Fats.

Fats are an essential part of a balanced diet, providing energy, supporting cell growth, and helping our bodies absorb vital nutrients. However, not all fats are created equal. Some fats promote health, while others can increase the risk of chronic diseases.^[1]

Let's explore the different types of fats and their impact on our well-being.

Types of Fats

These are the four main types of fats, order from healthy to least healthy.

1. Monounsaturated fats
2. Polyunsaturated fats
3. Saturated fats
4. Trans fats

Monounsaturated Fats

Monounsaturated fats are considered healthy fats and help lower LDL cholesterol levels while also raising HDL cholesterol levels, which reduces the risk of heart disease.

These fats are found in:

• Olive, canola, and peanut oils
• Avocados
• Nuts (e.g., almonds, cashews, and pecans)

Polyunsaturated Fats

Polyunsaturated fats are also considered healthy fats and are essential for overall health.

There are two main types of polyunsaturated fats:

1. Omega-3 fatty acids: Found in fatty fish (e.g., salmon, mackerel, and sardines), flaxseeds, chia seeds, and walnuts. Omega-3s have anti-inflammatory properties and can help reduce the risk of heart disease, stroke, and certain cancers.
2. Omega-6 fatty acids: Found in vegetable oils (e.g., soybean, corn, and sunflower oil), nuts, and seeds. While omega-6s are essential for health, consuming too much can lead to inflammation in the body.

Saturated Fats

Saturated fats are typically solid at room temperature and are primarily found in animal products, such as:

• Beef, pork, and lamb
• Butter, cheese, and whole milk
• Coconut and palm oil

CAUTION

Consuming excessive amounts of saturated fats can raise levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol. High LDL cholesterol levels can increase the risk of heart disease and stroke. However, it's important to note that not all saturated fats have the same impact on health. For example, some studies suggest that the saturated fats in dairy products may have a neutral or even beneficial effect on heart health ^[2] compared to those in red meat. Therefore, considering the source of saturated fats is crucial when evaluating their impact on health.

Trans Fats

Trans fats are the least healthy type of fat. They are created through a process called hydrogenation, which turns liquid oils into solid fats. Trans fats are commonly found in:

• Fried foods
• Baked goods (e.g., cookies, crackers, and pastries)
• Margarine and shortening

CAUTION

Trans fats not only raise LDL cholesterol levels but also lower high-density lipoprotein (HDL) cholesterol, or "good" cholesterol. Consuming trans fats significantly increases the risk of heart disease, stroke, and type 2 diabetes.

Understanding Cholesterol

Cholesterol is a waxy substance that is naturally present in the body's cells. It is essential for producing hormones, vitamin D, and substances that help digest foods. The body produces all the cholesterol it needs through a complex process that takes place primarily in the liver, but it can also be obtained from animal-based foods like meat, poultry, and dairy products.

There are two main types of cholesterol:

1. Low-density lipoprotein (LDL): often referred to as "bad" cholesterol. High levels of LDL cholesterol can lead to the buildup of plaque in the arteries, increasing the risk of heart disease and stroke.
2. High-density lipoprotein (HDL): often called "good" cholesterol. HDL cholesterol helps remove LDL cholesterol from the arteries and transport it back to the liver, where it can be broken down and eliminated from the body.

One of the main goals of a healthy diet is to reduce LDL (bad) cholesterol and increase HDL (good) cholesterol. This can be achieved by consuming a diet low in saturated and trans fats, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats like monounsaturated and polyunsaturated fats.

