Dear Friends and Patients:
In the next several issues of our Newsletter, I will be discussing the top five “foods to avoid.” This country is in the midst of an epidemic of increasing numbers of people with cancer, diabetes, obesity and heart disease. The most misunderstood aspect of nutrition is fat metabolism. The following article is an update from my previous articles on cholesterol and fats. I would like to give credit to the publications of Stephen Sinatra, M.D. for much of the technical parts of this information. Dr. Sinatra is one of a growing number of cardiologists who are pioneering nutritionally based cardiology.
In the 1950s nutrition pioneer Ancel Keys linked dietary fat to coronary heart disease. The nutrition community of that time completely accepted this hypothesis, and encouraged the public to cut out butter, red meat, animal fats, eggs, dairy and other “artery clogging” fats from their diets — a radical change at that time. What you may not know is that when Keys published his analysis that claimed to prove the link between dietary fats and coronary heart disease, he selectively analyzed information from only six countries to prove his correlation, rather than comparing all the data available at the time — from 22 countries. As a result of this “cherry-picked” data, government health organizations began bombarding the public with advice that has contributed to the diabetes and obesity epidemics going on today. Not surprisingly, numerous studies have actually shown that Keys’ theory was wrong. A Medical Research Council survey showed that men eating butter ran half the risk of developing heart disease as those using margarine. Of course, as Americans cut out nutritious animal fats from their diets, they were left hungry. Confident that, “as long as it was fat-free, it was okay,” many dieters compensated for lack of fat in the diet with sugar, often in unrestricted amounts. As people began to eat an abundance of fat-free ice creams, cookies, cereals, and breads, their insulin levels chronically soared. We now recognize that regular, excess insulin release can lead to insulin resistance and subsequent weight gain. We also know that low-fat or no-fat diets can cause depression, lethargy, and irritability due to deficiency of essential fatty acids.
In addition, people began eating more processed grains, more vegetable oils, and more high-fructose corn syrup. This is the type of diet that will eventually lead to increased inflammation. We now know that cholesterol per se is not the problem causing heart disease. It is only when cholesterol becomes oxidized that it sticks in the arteries. Oxidation occurs due to inflammation. Cholesterol production by the liver increases as a response to repair tissues damaged by inflammation in your body. Chronic inflammation is also caused by eating foods cooked at high temperatures, eating trans fats, a sedentary lifestyle, smoking, and emotional stress.
The bottom line is we need healthy fats; they should comprise approximately 30 percent of our daily caloric intake. Fats are not only tasty, but satiating. By adding healthy fats to our meals, we may actually eat less overall. More calorically dense than carbohydrates and proteins (each gram of fat has 9 calories, while each gram of carbohydrate or protein has 4 calories), eating fat can bring about a feeling of fullness. Additionally, as fat does not elicit an insulin response, eating it in moderation can actually make it easier for us to burn off our fat reserves and lose weight. This is one of the reasons the Adkin’s diet works for many people. Our bodies need fats to burn as fuel and for proper heart and brain function; the heart gets 60 percent of its fuel from fat. We also need fat to help us absorb fat-soluble vitamins like A, D, E, and K, as well as carotenoids.
The key to fats is good choices and moderation. Our understanding of the healthiness or unhealthiness of fats is constantly evolving. Ten years ago, doctors and nutritionists told us that unsaturated fats (monounsaturated and polyunsaturated fats) were good and that saturated fats were bad. This is because our bodies convert most saturated fat into cholesterol, and, at the time, we thought high cholesterol was the root cause of cardiovascular disease. As I previously stated, we have since learned that chronic inflammation and oxidized LDL cholesterol cause heart disease. Hence, we now consider fats which contribute to inflammation, rather than convert to cholesterol, unhealthy. We also are better aware that hydrogenated (unsaturated) fats, i.e. trans fats, are highly inflammatory and underlie numerous health problems, like cardiovascular disease.
The Structure of Fatty Acids Made “Simple”
Oils are added into almost all prepared foods or are used in salad dressings and for cooking. The use of unhealthy oils such as soybean and canola oils is widespread, even in the health food industry. The public is becoming more educated about avoiding hydrogenated or partially hydrogenated oils because of their association with heart disease and cancer. Without getting too technical, all fatty acids are a chain of carbon atoms: C-C-C-C-C- etc.
