits. We can do more by instilling healthy choices than restricting unhealthy choices. We have to remember, when we eat foods that are more healthy, we are able to eat more foods and those people who are "dieting" feel like they should not be consuming more foods, or they say they feel hungry more often, or they are unable to eat that amount of food/don't have time to eat that often. As practitioners, we need to be ready with suggestions to negate these barriers!
Everyone is bringing up excellent points about the fact that we shouldn't just focus on one particular nutrient and demonize it. Balance is key! The "Should" eating approach is a great idea. Good call, Sammy.
I agree that more research needs to be done, and also that heart disease is very multifactorial. I only asked this question because saturated fat really does get a bad rap. Caroline, you made a great point about how Americans like to associate one cause with the risk for something...and I think that's accurate for many Americans. As a little research project, I asked my wife, my dad, and my sister about what they thought of when I said "diet and heart disease," and all of their answers had something to do with dietary fat. They didn't mention any other factors such as the sugars, activity, predisposition etc. I just think it's interesting that for many Americans, that is the first thought that comes to mind. I guess we are all too young (we were like 3-5 years old at this point) but my Dad mentioned remembering in the late 1980's/ early 1990's when you couldn't go a day without hearing how bad dietary fat was for you, and how it would kill you...we've come a long way since then, but it's interesting nonetheless. Educating clients (especially those who were around and influenced by the news in the late 1980's and 1990's) about a complete balanced diet, that doesn't focus on eliminating any single component is a sound strategy. Good ideas, everyone.
Susan, I really like your point about the need for long-term intervention. Especially after an education in the inpatient setting. There simply isn't enough time to promote a complete, balanced lifestyle change in that 15 minute window. It's a good start, to be sure, but I agree that more follow-up is needed. A series of cardiac rehab classes is a good example of follow-up, and I would definitely encourage those with CVD to take part in that. I've had the chance to sit through (and even teach) a few classes at two of my rotation sites, and it's a great opportunity to create overall healthy lifestyle change for those in need. Thank you for your participation everyone! This is awesome!
Brady made a good point about not being able to read all the research. I think the research I have read has been conflicting and not always convincing, probably because there are other things that impact Heart Disease. I agree that it's better to look at eating whole foods, especially fruits, vegetables and whole grains, and try to avoid telling people what not to eat. I also agree with Brady that physical inactivity is the biggest factor for most people.
I don’t think we have enough evidence to clear the name of saturated fat as a whole. I remember reading an article a while back (granted I think it was a popular press article, maybe from Today’s Dietitian or the AND daily news article email) which discussed how different types of saturated fatty acids were potentially more atherosclerotic than others. The example provided noted stearic acid, the predominant type in beef was one of the less atherosclerotic types. If research is being performed in the hopes of taking it down to the level of genetic differences to figure out optimal diets, the least we could do is explore different outcomes in different types of saturated fatty acids. More detail is needed in research to better isolate causal relationships.
We need to be very careful about how we phrase things, consumers tend to hear what they want in statements about health and run with it. ("Give them an inch and they’ll take a mile" concept) I remember another popular press article titled “Butter is Back.” If you read the entire article they did discuss the issue from a more balanced perspective. If someone was just skimming titles though, it clearly sends the wrong message that butter can be liberalized with no consequence. We need to stand by our commitment to evidence-based practice and be honest with consumers. This issues is unclear, and it requires further investigation.
Over winter break I read the book "Intuitive Eating" by Evelyn Tribole and Elyse Resch. It went right along with what Sammy first brought up and what many of you agree with: restricting anything makes us want it more. It focuses our thoughts on those less healthy options. If we focus on promotion of what we should eat for health, we take the thought focus off of the unhealthy items in a passive aggressive manner. By setting goals to include healthier things in your diet, the idea is it naturally crowds out the unhealthier things. I always use fuel analogy, if you put low quality fuel in your tank, just like a car, you don't run as well...if done repeatedly, you breakdown. So let's keep focusing on the positive good quality food fuel.