Cholesterol Levels

When it comes to cholesterol levels, it's important to maintain a healthy balance. The following are the general guidelines for healthy cholesterol levels in adults. ^[3]

• Total cholesterol: Less than 200 mg/dL (milligrams per deciliter)
• LDL cholesterol:
  • Optimal: Less than 100 mg/dL
  • Near optimal: 100-129 mg/dL
  • Borderline high: 130-159 mg/dL
  • High: 160-189 mg/dL
  • Very high: 190 mg/dL and above
• HDL cholesterol:
  • Low (increases risk of heart disease): Less than 40 mg/dL for men, less than 50 mg/dL for women
  • High (protective against heart disease): 60 mg/dL and above

Relationship Between LDL and HDL Cholesterol

The primary goal in managing cholesterol levels is to reduce LDL (bad) cholesterol and increase HDL (good) cholesterol. Here's how HDL helps in lowering LDL cholesterol:

• Reverse Cholesterol Transport: HDL plays a crucial role in reverse cholesterol transport. This process involves HDL particles scavenging excess LDL cholesterol from the bloodstream and artery walls and transporting it back to the liver. In the liver, LDL cholesterol can be processed and excreted from the body. By removing excess LDL cholesterol, HDL helps to prevent the buildup of plaque in the arteries.
• Anti-inflammatory Properties: HDL has anti-inflammatory properties that can reduce the inflammation caused by LDL cholesterol deposits in the arteries. This helps to stabilize plaques and prevent them from rupturing, which can lead to heart attacks and strokes.

Risks of High LDL Levels

The main risk of High LDL levels is that that there is a significantly greater change that you will die in the next ten years. ^[4]

The quality of your life will not be as good as it should be, because you will be battling adverse health effects.

So there is a lot at stake — let's dive into more detail.

High levels of LDL cholesterol can be very harmful to your heart and blood vessels. LDL cholesterol can cause plaque, a fatty and waxy substance, to build up in your arteries. As plaque accumulates, it narrows the arteries, leading to a condition called atherosclerosis, which makes it harder for blood to flow. This can increase blood pressure and raise the risk of heart disease and heart attacks if a blood clot blocks an artery. Similarly, high LDL cholesterol can lead to strokes if clots form in the arteries that supply blood to the brain.

High LDL cholesterol can also cause plaque buildup in the arteries of your limbs, leading to peripheral artery disease (PAD), which causes pain and mobility problems.. High LDL cholesterol is part of metabolic syndrome, a group of conditions including high blood pressure, high blood sugar, and excess body fat around the waist, all of which increase the risk of heart disease, stroke, and diabetes.

Additionally, high LDL cholesterol can damage the blood vessels in the kidneys, contributing to chronic kidney disease. The inflammation in the arteries caused by high LDL levels further worsens the effects of plaque buildup, increasing the risk of cardiovascular problems.

Lowering Cholesterol

If you have high or very high LDL levels, addressing this should be one of your major life goals. Most other problems and goals should fade in the background.

To effectively lower LDL cholesterol and increase HDL cholesterol, a combination of strategies can be employed. It’s important to note that you cannot lower your cholesterol overnight. It likely took years of unhealthy lifestyle choices to reach your current state, and it will take many months or even years to reverse the consequences. Patience and consistency with lifestyle changes are key to improving cholesterol levels and overall heart health.

This journey requires dedication, but the rewards—a healthier heart and a more vibrant life—are profound.

Diet

Dietary changes play a crucial role in managing cholesterol levels. Replacing saturated and trans fats with healthier monounsaturated and polyunsaturated fats, such as those found in olive oil, nuts, seeds, avocados, and fatty fish, can significantly impact cholesterol levels.

Additionally, increasing fiber intake by consuming more soluble fiber, which is found in oats, beans, lentils, fruits, and vegetables, can help reduce LDL cholesterol. Soluble fiber helps by binding to cholesterol in the digestive system and removing it from the body before it can be absorbed into the bloodstream. This process effectively lowers LDL cholesterol levels.

Including plant sterols and stanols in the diet, available in fortified foods and dietary supplements, can also block cholesterol absorption in the digestive tract. Plant sterols and stanols are substances naturally found in plants that resemble cholesterol structurally. Because of this similarity, they compete with cholesterol for absorption in the digestive system. When sterols and stanols are consumed, they block the absorption of cholesterol, thereby lowering LDL cholesterol levels in the blood.

