Saturated fats;no longer deadly- BMJ

[donnellysdogs]

Gosh, that summary is exactly how I have read papers and articles. I hope you get a response.

 

[Southport GP]

This has all kicked off a bit since I last had a look at the thread.

I've not been here long so really don't know who @Southport GP is.
But I must admit to a bit of confusion, as I looked back at the previous threads he started.
Let me know if I've gone astray anywhere.

First one I found, he called 'low cabohydrate', no mention of fats,
'though porridge, new potatoes and oat cakes in moderation
may be fine'

'Proteins such as in meat, eggs, fish – particularly oily fish such as salmon, mackerel or tuna –
are fine and can be eaten freely.'

'Plain full fat yoghurt makes a good breakfast with the berries.
Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be
eaten in moderation.
Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than
margarine and could be better for you! Coconut oil is great for stir fries. Four essential vitamins
A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable
oil'

http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/March 2014/PP Unwin final proofs revised.pdf


Second post, again called a 'low carbohydrate diet', no mention of fats.

' This was accomplished using a low carbohydrate diet—in his words: “more a lifestyle than a diet.” The weight loss enabled him to take more exercise, join a gym, and take up yoga. He has come off sugar altogether and cut out bread (he previously consumed a lot of this), potatoes, pasta, cereals, and rice. This has led to greater consumption of green vegetables, but also eggs, full fat Greek yoghurt, and cheese.'

http://www.bmj.com/content/351/bmj.h4023.full?ijkey=AN2nBwW6h3wuQJK&keytype=ref

All sounds good so far.
I realise now that a lot of members on here obviously do high fat, and seem to have adopted Southport gp, and credited him with a LCHF 'prescription' diet, which he seems to have let carry him forward, without ever actually saying anything about fat.

But now he seems to be the champion of a high fat diet, and not only that, it's based on a report that says saturated fat is no worse than refined carbs.
Which means exactly the same as it's no better than refined carbs.
But it is better than trans fats.

So, a respectable journal like the BMJ seems to be recommending we eat saturated fats, as they are no worse than refined carbs, but they are better than a fat you would go to jail for using in some countries.
And Southport gp is suggesting we switch to it?
And quoting references to people that suggest we use it for what, 80% of our diet.
As saturated fat?
Like I say, must have missed something inbetween.

Me, I have to be honest, I missed the thread because I was out getting fish, and a few yams and some yucca.
After reading the evidence for saturated fat, it's well on the back burner, the grill is coming back out, the fat is being cut off, and I'm going for polyunsaturated, which the report shows actually is better than refined carbs for your health.

I don't do well with refined carbs, I don't want fat that is, at best, no worse than refined carbs for your heart.

I would be interested to see his response, as no doubt I have got something wrong, so I have tagged him in this post.

I suppose my first point is that as an NHS GP I am expected not to go too far away from the mainstream – even as it was my first article attracted hostility from health Care Professionals who are very nervous about the whole fats debate.

Another point is that where possible I try not to be too prescriptive about diet. People are in the end the best experts on their own life and having set Goals find their own route. I suppose its partly that which so impressed me about this forum in the beginning; so many folks with good goals and great results, sadly often not encouraged by health professionals. This partly because the low carbing thing is not in the ‘guidelines’.

I wondered if I could help by connecting the forum with some evidence that could be put to responsible health professionals, so they could see a more evidence-based reason for any particular dietary choice.

When I saw The BMJ article and others. I felt a ‘sea change’ in the professional view on saturated fats which I thought would be interesting, particularly to those who find a LCHF diet really suits them.

Choice of diet depends on so many things

• Where are you now ? eg overweight or not ,Type 1 or Type 2, medications , liver problems, struggling with family life etc etc
  
  
• What are your personal health goals?
  
  
• What are your resources to bring about this change? Energy, income

‘But now he seems to be the champion of a high fat diet’This process has taught me so much including the fact I really don’t know everything. I’m just a very motivated, interested GP. It’s true I’m a lot more tolerant of fat than 3 years ago and I suspect it has advantages as a source of energy.

