Is The Keto Diet Healthy? (Saturated Fats) | Jason Fung
Summary
TLDRThe video script challenges the conventional belief that a high intake of saturated fat, as seen in the ketogenic diet, leads to heart disease. It reviews recent evidence, including a state-of-the-art article from the American College of Cardiology, suggesting that natural saturated fats from whole foods may not increase the risk of heart disease, diabetes, or stroke. Instead, it posits that dietary carbohydrates, through de novo lipogenesis, could be more detrimental. The script also highlights historical dietary guidelines, the French paradox, and large-scale studies that indicate a reevaluation of saturated fat's role in heart health.
Takeaways
- 🫀 The keto diet, which includes high levels of total and saturated fat, is not unhealthy and does not clog arteries or cause heart disease.
- 📚 Recent scientific evidence shows that saturated fat does not cause heart disease, contrary to what was believed since the 1960s.
- 🔬 A state-of-the-art review by top cardiologists in the Journal of the American College of Cardiology concluded that there is no benefit in reducing saturated fat intake.
- 🥩 Whole foods like full-fat dairy, red meat, and dark chocolate, which contain saturated fats, do not increase the risk of heart disease, diabetes, or stroke.
- 🍞 Dietary recommendations should focus on whole foods rather than specific nutrients, as the overall food matrix is more important for health.
- 🇺🇸 The 1977 dietary guidelines recommending low fat intake were based on weak evidence and cherry-picked data.
- 🥄 Replacing saturated fats with unsaturated fats or vegetable oils, as was recommended in the past, led to the consumption of trans fats, which are harmful to heart health.
- 🍫 Studies have shown that there is no correlation between total fat intake and the risk of heart disease, and in some cases, higher fat intake is protective.
- 🧀 Full-fat dairy has been linked to a lower risk of diabetes and does not increase the risk of heart disease.
- 🫀 A high carbohydrate intake is more strongly associated with higher levels of saturated fat in the blood and an increased risk of heart disease than dietary fat intake.
Q & A
Is the keto diet considered unhealthy due to its high fat content?
-The script suggests that the keto diet, which is high in total fat and saturated fat, is not necessarily unhealthy. Recent scientific evidence and cardiologists' consensus indicate that saturated fat does not cause heart disease, and people who consume more fat may actually be protected against stroke.
What was the conclusion of the review published in the Journal of the American College of Cardiology in August 2020?
-The review concluded that reducing saturated fat intake does not have beneficial effects on heart disease. Instead, it found that consuming more fat could be protective against stroke. The top cardiologists recommended making dietary recommendations based on whole foods rather than specific nutrients.
What does the script say about the sources of most saturated fat in our diets?
-Most saturated fat comes from whole fat dairy, red meat, and dark chocolate, which are complex food matrices. The script emphasizes that these natural fats do not increase the risk of heart disease, diabetes, or stroke.
What was the initial recommendation in the 1977 U.S. dietary guidelines?
-The 1977 U.S. dietary guidelines recommended avoiding too much fat, saturated fat, and cholesterol. However, the script points out that this advice was based on weak evidence and a few observations from an influential researcher.
Why did the low-fat diet become popular, and what was its intended health benefit?
-The low-fat diet became popular because it was believed to reduce heart disease by lowering LDL cholesterol levels. However, newer research shows that it's not as simple as that, and the diet may not necessarily lead to a decrease in heart disease risk.
How does the body produce saturated fat in the blood, and what dietary factors are associated with it?
-The body produces saturated fat in the blood through a process called de novo lipogenesis, where excess carbohydrates are turned into fats for storage by the liver. The script indicates that the amount of saturated fat in the blood is more related to carbohydrate intake than dietary saturated fat.
What is the 'French Paradox' mentioned in the script, and how does it relate to saturated fat consumption?
-The 'French Paradox' refers to the observation that despite consuming a diet high in saturated fat, such as whole fat dairy, the French had less heart disease than other countries. The script suggests that the saturated fat in natural foods does not cause heart disease, thus explaining the paradox.
What did the largest epidemiologic study published in The Lancet in 2017 find regarding saturated fat and heart disease?
-The study found that as saturated fat intake increased, the risk of heart disease tended to decrease. It also suggested that consuming a high percentage of carbohydrates in the diet might increase the risk of heart disease.
What is the script's stance on the consumption of whole fat dairy and its relation to diabetes?