Like Janelle, I do not think there is sufficient evidence to change the recommendation of saturated fat or to completely eliminate the thought that excessive saturated fat consumption is the cause of many deaths in the USA. I think that with a disease like CVD, there are multiple nutrition factors involved such as saturated fats, sodium, dietary cholesterol and multiple other nutrients that all work together to lead to the development of the disease. I think rather than focusing in solely on saturated fats, RDs should promote overall health such as promoting fruits, vegetables, and whole grains and suggesting to limit sodium and saturated fats to minimize multiple life threatening diseases.
I do not think there is enough evidence to say saturated fat has nothing to do with the deaths of many Americans, especially with heart disease affecting so many Americans. I do not doubt there are other factors involved in causing heart disease besides a high consumption of saturated fat. However, we cannot say for sure that saturated fat is not one of these factors. There needs to be more studies isolating each factor of individuals varying in added sugar consumption, physical activity, saturated fat consumption, etc. to figure out how each factor is correlated. However, these studies are very costly and difficult to complete. To further examine the effect of saturated fats on heart health, perhaps we can look at heart disease rates in the past years compared to the amount of saturated fats in our food. For example, this study found that saturated fat density significantly increased in RTE GBP, did heart disease rates increase along with this fact? Looking further into these statistics could give us a better insight as to the role of saturated fat in heart disease, although it still wouldn't be clear cut evidence.
I definitely think there is not enough irrefutable evidence to clear sat fat of its bad reputation. It is also my opinion that as a culture, we spend way too much time and energy focusing on the details, when everyone would be better off thinking "big picture holistically". I think as Americans we have a tendency to behave with an all or nothing attitude. We hear "saturated fat is bad" and everyone becomes trendy superfood eating vegans....but the minute we hear "saturated fat actually might not be that bad" everyone wants the eat ALL THE BACON EVERY DAY!
So to answer the question I think that the real reason for obesity and rampant incidence of heart disease in our country is because we lack moderation and balance on a whole foods level. Sure saturated fat, added sugars, physical inactivity and many other things can certainly contribute to heart disease and obesity, but if we would change our mind set and behavior to one of balance and moderation, then I don't think there would be a reason to identify any of those components as the "blame" for chronic illness....because there would be much less of it.
Again, I agree with Vivian that more research and studies need to be done on saturated fat. I like that she mentioned added sugar consumption as another area to study for CVD, as I had not originally thought about that. She also made a good point about isolating the causation factors from one another, along with making the excellent point that studies are expensive and complex to do at times.
I also agree with Emma and Desiray on how people categorize food because they may contain a certain nutrient. People label foods as "good" or "bad" and go on "trend" or "fad" diets. We really need to focus on teaching consumers about moderation, balance, proper portion sizes, and to focus on telling the clients what they should be eating more of rather than what they shouldn't be eating/should be eating less of.
Like many others I believe there are multiple factors that influence heart disease. Saturated fat consumption has been shown to be one of those factors, which happens to fall in our field of nutrition. I believe our focus is often on saturated fat because food is what we study and what our careers revolve around. But as we know, nutrition is only a small piece to over all health which also includes, genetics, physical activity, emotional and psychological health, etc. I believe there are many factors to heart disease that we need to be aware of.
It will be interesting if future studies can provide enough evidence for RDs to change their viewpoint of saturated fat. I would like to think that excess consumption of saturated fat is bad, but there is a possibility that that is not the case. The field of nutrition is constantly evolving, and the more research studies that are conducted the better and stronger evidence we will have to back up what RDs are saying. I do like Sammy’s comment on focusing on what they should be eating instead of what they should not being eating. There is no doubt that Americans need to increase their fruits and veggie intake and an increase in fruits and veggie consumption could be beneficial for multiple reasons. Just like Sophie and many others said, there are multiple factors that influence heart disease, so I think it is unfair to blame heart disease on saturated fat only.