Exercise

Regular physical activity is another essential strategy for managing cholesterol. Engaging in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity each week can help raise HDL cholesterol and lower LDL cholesterol. Maintaining a healthy weight is equally important, as losing excess weight can lead to significant improvements in cholesterol levels, with even a small amount of weight loss having a beneficial impact.

Avoiding Smoking

Avoiding smoking is crucial for improving HDL cholesterol levels and enhancing overall heart health.

It may be surprising that smoking has an effect on LDL cholesterol, as the connection is not immediately obvious. However, smoking damages the walls of the blood vessels, making it easier for LDL cholesterol to adhere and form plaques. ^[5] Additionally, smoking lowers HDL cholesterol, which further impairs the body's ability to remove LDL cholesterol from the bloodstream. Thus, quitting smoking not only benefits cholesterol levels but also contributes to better cardiovascular health.

Statins

Statins are a class of drugs that are commonly prescribed to help lower LDL cholesterol levels, raise HDL cholesterol levels, and reduce inflammation in the arteries.

They work by inhibiting an enzyme in the liver that is responsible for producing cholesterol. Statins are effective in reducing the risk of heart disease, stroke, and other cardiovascular events, especially in individuals with high cholesterol levels or those who have already experienced heart-related issues.

While statins are generally safe, they can have side effects such as muscle pain, liver damage, and increased blood sugar levels which can increase the risk of type II diabetes. It's important to discuss these potential risks with a healthcare provider to weigh the benefits and drawbacks of statin therapy.

Statins are not a magic pill. While they can still be effective even without lifestyle changes, they are far more effective when combined with a healthy diet, regular exercise, maintaining a healthy weight, and avoiding smoking. Lifestyle changes can enhance the cholesterol-lowering effects of statins and improve overall cardiovascular health. ^[6]

Common Myths

Eating fat makes you fat.

"Despite decades of dietary advice that the lower the total fat content, the healthier the diet, researchers and public health authorities now agree that to consider the effect of total fat intake alone on health is meaningless; different types of fats must be considered".^[7]

There is a common myth that eating fats directly leads to weight gain and that low-fat products are inherently healthier. This misconception has led many people to avoid fats altogether, often replacing them with processed, high-sugar alternatives. However, the reality is more complex.

Fats are more calorie-dense than carbohydrates and proteins, with 9 calories per gram compared to 4 calories per gram. This higher calorie content can contribute to weight gain if consumed in excess. However, the type of fat consumed and the overall balance of one's diet are more important factors in maintaining a healthy weight.

In response to the low-fat trend, many food manufacturers began producing low-fat or fat-free versions of their products. However, to maintain taste and texture, they often replace the removed fats with added sugars, refined carbohydrates, or other unhealthy ingredients. As a result, these low-fat products can end up being less healthy than their full-fat counterparts.

For example, a low-fat flavored yogurt might have more sugar and calories than a full-fat plain yogurt. Similarly, low-fat salad dressings often contain more sugar and additives to compensate for the reduced fat content.

Furthermore, consuming healthy fats in moderation can actually support weight management and overall health. Monounsaturated and polyunsaturated fats help to promote feelings of satiety, which can reduce overeating and snacking between meals. These healthy fats also play crucial roles in hormone production, nutrient absorption, and brain function.

Instead of focusing on low-fat diets, it's more important to prioritize overall diet quality. This means choosing whole, minimally processed foods, including healthy fat sources like nuts, seeds, avocados, and fatty fish, while limiting intake of refined carbohydrates, added sugars, and unhealthy fats like trans fats.

Eating high-fat foods will raise your cholesterol levels.

Dietary cholesterol found in foods like eggs and shellfish has less impact on blood cholesterol levels than previously thought. Saturated and trans fats have a more significant effect on raising LDL cholesterol levels. The overall balance of fats and nutrients in the diet, along with other lifestyle factors, plays a more substantial role in determining blood cholesterol levels.

Eggs raise cholesterol levels and increase the risk of heart disease

For many years, eggs were believed to raise blood cholesterol levels and increase the risk of heart disease due to their high dietary cholesterol content. One large egg contains about 186 milligrams of cholesterol, which led to the recommendation to limit egg consumption.

