Beth Meertens and Garry Jennings

Beth Meertens is an Accredited Practicing Dietitian and Heart Foundation spokesperson on healthy eating and dietary patterns. Garry Jennings is the Heart Foundation's Chief Medical Officer.
It seems when healthy eating is the subject, everyone wants to talk about fat. It can be a confusing and polarising topic.

It seems when healthy eating is the subject, everyone wants to talk about fat. It can be a confusing and polarising topic.

Given this, we have recently summarised contemporary evidence on the topic with a completed an evidence review and position statement. Here we will use this science to answer some of the most common questions asked about fat - sorting the fat from the fiction, so to speak.

Is saturated fat healthy now?
What has fuelled much of the interest in fat are studies which find that saturated fat is not associated with heart disease. And if there is no association, then saturated fat must be healthy, right? But is this really the case?

The short answer is ‘no’. Reducing saturated fat alone, without considering what it is replaced with may not be beneficial and doesn’t tell the whole story.

The evidence
A recent evidence review which underpins the Heart Foundation’s Position on Fat, found that ‘proportional change in energy’ is important when we study the relationship between fat and health.

Say that again?
When we change the amount of a nutrient, like saturated fat, there is a proportional change in the energy from other nutrients in our diet. For example, if the amount of saturated fat in our diet decreases, there is less energy from saturated fat and an increase the proportion of energy from other sources.

The other sources of energy are important.

Evidence demonstrates that reducing saturated fat and:

• replacing it with unsaturated fat improves cardiovascular risk factors and reduces the risk of heart disease;
• replacing it with wholegrains improves some cardiovascular risk factors and reduces the risk of heart disease but not to the same extent as unsaturated fat; and
• replacing it with refined carbohydrate does not improve cardiovascular risk and does not reduce the risk of heart disease.

*Trans-fats, regardless of other sources of energy, are consistently linked to cardiovascular risk and to heart disease.

In short, unsaturated fat is preferred to saturated fat, both of which are preferred to trans-fat. (And wholegrains are preferred to refined carbohydrates.)

The take-home message
Changing saturated fat alone, without considering what it is replaced by is not enough. The ‘neutral’ or ‘no’ associations between saturated fat and cardiovascular disease (CVD) does not mean it is ‘healthy’ and we should eat more, as studies of saturated fat compared to unsaturated fats and wholegrains consistently finds the latter two promote heart health.

The combined evidence suggests that improving the whole eating pattern, not just altering one nutrient is required to promote cardiovascular health.

This concept is embodied in the Heart Foundation’s new position statement on Dietary Fat and Healthy Eating, along with the American Heart Association, the Canadian Heart & Stroke Foundation and the New Zealand Heart Foundation which all recommend that the shift from saturated to unsaturated fat should occur within a healthy eating pattern.

Is Omega-6 good or bad for my heart?
Claims have been made that Omega-6 promotes inflammation or, worse yet, increase the risk of heart disease. So, should we be avoiding Omega-6 fats?

No, from the evidence we know that Omega-6 is an important part of a healthy diet. Not the only part, but an important part.

The evidence
We should not avoid Omega-6 as it is an essential fat, meaning it is a type of fat that the human body cannot make naturally and so it must be sourced from the diet to avoid deficiency. The human body can make saturated fat, monounsaturated fat and cholesterol which means they are not considered essential fatty acids.

Many studies consistently demonstrate the link between intake of Omega-6 and a lower risk of heart disease. For example a systematic review and meta-analysis of prospective cohorts found that increasing Omega-6 by 5% was associated with a 9% lower risk of having heart disease, and a 13% lower risk of dying from heart disease.

Research has not found evidence to support claims about an association between inflammation and Omega-6. A systematic review of randomised controlled trials found no evidence that dietary Omega-6 contributes to inflammation. The American Heart Association also found that Omega-6 fats are not pro-inflammatory and that they are associated with reduced risk of heart disease.

The take-home message
Food sources of Omega-6 include nuts, seeds and their oils (including sunflower, safflower, sesame, canola and to a lesser extent olive oils).

But be careful
Omega-6 is found in many types of oils, this means that it can be found in discretionary foods like biscuits, cakes and takeaway foods (in which oil is a substantial ingredient). The fact that Omega-6 can be found in these foods does not make them healthy.

All Australians would do well to consume less discretionary foods and beverages. As a whole, this group of products contributes the most saturated fat, trans-fat, refined carbohydrates and sodium to the diet which not only raise risk factors for many health complications but also take up space in the diet where healthy foods should be. Read more about the Heart Foundation’s Healthy Eating Principles which promote a good balance of fats, including Omega-6.