As I am reading through the comments I notice an emphasis on education. I completely agree that teaching balance and working to instill a total diet approach (as Charity so eloquently stated) is the way to go. I think something we as creative, young RDs and Future RDs could do is figure out a way to make moderation trendy. Instead of having the people focus on eating kale and chia everything, we should focus on getting them to crave moderation.
Heart disease runs in my family and having had a healthy in shape sister at the age of 17 have heart surgery I can tell you that there are many more factors other than increased intake of saturated fat that play a role in heart disease. In today’s society we focus on a quick fix and want to hone in on that one part of our diet that is causing our bodies problems like heart disease, when in reality it’s a combination of everything that we eat that can lead to diseases such as heart disease. I also think by choosing one ingredient and demonizing it, it causes people to consume another nutrient or ingredient in excess to replace the “demon nutrient.” This then causes a vicious merry- go round effect where the food industry rotates what food product will be the demon product of the month. For example, the food industry decided sugar was bad for Americans so then everyone switched to artificial sweeteners, but now the food industry decided artificial sweeteners are the demons. In reality, real sugar or artificial sugars are fine in MODERATION. As RDs and future RDs we need to focus on teaching our clients moderation rather than good food/bad foods causing disease.
I agree with Tina and Charity that Americans hate being restricted. I think that encouraging Americans to eat more fruits and vegetables and practicing moderation with other foods is a great way to educate consumers and eliminate education on “bad foods or good foods.”
I also agree with Des that Americans tend to have an all or nothing attitude and that is why when we say it is a “bad” food they want to eliminate it from their diet completely, but when we say it is a “good” food they want to consume it all day everyday. Good or bad foods are too broad for people that lack the education that we as dietetic students have on moderation. Changing the way we educate clients to teaching clients moderation rather than good or bad foods can really change the way America begins to look at food and their individual diets.
As I was reading this month’s article and it stated that the saturated fat content had gone up, I immediately wondered if it had anything to do with the current trends in Paleo dietitians/fitness people promoting saturated fat as being beneficial. One dietitian in social media comes to mind, Dietitian Cassie (http://www.dietitiancassie.com/) who is always promoting the use of butter and coconut oil on everything! The debate of saturated fats being “good” or “bad” always makes me a bit uncomfortable. My gut instinct is to say that the bulk of our evidence points to saturated fat contributing to health problems, such as CHD/CVD. However, if someone were to challenge me with the two supplemental articles showing no association, I’m not sure how I would readily reply. I think there is so much more research that needs to be done on the subject before I would ever be comfortable saying, “No, there is no association between saturated fat consumption and heart disease.” It will be interesting to see how this subject evolves over the course of our career as dietitians. I’m sure it will not be the first area of nutrition where we will see changes.
In addition, I agree with Jenn’s point about the onset of a disease being caused by a number of factors. One of the frustrating parts of our field is trying to describe to people how it is your overall diet, activity, and lifestyle that contributes to good health. I cannot begin to tell you the number of times that people have asked me, “fat is good now, right? Sugar is the real problem.” It is this ideology that disease is caused by a single factor that is problematic. I agreed with Jessica’s comment about American values being skewed. Our role as future dietitian’s is to promote a healthy, well-balanced relationship with food instead of labeling things as good or bad.
Sammy brings up a great point to focus on what we should be eating, rather than focusing on what foods to label as bad. I think we have gotten used to labeling foods, especially fats as "the good", "the bad", and "the ugly", that we don't know what to do with them when research results are mixed. So while science is trying to figure itself out, we should educate our clients on what to eat and how to live healthier.
Janelle also brings up a wonderful point about moderation. We don't want to scare our clients into completely eliminating foods. Labeling saturated fats as directly linked to heart disease can do just that. It could turn people away from healthy foods such as milk that does have 1.5g of saturated fat per cup. But it also contains plenty of nutrients good for us. So we have to emphasize what to eat and how much to eat!
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