This chain is analogous to the aisle in a bus or airplane. On either side of the aisle there is either an empty or occupied seat (with a hydrogen atom). If all the seats are “occupied,” the fat is a saturated fat. If some of the seats are “empty,” this is an unsaturated fat.
Butyric acid molecule found in butter. This is a saturated fat.
Because a fat is saturated, does not make it “bad.” All saturated fats have the advantage over unsaturated fats that they do not become easily oxidized. This is why butter and coconut oil are the best oils to cook with. Toxic oils that are overheated are the #1 health threat in this country, in my opinion, and lead to inflammation, heart disease and cancer. Food manufacturers began to artificially add hydrogen atoms (artificial hydrogenation) to corn and soy oils because they found a cheaper alternative to prevent spoilage.
Scientists have grouped all fats into 3 primary categories: saturated, monounsaturated, and polyunsaturated. As of this publication, the Mayo Clinic has listed ALL saturated fats as harmful on its website. I do not agree with this statement as the human body needs saturated fats to function. But I’ll go into this later in this article.
Monounsaturated fats have a single double bond, hence they are called “mono.” As monounsaturated fats help reduce inflammation while not catalyzing insulin release, they help us lower our risk of heart disease. While olive oil is probably the best source of monounsaturated fat, we can also get it through foods like avocados, and various seeds and nuts. Monounsaturated fats are liquid at room temperature which is why the oil separates with freshly ground nut butters. Not all monounsaturated fats are healthy. For example, oleic acid makes up 77% of olive oil and is very healthy. Erucic acid, another monounsaturated fat, is highly toxic. Canola (Rape seed) oil is made of over 60% Erucic acid. In order to decrease its toxicity, canola has been genetically modified to include only 1% or less Erucic acid. This is still too much and quite toxic.
Olive oil is best consumed in uncooked form, since heat can damage its health-enhancing compounds. Its smoke point is 420 degrees Farenheit. Light or extra light olive oil is good for stir-frying or baking, while extra virgin olive oil works well for light sautéing, or drizzled on appetizers, salads, vegetables, etc.
Polyunsaturated fats have many (poly) double bonds. Polyunsaturated fats, also liquid at room temperature, are a double-edged sword when it comes to health. Those such as corn oil, safflower oil, and canola oil, were once the darlings of nutritionists because of their ability to lower LDL cholesterol. Unfortunately, they also lower HDL, the “good” cholesterol. Additionally, some polyunsaturated fats oxidize quickly in our bodies, making our cells more vulnerable to degenerative diseases like cancer, cataracts, Alzheimer’s disease, and cardiovascular disease.
The problem is we need to consume some polyunsaturated fats because they contain essential fatty acids (EFAs). EFAs are “essential” because we don’t make them in our bodies so we must get them either through the diet or supplementation. There are two major EFAs in polyunsaturated fats, alpha-linolenic acid (ALA) and linoleic acid (LA), which are also categorized as either omega-3s or omega-6. While ALA, an omega-3, can help decrease inflammation, too much LA, an omega-6, can increase it. Our bodies convert LA to arachidonic acid, a highly inflammatory polyunsaturated omega-6 fatty acid, which our bodies also produce in response to free radical activity. While necessary in small amounts, too much arachidonic acid can set into motion a cascade of biochemical events that raise blood pressure and can block arteries. The key to polyunsaturated fats, then, is to consume a balance of omega-3 and omega-6s.
Omega 3 Fatty Acids
From ALA, our bodies produce two other crucially important fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega-3 fatty acids, which we need for brain function and normal growth and development, are anti-inflammatory and cardio-protective. They defend against heart attacks by preventing the formation and attachment of blood clots in our arteries, as well as the rupture of unstable arterial plaques. They also prevent spasms in blood vessels. Studies have also shown that higher omega-3 consumption, especially through dietary sources of EPA and DHA, is associated with lowered risk of heart disease. Eskimos eat a very high fat content diet, but it also contains large amounts of Omega-3 fatty acids from seafood. They have the lowest incidence of heart disease on the North American continent.