If I champion anything its patient choice after education. If the LCHF diets suits someone and medically they are doing OK (weight BP etc ) then perhaps we should be working with the patient rather than threatening them with dire consequences as has occurred.

Three things I do feel need championing

1. The fundamental idea that for someone with diabetes dietary glucose is arguably a poison - its consumption has consequences that someone with diabetes should be informed about before they make dietary choices.
   
   
2. If a type two diabetic is overweight they will probably improve their health greatly with weight loss
   
   
3. Eat loads of green veg if you can.

Crikey that became more serious than I meant at the start, but I hope helps you understand. Time for me to get back to family life!

 

[jddukes]

The problem is all of these studies cannot answer the very specific questions people are trying to make them answer. For example, you cannot take a crude look at trans vs saturated fat without other constraints and then say this proves something for a diet that is restricted abnormally (and abnormally I mean not the general populous norm). It simply is what it is. Which, very simply is fat is not as bad for the heart as people have been spoon fed to believe it is for 60 years.

Diet still come back to the most crucial point - context; and context is hugely important and up there with genetics (if not superseding it).

 

[SunnyExpat]

I suppose my first point is that as an NHS GP I am expected not to go too far away from the mainstream – even as it was my first article attracted hostility from health Care Professionals who are very nervous about the whole fats debate.

Another point is that where possible I try not to be too prescriptive about diet. People are in the end the best experts on their own life and having set Goals find their own route. I suppose its partly that which so impressed me about this forum in the beginning; so many folks with good goals and great results, sadly often not encouraged by health professionals. This partly because the low carbing thing is not in the ‘guidelines’.

I wondered if I could help by connecting the forum with some evidence that could be put to responsible health professionals, so they could see a more evidence-based reason for any particular dietary choice.

When I saw The BMJ article and others. I felt a ‘sea change’ in the professional view on saturated fats which I thought would be interesting, particularly to those who find a LCHF diet really suits them.

Choice of diet depends on so many things

• Where are you now ? eg overweight or not ,Type 1 or Type 2, medications , liver problems, struggling with family life etc etc
  
  
• What are your personal health goals?
  
  
• What are your resources to bring about this change? Energy, income

‘But now he seems to be the champion of a high fat diet’This process has taught me so much including the fact I really don’t know everything. I’m just a very motivated, interested GP. It’s true I’m a lot more tolerant of fat than 3 years ago and I suspect it has advantages as a source of energy.

If I champion anything its patient choice after education. If the LCHF diets suits someone and medically they are doing OK (weight BP etc ) then perhaps we should be working with the patient rather than threatening them with dire consequences as has occurred.

Three things I do feel need championing

1. The fundamental idea that for someone with diabetes dietary glucose is arguably a poison - its consumption has consequences that someone with diabetes should be informed about before they make dietary choices.
   
   
2. If a type two diabetic is overweight they will probably improve their health greatly with weight loss
   
   
3. Eat loads of green veg if you can.

Crikey that became more serious than I meant at the start, but I hope helps you understand. Time for me to get back to family life!

I see you still refer to your advice as low carbing, but you haven't actually said if you believe HF, particularly saturated fat, should be a very high proportion of the diet you recommend to your patients, nor any comment on the polyunsaturated fats seeming to be more beneficial in the article you provided.
As you seem to appreciate, this is a site where a lot of members believe LC and HF is intrinsically linked, and you seem to be undecided on that aspect of the diet.

As to the article you linked to, at best there does seem to be some correlation to increased CHD, and it seems to have received not exactly the best reception in it's peer review.

http://static.www.bmj.com/sites/def...le/pre-pub-history/First_decision_29.3.15.pdf

I agree with all three of your final points to champion though.

Cut the carbs, lose weight, eat greens.