However, recent studies have shown that dietary cholesterol has less impact on blood cholesterol levels than previously thought. The 2015-2020 Dietary Guidelines for Americans removed the recommendation to limit dietary cholesterol to 300 milligrams per day, stating that cholesterol is not a nutrient of concern for overconsumption . ^[8]

Research has shown that consuming eggs as part of a balanced diet does not significantly increase the risk of heart disease in most people. A meta-analysis of prospective cohort studies found no significant association between egg consumption and the risk of coronary heart disease or stroke. ^[9]

Eggs are also a nutritious food, providing high-quality protein, vitamins (such as vitamin D, vitamin B12, and vitamin A), minerals (such as selenium and choline), and antioxidants (such as lutein and zeaxanthin). These nutrients are important for maintaining overall health, including eye, brain, and liver function.

Margarine is a healthier alternative to butter.

Many margarine products, especially older formulations, contain trans fats, which are the least healthy type of fat. Trans fats raise LDL cholesterol and lower HDL cholesterol, increasing the risk of heart disease. Some newer margarine products have been reformulated to remove trans fats, but butter from grass-fed cows, consumed in moderation, can be a healthier choice due to its nutrient content.

Cooking with olive oil is unhealthy due to its low smoke point.

While it's true that extra virgin olive oil has a lower smoke point compared to some other cooking oils, it is still a healthy choice for cooking at low to medium temperatures. Olive oil is rich in monounsaturated fats and antioxidants, which can provide health benefits. For high-heat cooking, oils with higher smoke points like avocado oil or refined coconut oil can be used.

References

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1. Lawrence, G.D. (2013) 'A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion', Nutrition Journal, 12, p. 164. Available at: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-12-164 (Accessed: 24 April 2024). ↩︎

2. Markey, Oonagh, Dafni Vasilopoulou, David Ian Givens and Julie Anne Lovegrove. “Dairy and cardiovascular health: Friend or foe?” Nutrition Bulletin / Bnf 39 (2014): 161 - 171. ↩︎

3. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Executive Summary." National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 01-3670, May 2001. https://www.nhlbi.nih.gov/files/docs/guidelines/atp3xsum.pdf ↩︎

4. Rong, Shuang, Benchao Li, Liangkai Chen, Yangbo Sun, Yang Du, Buyun Liu, Jennifer G. Robinson, and Wei Bao. "Association of Low‐Density Lipoprotein Cholesterol Levels with More than 20‐Year Risk of Cardiovascular and All‐Cause Mortality in the General Population." Journal of the American Heart Association 11, no. 15 (2022): e023690. https://doi.org/10.1161/JAHA.121.023690. ↩︎

5. Benowitz, Neal L. "Cigarette Smoking and Cardiovascular Disease: Pathophysiology and Implications for Treatment." Progress in Cardiovascular Diseases 46, no. 1 (2003): 91-111. https://doi.org/10.1016/S0033-0620(03)00087-2. ↩︎

6. Stone, Neil J., Jennifer G. Robinson, Alice H. Lichtenstein, C. Noel Bairey Merz, and Connie B. Newman. "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults." Journal of the American College of Cardiology 63, no. 25 Part B (2014): 2889-2934. https://doi.org/10.1016/j.jacc.2013.11.002. ↩︎

7. Mozaffarian, D., Appel, L.J., and Van Horn, L. (2010) 'Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance', The BMJ, 341, c4222. Available at: https://www.bmj.com/content/361/bmj.k2139 (Accessed: 24 April 2024). ↩︎

8. U.S. Department of Health and Human Services & U.S. Department of Agriculture. (2015). 2015-2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015 ↩︎

9. Rong, Y., Chen, L., Zhu, T., Song, Y., Yu, M., Shan, Z., Sands, A., Hu, F. B., & Liu, L. (2013). Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ, 346, e8539. https://doi.org/10.1136/bmj.e8539 ↩︎