Is butter better because it’s less processed?
With headlines suggesting ‘butter is back’ and a sense that ‘less is more’ when it comes to food processing, we are often asked, ‘is butter better’?

Here again, we must ask, ‘what we are being asked to compare it to?’

Put bluntly, butter is not a health food.

The evidence
Butter is made up of 50% saturated fat and 4% trans-fat. Compared to other oils like olive and canola oil, butter raises LDL (bad) cholesterol which is a risk factor for heart disease.

When studies look at the development of heart disease over long periods of time, a relatively small risk or neutral relationship exists between butter – mortality and cardiovascular disease (CVD).
However, this is in stark contrast to the corresponding benefits of fruits, nuts, legumes, healthy oils, and fish.

Often the merits of butter rest on its perceived status as a ‘natural’ product compared to alternatives like margarine.

While research suggests that the degree of processing is relevant to the healthiness of a product, it’s not as black and white as processed=unhealthy and unprocessed=healthy.

Technically, processed just means a deliberate change in a food that occurs before it is available for us to eat it, for example, canned and frozen vegetables are processed but are arguably healthy foods.

The take-home message:
Be discerning about the term ‘processed’; processing is not a proxy for unhealthy.  

A better, ‘natural’ alternative to butter would be olive oil, avocados, nut butters or tahini which provide unsaturated fats, minimally saturated fats and no trans-fat, and are all linked to having a healthier heart.

Is coconut oil the ultimate superfood?
Remarkable claims have been made about the health benefits of coconut oil. While coconut oil is 92% saturated fat, some claim that because the saturated fat in coconut oil is slightly different to that in animal products, it is a healthy choice. Is this the case?

Simply put, there is no evidence to support the consumption of coconut oil for heart health.

The evidence
Coconut oil consumption raises total cholesterol, high density lipoprotein (HDL) and low-density lipoprotein (LDL) when compared with other fat sources, except butter which raises them further.
Evidence does not support the claim that saturated fat in coconut oil acts differently to other saturated fats. Studies that relate to medium chain triglycerides (namely MCT oil - a type of manufactured fat used for some clinical conditions) cannot be used to support coconut oil consumption in general, as coconut oil has a much higher level of lauric acid (a long-chain saturated fat). Lauric acid is the main fatty acid in coconut oil and similar to other types of saturated fat it raises LDL(bad)-cholesterol.

Take home message
Like butter, coconut oil is not a health food. Health food status is reserved for foods which are proven to promote health such as vegetables, legumes, fruit and nuts.

Eating spoonsful of coconut oil is not healthy and may indeed be harmful.

There’s better alternatives to coconut oil - include olive and canola oils and spreads, avocado and nut butters regularly instead.

Should I choose reduced fat or full fat dairy products?
Two of the most common questions about fat are if full fat or reduced fat milk is the healthier option? And are milk, cheese and yoghurt actually good for your heart?

In short, milk, yoghurt, and cheese are healthy snack options in preference to discretionary foods and can contribute to healthy meals when eaten with vegetables, wholegrains or fruit.

Choosing reduced fat unflavoured varieties of milk and yoghurt, and cheese over added sugar/flavoured and high fat varieties is the healthier choice.

The evidence
Similar to other foods like eggs and poultry – milk, cheese and yoghurt are not associated with cardiovascular risk. This means that they do not increase risk which is a good thing, but they do not decrease the risk in the same manner that vegetables, legumes, fruits and nuts do.
In a review of dietary patterns linked to heart health, some but not all dietary patterns included milk, cheese and yoghurt and when they do, they are usually the reduced fat and unflavoured varieties. There is some evidence that reduced fat dairy (usually milk and yoghurt) is associated with a reduced risk of hypertension as part of a broader healthy eating pattern and evidence that replacing dairy fat with plant-based fat (i.e. nuts, oils etc.) is associated with a reduced risk of adverse lipoproteins and risk of heart disease.

Take home message
On balance, dairy products (milk, cheese and yoghurt) can be included in a healthy eating pattern. This evidence for milk, cheese and yoghurt does not translate to other dairy foods like butter, cream or other high-fat dairy products like ice cream which should be limited.

Essentially, adding dairy fat (by choosing full fat products) to your eating pattern won’t make it healthier while removing some (by choosing reduced fat products) to make room for fat from plant sources such as olives, nuts and seeds is a healthier choice.

Conclusion
In sorting the fat from fiction, we find:

• The whole eating pattern, not just one nutrient, is important for heart health.
• Unsaturated fat is preferred to saturated fat, both of which are preferred to trans-fat.
• Adopting the Heart Foundation’s Healthy Eating Principles will help achieve the balance of fats the evidence demonstrates are important for heart health.