-The script suggests that contrary to previous recommendations to consume low-fat dairy, whole fat dairy does not lead to an increased risk of heart disease and could protect against diabetes, which is a risk factor for heart disease.
Why have some physicians started to favor the ketogenic diet?
-Some physicians favor the ketogenic diet because it includes natural fats and saturated fats, which recent evidence suggests may not lead to heart disease and could be protective against stroke. Additionally, it has been linked to a reduced risk of diabetes.
Outlines
🧠 Reevaluating the Ketogenic Diet's Impact on Heart Health
This paragraph delves into the controversial topic of the ketogenic diet and its emphasis on high-fat consumption, specifically saturated fats. Historically, saturated fats have been considered a risk factor for heart disease, but recent evidence suggests otherwise. The paragraph reviews a state-of-the-art article from the American College of Cardiology, which concludes that reducing saturated fat intake does not lower the risk of heart disease. Instead, it points out that natural fats from whole foods like dairy, red meat, and dark chocolate do not increase the risk of heart disease, diabetes, or stroke. The emphasis shifts from avoiding specific nutrients to considering the whole food context, challenging the 1977 dietary guidelines that advised against high-fat consumption.
🍰 The Misconception of Saturated Fat and Heart Disease
This paragraph explores the relationship between saturated fat in the diet and its levels in the blood, highlighting that blood saturated fat levels are more closely related to carbohydrate intake through a process called de novo lipogenesis. The low-fat diet trend, once believed to reduce heart disease by lowering LDL cholesterol, is now seen in a new light as research shows no correlation between dietary saturated fat and blood saturated fat levels. The paragraph also discusses the complexity of food components and how the health effects of fats cannot be isolated from the whole food matrix. It reflects on past dietary recommendations and the unintended consequences of promoting low-fat diets, such as the increased consumption of trans fats, which are now known to be harmful to heart health.
🥐 The Protective Role of Saturated Fat in Heart Health
The final paragraph presents evidence that challenges the conventional wisdom on saturated fats, suggesting that they may actually be protective against heart disease and stroke. It discusses various studies, including a large epidemiological study that found no correlation between heart disease risk and total fat or saturated fat intake. Instead, it indicates that a diet high in carbohydrates may increase the risk of heart disease. The paragraph also touches on the 'French Paradox,' where high consumption of whole fat dairy in France did not lead to increased heart disease rates. The conclusion drawn from over 50 years of research is that natural saturated fats, as recommended in diets like the ketogenic diet, are not harmful and could potentially offer protective benefits against heart disease and stroke.
Mindmap
Keywords
💡Keto diet
💡Saturated fat
💡Heart disease
💡De novo lipogenesis
💡LDL cholesterol
💡Diabetes
💡Total fat
💡Carbohydrates
💡French paradox
💡Trans fats
💡Dietary guidelines
Highlights
The keto diet, which recommends high intake of total and saturated fats, is reviewed for its health implications.
Recent evidence suggests that saturated fat does not cause heart disease, contrary to previous beliefs.
Cardiologists agree that the ketogenic diet's high-fat intake may not be harmful and could be protective against stroke.
A state-of-the-art review published in the Journal of the American College of Cardiology in August 2020 challenges the traditional advice on saturated fat.
Studies over the last 50 years indicate no increased risk of heart disease, diabetes, or stroke from natural saturated fats.
Recommendations should be based on whole foods rather than specific nutrients, according to top heart specialists.
Saturated fats from whole fat dairy, red meat, and dark chocolate are not associated with increased heart disease risk.
The 1977 U.S. dietary guidelines, which advised against saturated fat, were based on limited and potentially cherry-picked data.
De novo lipogenesis, the process of turning excess carbs into saturated fats in the liver, is more related to blood saturated fat levels than dietary fat intake.
Low-fat diets may reduce larger LDL particles not associated with heart disease, while increasing dietary saturated fat may lower blood saturated fat levels.
High levels of palmitoleic acid, a saturated fat, are associated with increased risk of heart disease and stroke.
The interaction of naturally occurring components in foods and unhealthy components induced by processing is crucial for understanding dietary impact.
The shift from butter to margarine in the 1950s due to the belief in heart health benefits of vegetable oils led to increased consumption of harmful trans fats.
Studies from the 1990s and 2000s showed no correlation between total fat or saturated fat intake and heart disease risk.
Consuming more saturated fat was found to be protective against heart disease and stroke in a study of 58,000 people.