EPA and DHA are omega-3s found in fish (and fish oil) that can help lower blood pressure and prevent arteriosclerosis (blood vessel damage due to thickened walls and loss of elasticity). Omega-3s stimulate both the production of chemical mediators which relax smooth muscles, and prostaglandins, hormones which prevent blood clots. Omega-3s are also vasodilative (they help keep blood vessels open so oxygenated blood can easily flow through), in that they block the effects of certain chemical mediators which raise blood pressure. Research has also shown that fish and fish oils are great brain food. Omega-3s can help alleviate psychological problems including depression, bipolar disorder, and even suicidal tendencies. DHA, in particular, is critical for the development of the retina and the fetal brain, and is necessary for brain and male reproductive health.
It’s important to remember that fish may contain excessive amounts of mercury and other contaminants due to environmental pollution; the higher up the seafood chain, the greater the chance of toxicity. Try to find a pure, uncontaminated fish oil that contains both EPA and DHA, and/or eat small migratory fish like wild-caught Alaskan salmon, Atlantic or Alaskan halibut, and cod. At the Center, we carry Biotic’s brand Bio Omega 3 fish oil, which is mercury-free. Do not eat farm-raised fish, including farm-raised salmon, which tend to contain greater levels of heavy metals in addition to insecticides and pesticides Also avoid large predatory fish like shark, tuna, kingfish and swordfish. Eating wild-caught fish three to four times per week, or supplementing with 1,000 mg of fish oil daily, can help us get the omega-3s we need for health maintenance.
Vegetarians and other people who don’t consume fish or fish oil can get the building blocks for EPA and DHA by consuming ALA. ALA is an omega-3 EFA that can be transformed in the body into small amounts of EPA and DHA. Ground flaxseed is a good source of ALA as well as fiber, which offers the added benefits of healthier skin, lower cholesterol, improved digestion, and a cleaner bowel. There is some controversy about flax seed oil itself that I will not go into at this time. ALA is also found in walnuts, tofu, wheat germ, and green, leafy vegetables like spinach.
Omega-6s – Linoleic and Linolenic Acid
Omega-6s are essential for brain and reproductive health, as well as for bone, skin, and hair development. There are many different types of omega-6s. Some, like gamma-linolenic acid (GLA) found in evening primrose oil or black currant seed oil, are non-inflammatory. Others, like the essential linoleic acid (LA), can cause inflammation. LA tends to be the primary type of omega-6 we consume, perhaps due to its prevalence in meats and most vegetable oils (e.g. sunflower, safflower, and soy), as well as in processed foods which contain these oils. From LA our bodies make pro-inflammatory arachidonic acid. High LA consumption, in the absence of adequate omega-3 intake, is associated with oxidation of LDL cholesterol in the body, which can promote vascular inflammation.
Omega 9s are a family of unsaturated fatty acids, which are not essential (i.e. the body produces them on its own) and are the most abundant fatty acid found in nature, both in animal and plant sources. The oleic acid found in olive oil is an example of an omega-9. Canola and corn oils are also examples of Omega 9. Olives, avocados, almonds, peanuts, pecans, pistachio nuts, cashews, hazelnuts, and macadamia nuts are also sources of Omega 9s. Please note that foods do not contain a single source but are a mixture of different essential and non-essential fatty acids. So olive oil and many nuts also contain Omega 3s.
Saturated fats, such as butter, are found primarily in animal products such as meat, cheese, milk, full-fat yogurt and eggs. They are solid at room temperature and convert to cholesterol in the body. Plant sources of saturated fat, which do not convert to cholesterol, include palm and coconut oil. We need cholesterol in our bodies to maintain the integrity of cell membranes, produce cellular structures and hormones, and for digestion. While our bodies are able to generate about 85 percent of our cholesterol, we obtain the rest from dietary sources, like saturated fats.
The downside of saturated fats is that they can cause inflammation if our blood levels of LDL cholesterol are high and our blood also has too much homocysteine, ferritin (iron), and/or Lp(a). These three substances each increase risk of oxidation of LDL cholesterol, which can lead to dangerous unstable plaque in blood vessels. Reducing levels of these substances, then, can help reduce our risk of cardiovascular disease linked to saturated fat intake.