But you are seen as the champion of a saturated fat diet now, and a great reinforcement to the idea of LCHF as a lifestyle, and possibly slightly more than it being 'suspect it has advantages as a source of energy.'

 

[AndBreathe]

I see you still refer to your advice as low carbing, but you haven't actually said if you believe HF, particularly saturated fat, should be a very high proportion of the diet you recommend to your patients, nor any comment on the polyunsaturated fats seeming to be more beneficial in the article you provided.
As you seem to appreciate, this is a site where a lot of members believe LC and HF is intrinsically linked, and you seem to be undecided on that aspect of the diet.

As to the article you linked to, at best there does seem to be some correlation to increased CHD, and it seems to have received not exactly the best reception in it's peer review.

http://static.www.bmj.com/sites/def...le/pre-pub-history/First_decision_29.3.15.pdf

I agree with all three of your final points to champion though.

Cut the carbs, lose weight, eat greens.

But you are seen as the champion of a saturated fat diet now, and a great reinforcement to the idea of LCHF as a lifestyle, and possibly slightly more than it being 'suspect it has advantages as a source of energy.'

I don't see @Southport GP as being a champion of HF. I see him acknowledging fat, and making a stated fact that he is "....a lot more tolerant of fat than 3 years ago and I suspect it has advantages as a source of energy...."

If I may state my own position on the fat consumption debate. I eat a reduced carb diet, and where and when necessary, I use fat to make up any calorific deficit I find myself in. I really the title LCHF, because the HF part of the title significantly increases rejection rate for the way of eating by those who want to explore alternative (to the NHS Eat Well late) ways to significantly improve their diabetes. I find my personally coined title of LCBF (Lower Carb, Balancing Fats) as being more descriptive of what I do, and has certainly been more readily acceptable to others I have discussed it with. I rarely even get the usual questions around lipids, because I make it plain it's only necessary to raise fats if weight loss continues beyond a desirable weight, and if hunger persists, having trimmed carbs back.

I think I want a campaign to change the name of the way of eating. Well, it'd make a change from folks wanting to dissociate T2 and T1?

 

[SunnyExpat]

'One of the biggest barriers to professional acceptance of the LCHF diet has been the HF- high fat bit. And yet without it the diet is a terrible struggle!
Partly through steady pressure by people like Zoe Harcome and Trudy Deakin the 'all fats are bad and saturated fats are very very bad' dogma is wearing thin.'

As in the opening paragraph, I suspect Southport GP is happy with the High Fat terminology.
Let us not forget Trudy put the marker in for her personal preference of High Fat as 82% of her diet.
Yet he does not report his patients struggling on the diet's he has reported them to be on?
Obviously we can only go on what he has stated on this forum, but they didn't look to be a 'High Fat' diet.

Hence my confusion over the apparent major change of stance.

 

[donnellysdogs]

I dislike the lchf label. I would totally agree with @andbreathes label of LCBF totally...

 

[Spiker]

But you are seen as the champion of a saturated fat diet now,

By whom?

He hasn't put himself forward as a saturated fat champion or even an HF champion? Why would you expect him to even respond to that question?

 

[SunnyExpat]

I dislike the lchf label. I would totally agree with @andbreathes label of LCBF totally...

The numbers don't do that though.

If you have 50g of carbs, on a low carb diet, that's 200 calories from carbs.
So about 10% of the average 2000 calories.
So 90% from fats and proteins.

It's always going to be high fat.
High saturated fat for Trudy, and many others.

 

[Spiker]

'One of the biggest barriers to professional acceptance of the LCHF diet has been the HF- high fat bit. And yet without it the diet is a terrible struggle!
Partly through steady pressure by people like Zoe Harcome and Trudy Deakin the 'all fats are bad and saturated fats are very very bad' dogma is wearing thin.'

As in the opening paragraph, I suspect Southport GP is happy with the High Fat terminology.
Let us not forget Trudy put the marker in for her personal preference of High Fat as 82% of her diet.
Yet he does not report his patients struggling on the diet's he has reported them to be on?
Obviously we can only go on what he has stated on this forum, but they didn't look to be a 'High Fat' diet.