The 'French Paradox', where high saturated fat intake did not lead to increased heart disease, challenges the notion that saturated fat is harmful.
The 2017 Landsat study of 135,000 people across 18 countries found no link between heart disease and total or saturated fat intake, but a higher risk with carbohydrate intake.
Whole fat dairy consumption has been linked to a reduced risk of diabetes, which in turn lowers the risk of heart disease.
The ketogenic diet, which includes natural saturated fats, is not associated with unhealthy consequences and may be beneficial for weight loss and heart health.
Transcripts
is the keto diet unhealthy
it recommends eating plenty of total fat
and saturated fat
and isn't that going to clog up your
arteries causing heart attacks
and strokes we're going to review the
latest scientific
evidence as reviewed by the top heart
doctors
[Music]
should you eat saturated fat since the
1960s
doctors have been saying that we should
avoid this to prevent heart disease
but i'm going to review the surprising
results
of the recent evidence that shows that
saturated fat
does not actually cause heart disease
one of the big
trends over the last few years is the
ketogenic diet
that has said you don't have to worry
that eating too much
saturated fat and total fat might cause
heart disease
and surprisingly the cardiologists
agree i'm going to review this article
which was published in the journal of
the american college of cardiology
in august of 2020. it's a
state-of-the-art review which means that
all the top cardiologists the top heart
specialists got together
to discuss should we place limits on how
much saturated fat
we eat and the surprising conclusion
they came to
is this this is their abstract which
says
that many years of studies
have shown that there's actually no
beneficial effects of reducing saturated
fat
on heart disease instead they found that
people
who ate more fat tended to be protected
against stroke this illustration from
this paper
shows that the previous advice was
to limit how much saturated fat you ate
but when they look at all the studies
that have been done over the last 50
years
that you really have to look not just
at the saturated fat in the food but
the whole food all together to determine
whether or not
it's healthy or not most saturated fat
comes from whole fat dairy from red meat
and from dark chocolate
which are complex food matrices that
tend to have a lot of saturated fat
and when you study these foods these
natural fats
it's clear that there's no increased
risk of heart disease
diabetes or stroke so what these
top heart specialists are calling for in
this state of the art review
is that we should make recommendations
not
on specific nutrients but we should base
them
on foods we shouldn't be avoiding
fat because we don't eat fat we eat
foods we eat
dairy we eat meats we eat breads these
are
foods you have to look at the whole food
in context
and when you look at those there's no
reason to avoid
full fat dairy red meat or dark
chocolate
and that's their conclusion after coming
together and discussing it
and we'll go through the evidence why
let's go back in time and see
how we got to this point in 1977
the american government released a
document the dietary guidelines
and in it they specifically recommended
to avoid eating too much fat
too much saturated fat and too much
cholesterol
but the evidence to support this
statement was not very strong
it was based on just a few observations
from an influential researcher this was
a seven-country study
and in it it shows the association
between countries that ate a lot of
saturated fat and their rate of heart
disease
but it wasn't quite true because the
data was
cherry picked when you looked at all the
countries that had data available
the correlation was very weak but
nevertheless
the american government felt that they
had to make some kind of recommendation
so they hastily made that recommendation
to avoid
eating too much fat and too much dietary
fat
and this led to the change
in habits from eating for example animal
fats which are high in saturated fats
and things such as butter and instead we
were recommended
to eat lots of margarine as a
replacement which was made
from unsaturated fats or vegetable oils
it's also important to distinguish
between
the saturated fat in our diets
and the amount of saturated fatty acids
in our blood
because when we look at the science we
see that the amount of saturated fat in
our blood
is more related to the amount of
carbohydrate that we take
through the process of de novo
lipogenesis
de novo lipogenesis is where the body
takes excess carbohydrates and the liver
will turn that into fats for storage and
these tend to be saturated fats
in the blood all of this that i'm going
over
in this video can also be found in that
article so you can have a look at it if
you're interested for more details the
reason the low-fat diet was
thought to reduce heart disease is
because it could lower
the ldl cholesterol and
the ldl cholesterol was associated with
the rate of heart disease
but newer research has shown that it's
not quite that simple
because these lower fat diets tend to
reduce
the larger ldl particles which are not
thought to cause
heart disease on the flip side
we know that things such as diabetes and
other metabolic diseases
contribute hugely to the risk of heart
disease
and the amount of dietary saturated fat
is actually not related to the level of
blood saturated fat because
