Since almost the beginning of my career I’ve suspected that the medical and nutritional establishment was wrong on fat and cholesterol. For the last two decades, I’ve been certain of it. And the research—especially since 2010, has backed me up. Saturated fat does not cause heart disease. And neither does cholesterol.
Whoops.
Now, a new and beautifully designed study out of Malaysia adds more fuel to the bonfire on which we should burn terrible notions such as the fear of witches, the belief that the Milwaukee Brewers will win the World S eries, or the misguided and unsupported fantasy that banishing fat from our diet will have any positive impact on heart disease or diabetes.
Scientists in Malaysia studied the diets of 577 healthy adults, but in a much more sophisticated way than is usually done in epidemiological studies.
First of all, they didn’t just study a single macronutrient (i.e. fat, carbs or protein); they studied patterns of eating (i.e. low-carb high fat, high-carb low-fat, high-carb high-fat, and low-carb low-fat). I studied under a legendary gestalt psychologist when I was in my Master’s program at the New School, so I’m very much a fan of looking at patterns and context when it comes to health. (The word “gestalt” means “an organized whole that is more than the sum of its parts”.) So looking at patterns of eating rather than a single component of the diet seems to me a major upgrade.
Second of all, they didn’t just measure “cholesterol” as a stand-in for heart disease, a “gold-standard” measurement of the 1960’s, but long past its expiration date. They measured real, meaningful markers that are relevant today and supported by research, like cholesterol particle size and insulin resistance. (I n my opinion, insulin resistance is the earliest and most consistent predictor of future heart disease, a subject I will cover in depth when the new edition of The Great Cholesterol Myth comes out next year.)
Here’s what the study found after examining patterns of eating and relating them to advanced and meaningful risk factors for heart disease:
It didn’t much matter how much fat people ate.
What did matter was the percentage of carbs in their diet.
Both patterns of lower-carb eating— whether the high-fat version or the low-fat version—did better than both versions of higher-carb eating, whether the high-fat or the low-fat version.
The pattern of eating that was the most associated with the most cardiovascular risk was… wait for it….high-carb high-fat.
(This reminds me of something Professor Jeff Volek once told me in an interview, something that’s been known by low-carb researchers for over a decade: “Saturated fat behaves very differently in the context of a low-carb diet as opposed to a high-carb diet”.)
It should be noted that in this study, the majority of fat consumed in the diets was Malaysian palm oil, which is indeed 50% saturated, with the other 50% coming mainly (40%) from monounsaturated fat, the same kind found in olive oil and avocados. It didn’t make a bit of difference as far as cardiovascular risk was concerned.
What did make a difference—and it bears repeating— was consuming a high-carb diet. Restricting carbs had a significantly greater benefit to heart health than restricting fat consumption. Those eating a high carb/low fat diet had worse outcomes.
And evaluating them for multiple heart disease risk factors, researchers in Malaysia concluded something remarkable:
These results fly in the face of traditional advice. You might predict that people following low-fat diets would have better cholesterol profiles than those eating high-fat diets. That did not happen in this study.
The newly published study also took other factors into account, including lifestyle, genetics, age and socioeconomics. These study participants lived in urban areas and held white collar jobs. And they were a healthy bunch. They didn’t smoke or drink. They didn’t have diabetes, high blood pressure, heart disease, kidney disease or cancer. None had ever had a stroke. Even their thyroids were working properly!
What does this mean for you and me? It’s never a good idea to completely ignore an entire food group. Proteins, fats and a limited amount of carbs all deserve a place in a heart-healthy diet.
If you should do one thing different because of this study, it’s this: Pay closer attention to the type of carbs you’re eating. And for goodness sake, stop worrying about fat.