Hence my confusion over the apparent major change of stance.

Your confusion seems to be based on a basic logical error (as well as ignoring what SouthportGP himself has said to clarify).

Your logical error being that you are equating "opposing the dogma that 'all fats are bad saturated fats are very very bad'" is the same as saying "diets should be high in fat / high in saturated fat". The two statements are not equivalent and your inference is not valid. Even if it hadn't been contradicted by SouthportGP in his own words.

 

[Spiker]

The numbers don't do that though.

If you have 50g of carbs, on a low carb diet, that's 200 calories from carbs.
So about 10% of the average 2000 calories.
So 90% from fats and proteins.

It's always going to be high fat.
High saturated fat for Trudy, and many others.

Why do you conflate fats and proteins to get 90%? That doesn't make any sense at all in terms of your argument. For all I know that could be 80% protein and 10% fat, more like an Atkins diet than LCHF.

You're not making a lot of sense, though I can see you have a very strongly held opinion.

 

[AndBreathe]

'One of the biggest barriers to professional acceptance of the LCHF diet has been the HF- high fat bit. And yet without it the diet is a terrible struggle!
Partly through steady pressure by people like Zoe Harcome and Trudy Deakin the 'all fats are bad and saturated fats are very very bad' dogma is wearing thin.'

As in the opening paragraph, I suspect Southport GP is happy with the High Fat terminology.
Let us not forget Trudy put the marker in for her personal preference of High Fat as 82% of her diet.
Yet he does not report his patients struggling on the diet's he has reported them to be on?
Obviously we can only go on what he has stated on this forum, but they didn't look to be a 'High Fat' diet.

Hence my confusion over the apparent major change of stance.

For the record, I only increased my fat consumption when I got very close to target weight, which took a while. To be honest, I can't put a time scale on it, but it was months. I didn't struggle. Had I struggled, like so many others, it is highly likely I would have deviated from my plan and lapsed. I didn't. I have rarely felt the need to chastise myself for my food choices since I got the hang of this.

I'm not up at 80+% fat, but then again, I tolerate quite a mixed diet these days, should I choose it. I eat a lot, and that is often commented upon when we eat with friends who seem aghast what I can "pack away".

I can only speak definitively from my personal experience, obviously.

 

[donnellysdogs]

The numbers don't do that though.

If you have 50g of carbs, on a low carb diet, that's 200 calories from carbs.
So about 10% of the average 2000 calories.
So 90% from fats and proteins.

It's always going to be high fat.
High saturated fat for Trudy, and many others.

But the fats I personally eat are not heavy
saturated ones. As a T1 I can eat fruit and this is my main source of carbs each day. A little portion of apple, kiwi, mango n orange wirth chia and flaxseed. Apart from that mainly salads...

I see my diet as good for me because the majority has always been natural foods. Now its even more natural without aspartame and preservatives as much as poss.

I think I just wish more people ate less processed foods and takeaways, sandwiches, on the go foods etc.

To be honest I don't analyse my food content as in fat/carbs/protein. Just so long as I keep my size 8 and bloods ok I'm doing ok. I was deeply unhappy adding carbs in and putting on weight... I was deeply unhappy when hubby n I both had raised cholesterol with the saturates... So I see myself and my body as balanced... Not necessarily I guess that my intake is.

Still think that LCHF gives the wrong impression though...

 

[Spiker]

Still think that LCHF gives the wrong impression though...

Personally I think it gives the right impression, because everyone, correctly, (except possibly @SunnyExpat), understands it to mean "more fat than you are used to having and more fat than you were told you ought to have". And that is the crucial message to get across. Eat more fat than you are used to and more fat than you are used to being told is OK.

LCHF is not a macronutrient ratio. It's a re-education exercise.