in fact it tracks much more closer to
the amount of carbohydrates we take in
through that process of de novo
lipogenesis
and therefore higher dietary fat
intake is going to be associated with a
lower saturated fat in the blood whereas
increased carbohydrates in the diet are
going to be
increasing the amount of saturated fat
in the blood exactly the opposite
of what you would think the high
levels of palmitoleic acid a type of
saturated
fat in fact is associated with
a 67 increased risk of heart disease
and a 52 increased risk of stroke
the other thing that became clear over
the last 50 years of research
is that a food is more than just
the macronutrients it contains the carbs
the proteins and the fats because there
are differences
between fats and different the types of
fats that are in it
and it's an interaction between the
naturally occurring components
and the unhealthy components which are
induced by
processing this is best illustrated
in the whole trans fat debacle
in the 1950s vegetable oils were
recognized to lower our serum
cholesterol and therefore thought
to be heart healthy this led to a huge
movement
away from butter and we are encouraged
for our heart's sake
to eat more margarine in order to
stabilize that margarine
these vegetable oils were hydrogenated
which created
trans fats so in our effort to protect
our heart
we are actually eating the trans fats
that are now known
to cause heart disease in the 1980s and
1990s
all the nutritional authorities the
doctor kept
emphasizing that you should eat very low
fat
but slowly over those decades it was
clear that this initial gas
because there was no evidence to
actually support that was not
correct in 1997 a very large study
called the nurses health study out of
harvard
showed that no matter how much fat you
ate
it wasn't related to the risk of heart
disease
in 2001 top researchers
from the harvard medical school wrote
it is now increasingly recognized that
the low fat campaign
has been based on little scientific
evidence and may have caused unintended
health
consequences we were starting to see
study after study that showed that foods
high in fat things like nuts avocados
olive oil the mediterranean diet for
example
were not unhealthy they were actually
extremely healthy
in 2009 another published extensive
review
of all the literature to date showed
that
total amount of fat you ate the amount
of saturated fat
and the amount of unsaturated fat
had no correlation to your risk of heart
disease
and the study shows that these hazard
ratios are close to one
which means that there's no risk or
benefit with eating any of these
foods other studies began to show that
eating more saturated fat
was actually protective against heart
disease and stroke
this study broke 58 000 people into
five different groups quintile 1 which
ate
the least saturated fat and quintile 5
which ate the most saturated fat when
they followed them over time
the group that ate the most saturated
fat
had an adjusted odds ratio of about 0.7
to 0.8
meaning they had 20 to 30 percent
less heart disease less stroke and
less total mortality compared to those
who ate the least saturated fat looking
at these studies you might see
that eating saturated fat might actually
be protective
this reflects what was called in the
1980s and 1990s
the french paradox the french people
were eating a lot of whole fat
dairy and had a lot less heart disease
than other countries so this seemed to
be paradoxical
if you thought that saturated fat cause
heart disease
how could these people eat so much
saturated fat
and not get heart attacks and the answer
is quite clear in retrospect that the
saturated fat in these
natural foods was not causing heart
disease
and there was no paradox after all in
2017
the largest epidemiologic study was
published in the landsat
it covered 18 countries 135 000 people
and followed them over seven years it
measured
how much saturated fat total fat and
carbohydrates they ate
and compared that to the rates of heart
disease
you can see that the risk of heart
disease
looking at total fat and saturated fat
tended to go down as you ate more
saturated fat when you look at
carbohydrates
as you ate a higher and higher
percentage of your diet from
carbohydrates
the higher your risk of heart disease so
eating the fat did not seem to lead to
heart disease but eating a very high
percentage of carbohydrates
might in fact do that the conclusion
from a review by these heart specialists
of all the evidence that has accumulated
over the last 50 years
is that eating more natural fats
and natural saturated fats such as
might be recommended in the keto diet
for example
is not going to lead to more heart
disease
but in fact could be protective against
stroke
and if you're doing well with it and
losing weight there's no reason
to think that you're going to have
unhealthy consequences
whole fat dairy has also been linked
to less diabetes so as opposed to our
previous recommendation of making sure
you ate low-fat dairy if you eat
full-fat cheese full-fat milk
it does not lead to an increased risk of
heart disease
but could protect you against something
like diabetes which
does raise your risk of heart disease
and that's why the ketogenic diet
has been favored by some physicians
thanks for watching if you learned
something
maybe share with your friends they might
learn something too
if you liked it please hit the like
button and i'll see you next week
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