The Heart Foundation’s Healthy Eating Principles promote a healthy eating pattern based a combination of foods, chosen regularly, over time. This optimal combination is based on research into dietary patterns including the Mediterranean and DASH diet. It has been categorised into five healthy eating principles for ease of reference:

1.Fruits, vegetables and wholegrains

2.A variety of healthy protein sources including fish and seafood, lean meat and poultry, legumes, nuts and seeds

3.Reduced fat dairy such as unflavoured milk and yoghurt, and cheese

4.Healthy fat choices with nuts, seeds, avocados, olives and their oils for cooking

5.Herbs and spices to flavour foods, instead of adding salt

This style of eating is naturally low in saturated and trans fats, salt and added sugar and rich in wholegrains, fibre, antioxidants and unsaturated fats (omega-3 and omega-6). Eating this way will improve the heart health of all Australians by reducing cardiovascular disease (CVD) risk factors such as high blood pressure and blood lipids and decreasing the risk of CVD events and mortality.
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For more information watch the Heart Foundation’s Healthy Eating Principles Webinar along with the “Where does fat fit in healthy eating” Webinar.
 
https://www.heartfoundation.org.au/news/sorting-fat-from-fiction

Only 20 years ago butter was the public villain – contributing to raised cholesterol levels and public concern over an increased risk of heart disease. Now this public perception seems to have been reversed, and reality cooking shows seem to use butter in every recipe. But what has caused this shift in perceptions and is it based on scientific evidence?

In the domestic market more people buy margarine than butter, with 27% of respondents in an ABS survey eating margarine the day before, and 15% consuming butter. 

Do we still need to be concerned about butter’s links to heart disease, and is there any evidence to suggest butter is better for our health compared to margarine? To answer this we first need to look more closely at the make-up of butter and margarine.

Where do our favourite yellow spreads come from?
Butter is made from the processing of cream. The cream is churned until the liquid (buttermilk) separates from the fat solids. These fat solids are then rinsed, a little salt added, and shaped to form the butter we all love.

Margarine was first developed in France by Napoleon as a substitute for butter to feed the armed forces and lower classes. Margarine is made from vegetable oils, beta-carotene (added for colour), emulsifiers (to help the oil and water mix), salt and flavours (which can include milk solids). Vitamins A and D are also added to the same level present in butter.

Any diet app will tell you margarine has about 10-15% fewer kilojoules than butter. But whether this is significant will largely depend on the amount you consume each day.

A national nutrition survey indicates the average person over 19 years consumes 20 grams per day of spreads (either butter or margarine), which equates to a difference of 100kj. This difference is largely insignificant in a usual daily intake of 8700kj/day.

It’s all in the fatty acids
The significant nutritional difference actually lies in the fatty acid profiles of the two products. The health differences between butter and margarine are based on the presence of different types of fats.

There are three types of fats in our food: saturated fat, monounsaturated fats and polyunsaturated fats. The difference between these lies in their chemical structure. The structure of saturated fats has no double bonds in between the carbon atoms, monounsaturated fats have one double bond between the carbon atoms, and polyunsaturated fats have two or more double bonds between the carbon atoms.

These subtle differences in structure lead to differences in the way our body metabolises these fats, and hence how they affect our health, in particular our heart health. 

Margarine can be made from a number of different oils. If coconut oil is used the margarine will be mainly saturated fat, if sunflower oil is used it will mainly be a polyunsaturated fat, and if olive oil or canola oil is used it will mainly be a monounsaturated fat.

Butter, derived from dairy milk, is mainly saturated fat, and the main saturated fats are palmitic acid (about 31%) and myristic acid (about 12%). Studies have shown these raise blood cholesterol levels. 
While there is debate in the scientific world about the relative contributions of saturated fats (and the different types of saturated fatty acids) to heart disease, the consensus is that replacing saturated fats with monounsaturated or polyunsaturated fats will lower the risk of heart disease.

The Australian Dietary Guidelines and World Health Organisation recommend the lowering of saturated fats to below 10% of daily energy intake. Depending on the overall quality of your diet and intake of saturated fats, you may need to swap your butter for margarine. 


Check the labels
Extra-virgin oil protects against heart disease. There is strong evidence extra-virgin olive oil (a monounsaturated fat) provides strong benefits for heart disease protection – but there isn’t enough extra-virgin olive oil in margarine products to confer this benefit. Using olive-oil-based margarines is going to contribute very little to your daily intake of extra-virgin olive oil.