To prevent excess levels of homocysteine, we need to get enough B vitamins in our diets. While too much Lp(a) is genetically inherited, one can often lower Lp(a) by increasing vitamin C intake and/or by taking Niacin (vitamin B3). Donate blood to prevent high iron levels (for women, regular loss of menstrual blood helps serve this purpose).
For people who have a penchant for fatty meat, eggs, and dairy products, supplementing with coenzyme Q10, as well as fish oil, can help prevent oxidation of LDL cholesterol.
One of the benefits of saturated fats is that, unlike polyunsaturated (including trans) fats, they do not oxidize easily at high temperatures. Oxidation of fat itself, as opposed to LDL cholesterol, causes inflammation due to increased free radical activity and possible degenerative disease. Cooking with saturated fats like coconut oil or butter can help prevent oxidation-related inflammation.
The other side of the coin is animal sources of saturated fats, such as fatty meats and eggs, tend to also contain arachidonic acid which is highly inflammatory. This may explain why high saturated fat intake has been linked to heart disease, hypertension, stroke, and diabetes, as well as cancer. As a general guideline, moderate saturated fat intake is okay if you stick to an otherwise healthy, non-inflammatory diet full of fresh fruits and vegetables.
Hydrogenated or Trans Fats
Hands down, hydrogenated /trans fats are the unhealthiest fats around. Trans fats are vegetable oils to which an extra hydrogen molecule has been artificially added. They are found in processed foods like margarine and commercial baked goods, as well as fried foods. I remember my Swedish grandmother never using margarine. She always cooked with pure butter and never had heart disease. She lived to be 96 years old and my Swedish grandfather, who ate her cooking, lived to be over 100.
Adding a hydrogen molecule makes these fats solid at room temperature and increases their shelf life. Consumption of trans fats severely increases inflammation in our bodies by causing free radical damage to cell membranes, and increasing blood levels of LDL cholesterol and (Lp(a). Together, oxidized LDL molecules and Lp(a) are a deadly combination: they can cause buildup of plaque and formation of blood clots in arteries, which can result in heart attacks. Trans fats are also linked to increased risk of some cancers.
A Word About Coconut Oil
Coconut and its oil contains saturated fats that are unique – medium chain saturated fatty acids (caprylic and lauric Acids) that are very healthy and should not be confused with the long chain saturated fats found in animal meats. Countless studies have shown that unhydrogenated coconut oil does not raise LDL cholesterol nor is its use correlated with any form of heart disease. Medium chain triglycerides are absorbed directly into the blood via intestinal capillaries making it a very easily digestible food, whereas long chain fatty acids require a more complex digestive process. Medium chain triglycerides are also found in human mother’s milk. One big reason mother’s milk is so valuable for newborns is the lauric acid which protects babies from infection when they are still developing their immune systems. So again, we need to differentiate between “good” and “bad” types of saturated fat.
Summary and Actions to Take
1. Most foods contain a different combination of fats. Choose foods with fats that are primarily monounsaturated or contain omega-3 polyunsaturated fats because these fats are anti- inflammatory. Avoid all processed foods.
2. Omega-6 polyunsaturated fats are tricky: they are inflammatory, but we need to ingest them in small amounts. We should consume an equal amount of omega 3s and omega 6s to balance inflammatory activity. Generally, traditional Mediterranean or Pan Asian diets reflect balanced EFA intake, while Western diets do not.
3. Eat wild Alaskan salmon, halibut or cod three to four times weekly; or supplement your diet with a mercury-free source of omega-3 oil such as Biotics Bio Omega 3. If you are a vegetarian, you will need to get your omega-3 oil from vegetable sources such as ground flax seed.
4. Saturated fats can be inflammatory, in that they contribute to increased LDL cholesterol which then can oxidize when in the presence of other substances. However, the body needs some dietary cholesterol. Saturated fats are also resistant to oxidation, making them good choices when consumed in small to moderate amounts.
5. Always read nutrition labels and avoid, at all costs, anything with the words “hydrogenated,” or “partially hydrogenated.” Avoid fast foods.
6. When cooking, use either coconut oil or butter. If you can turn the heat down, olive oil is okay. Do not use corn oil, canola oil, or soy oil. These oils are derived from genetically modified crops whose safety has not been proven. Canola oil has Erucic acid, which is toxic.