 

[SunnyExpat]

But the fats I personally eat are not heavy
saturated ones. As a T1 I can eat fruit and this is my main source of carbs each day. A little portion of apple, kiwi, mango n orange wirth chia and flaxseed. Apart from that mainly salads...

I see my diet as good for me because the majority has always been natural foods. Now its even more natural without aspartame and preservatives as much as poss.

I think I just wish more people ate less processed foods and takeaways, sandwiches, on the go foods etc.

To be honest I don't analyse my food content as in fat/carbs/protein. Just so long as I keep my size 8 and bloods ok I'm doing ok. I was deeply unhappy adding carbs in and putting on weight... I was deeply unhappy when hubby n I both had raised cholesterol with the saturates... So I see myself and my body as balanced... Not necessarily I guess that my intake is.

Still think that LCHF gives the wrong impression though...

I don't especially eat saturated fats, more fish, olives, although the butter is in there, in fact it sounds a very similar diet.
But my fat is definitely high, otherwise it's going to have to be more protein.
I haven't really counted it much recently either, just in a pattern that works.
Actually, the heat tends to stop me eating as much, so energy dense foods seem to be more palatable.

As to processed food, it's a lot easier simply to walk down to the markets here, so daily fresh food is cheap, and easy.
Blood tests are always ok as well, so I can't really see any great change coming, but, I will be knocking the saturated fat down now.

 

[donnellysdogs]

Trouble is whilst the populations hear its ok to eat "fat"- they aren't hearing about lowering the carbs. Sure they hear about sugar in coke or juices etc... But they aren't hearing about reducing bread, rice, pasta etc...

Thats the flaw in the release of the "fats are ok"... From the media...

 

[SunnyExpat]

Trouble is whilst the populations hear its ok to eat "fat"- they aren't hearing about lowering the carbs. Sure they hear about sugar in coke or juices etc... But they aren't hearing about reducing bread, rice, pasta etc...

Thats the flaw in the release of the "fats are ok"... From the media...

Yes, that's where I came from, High carb, high fat, high, protein.
But, I started in a very active job, then moved to a desk, but still grabbing the same food as everyone else.
All I really had to do was reduce the carbs!
(And change from the junk to healthy fats and proteins)

One of the reasons education is the best tool, as sometimes you need to take a step back, and see what you really are eating.

 

[jddukes]

People want re-education of the masses but the problem is deeper and not as simple as that. The government has bought into a set of nutritional advice and system that was fundamentally flawed and based largely on the erroneous conclusion that the observation of high fat and cholesterol in the blood was correlative to heart disease that the consumption of these nutrients must lead to that high serum level, which is in fact been shown to be a fallacy.

A multibillion £ industry has been based on this faulty assumption and that industry also has large lobbying power and a real motive to not easily reverse their approach. As a food and nutrition advisor/representative stated on that Jamie Oliver show on sugar the other night "we have spent 80 years trying to educate the public on calorific content and they are only just beginning to understand it." In other words, his argument is "don't change the advice now as it will confuse people!". As said, unfortunately that "education" people are starting just now to "get" is wrong however it is engrained in so many people's minds ie. fat = bad/heart disease + diabetes.

So you are fighting an institution that resists just changing decades of advice and alongside that the lobbying and finance-backed power of a multi-billion £/$ industry that stands to lose a lot. That does not make a good or easy combination to re-educate people and change the story on what is really bad for you and how a balanced diet should look (especially moving away from the carb-centric diet promoted for decades).

Fortunately we live in the age of information and readily accessible information. We also live in the age of accountability for GPs and health care professionals whereas people (for good or bad in some cases) are seen as more entitled to their choice of options and challenging to a degree advice they are given. This still has a ways to go to balance it out, but it is certainly better than say 10-20+ years ago. That is why places like this forum are essential for the education of the masses about the truth behind nutrients and making the technical readily available to the wider audience and also in improving outcome for patients with diabetes. It is not going to come anytime soon from the government so we have to progress it and we have that capability with the reach of such forms as this.