And this is why it’s confusing for the consumer – despite a margarine being labelled as being made from olive oil, it may contain only small amounts of olive oil and not be as high in monounsaturated fats as expected. It’s best to read the nutrition information panel to determine which margarine is highest in monounsaturated fats.
Another point of difference between butter and margarine is that margarine may contain plant sterols, which help reduce cholesterol levels.

At the end of the day, if you consume butter only occasionally and your diet closely adheres to the Australian Guidelines for healthy eating, there is no harm in continuing to do so.
Another option to consider would be the butter blends. These provide the taste of butter while reducing saturated fat intake to half, and they are easier to spread. Of course, if you consume lots of butter, swapping for a low saturated fat margarine is your healthier option – perhaps reserve the butter for special occasions.
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If you’re concerned about saturated fat levels in your diet, you should read the nutrition information panel to determine which margarine is lowest in saturated fat, regardless of which oil is used in the product.
As always, people need to base their decision on their family and medical history and obtain advice from their Dietitian or GP.

BY THE DIETITIANS ASSOCIATION OF AUSTRALIA

The Dietitians Association of Australia (DAA) is disappointed with recent media reports, including a piece on Channel 7 News (23 May 2016) titled ‘Fatty foods don’t make you fat, but sugar is off the menu: Dieticians (sic)’. 

These alarmist reports contain many factual inaccuracies, with the information presented to Australians not in line with the latest evidence.

Sadly, such reports only confuse the Australian public about what to eat for good health. DAA, and the 5,900 members the Association represents, take very seriously our responsibility of promoting accurate, balanced and complete nutrition information to the public.

We are deeply concerned that yesterday’s media reports suggest ‘dietitians’ agree with the statements in the news reports, as this is not the case.

Check the qualifications of anyone providing nutrition advice
DAA recommends checking the nutrition qualifications of anyone providing dietary advice. As with any field, it’s important that advice is provided by those qualified to do so, working within their scope of practice.

Accredited Practising Dietitians (APDs) are nutrition scientists with a minimum of four years’ university study behind them. APDs assess individuals and provide tailored, expert nutrition advice and support, based on the latest evidence. They undertake ongoing training and development to ensure they are up-to-date, and like other health professionals, are bound by professional standards and accountable for the advice they provide.

Unfortunately, an APD was not interviewed for the Channel 7 News story, or other associated stories.

The Australian Dietary Guidelines: Evidence-based guidelines Australians can trust
It is without basis, and grossly misleading, to claim the Australian Dietary Guidelines (ADG) are ‘making us sick’ (as was the suggestion in the Channel 7 News story).

The evidence-based ADG, which were developed by independent experts in nutrition, working with the National Health and Medical Research Council, provide a framework for healthy eating – and DAA supports these recommendations for the healthy population. An assessment of more than 55,000 studies informed the recent review of the 2013 Australian Dietary Guidelines.

The ADGs are similar to evidence-based guidelines around the world, across a range of cultures and food systems – but our Guidelines are specific to issues and concerns within the Australian population.

Regarding fat and carbohydrates, the nutrition science tells us:

• When it comes to carbohydrates, good-quality choices (such wholegrains and legumes) can be part of a healthy diet, and are in fact recommended to help meet daily fibre targets. When it comes to wholegrains, for example, there is strong evidence to link wholegrain intake with lower body mass index, smaller waist circumference, and reduced risk of being overweight.

• A diet high in saturated fat is a risk factor for heart disease, one of our nation’s biggest killers. Saturated fats tend to increase LDL (unhealthy) cholesterol in the blood and current evidence suggests these should be eaten sparingly to minimize the risk of heart disease. Instead, foods that are rich in unsaturated fats (such as monounsaturated and polyunsaturated fats) are recommended.

DAA agrees with the message to limit manufactured (or processed) foods that provide little nutrition value – this is what the ADG also recommend, so this is nothing new. The ADG encourage Australians to choose whole foods, such as vegetables, legumes, fruit, lean meats and eggs. And for foods within a package, DAA recommends Australian read the nutrition information panel to be able to make informed choices. An APD can work with people on these, and other strategies, to help them achieve a healthy eating plan, tailored to their individual needs.

DAA points out that the ‘panel of global dietary experts’ mentioned in yesterday’s media reports consist of the UK-based National Obesity Forum and the Public Health Collaboration – whose views on saturated fat have been questioned by the UK’s Royal College of Physicians and Public Health England. See the response by Public Health England to the National Obesity Forum and Public Health Collaboration opinion paper.

DAA appeals to journalists reporting on diet-related issues in Australia to report responsibly, and to source and discuss facts with local experts.  
 

SOURCED FROM: Dietitians Association of Australia > For the Media > Hot Topics > Misleading media reports on high fat, low carbohydrate diet for Australians