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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Saturated Fat is Back for People with Diabetes

May 15th, 2014 · 19 Comments

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A fundamental pillar of misguided medical dogma fell last week. A massive study has just exposed the belief that saturated fat, the type of fat in dairy products and meat, causes heart disease. It doesn’t.

butter (1).jpg

But for almost 60 years this fear of saturated fat, unsupported by any good science, has stopped the safest and most effective way we have to manage our diabetes. For the first 13 years after my diabetes diagnosis in 1994 it stopped me from eating low-carb — which requires high-fat for energy — making tight blood sugar control and weight management impossible without drugs.

This fear is probably also the basis for the twin epidemics of diabetes and obesity that plagues the modern world. Until now the medical establishment has pushed us to eat “whole grains” and other high glycemic carbohydrates that make preventing and managing our diabetes so tough and contributes so much to our collective gain in weight.

The University of Cambridge in England led an international research collaboration that analyzed data from 72 cohort studies and randomized trials with more than 600,000 participants from 18 countries. The scientists found that total saturated fat was not connected to the risk of heart disease, which is the single leading cause of death and disability for people with diabetes and all humans around the world.

This new research has impeccable credentials. The British Heart Foundation funded it. One of the world’s leading medical journals, Annals of Medicine, published the results of the research March 18. The abstract of the study, “Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis,” is online, and people at the University of Cambridge kindly sent me the full-text. The Annals is a journal of the American College of Physicians, which with 137,000 members is the largest medical-specialty organization in the United States. The lead researchers include scientists and professors from Harvard University and the University of Oxford as well as from the University of Cambridge and its Medical Research Council.

People are listening to the new message. In recent days widespread media reporting has featured the findings of this new study. That’s great, because some were on message, but ingrained bias led many headline writers to obfuscate the true story. During the first days after the study became public Google News linked thousands of reviews in the press. Time totally missed the boat with “Uh Oh, Unsaturated Fats May Not be as ‘Good’ As We Thought.” Health Magazine announced “Bad News About Good Fats.”

Fortunately, most of the press not only captured the significance of the study but also captured it pithily: “Saturated fat does not cause heart disease: High carb diet does.” And this one: “Don’t Fear the Fat.” Or this NPR broadcast, “Saturated Fat Is Back!” And my favorite: “Was all that we knew about the link between fat and heart disease wrong?

I am convinced that it was indeed wrong. The new findings are the capstone of a growing body of research that challenges the accepted wisdom that saturated fat is inherently bad for you. The first shoe dropped four years ago with the research published in The American Journal of Clinical Nutrition that Dr. Ronald Krauss led, “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.” That review of prospective observational studies raised serious questions about whether consuming saturated fat leads to heart disease.

We started to go off the tracks with the launching in 1956 of the “Seven Countries Study” led by Ancel Keys, who started the demonization of saturated fat.This study was, however, fatally flawed. It cherry-picked data that fitted the author’s preconceptions, ignoring data from more than a dozen other countries that didn’t support what he was trying to prove. Nevertheless, in 1956 the American Heart Association told us that eating lots of butter, eggs, and beef would lead to our getting heart disease. The steamroller intensified when the United States Senate Select Committee on Nutrition and Human Needs, generally known as the McGovern committee, bought into the argument. The rest was our sad, misguided history. Until now.

But not all fats are good fats, as the authors of the new study are quick to point out. Nowadays, just about everyone knows that those artificially created trans fats made from partially hydrogenated vegetable oils are about the worst “food” we can put in our mouths.

The researchers of this study also found insufficient evidence in support of long-standing guidelines that we should consume lots of polyunsaturated fats to reduce our risk of heart disease. But that’s another key area where we went off the tracks that deserves and will get separate coverage here. For now the message is to relax and appreciate the benefits of eating those healthy saturated fats so we can cut way back on the carbs.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Diabetes Diet

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19 responses so far ↓

  • 1 Helen O'Neill // May 15, 2014 at 9:18 am

    Am so very glad to see this post. Everything I’ve been reading points to this as the truth. Unfortunately, mainstream America will take a long time to be convinced. If our doctors don’t believe it, it’s very difficult to hold on to this truth. I hope you live to be a hundred David, as you are my diabetes II go to guru. Thank you.

  • 2 David Mendosa // May 15, 2014 at 12:18 pm

    Dear Helen,

    Thank you so much! I’m with you. I want those 22 more years!

    Namaste,

    David

  • 3 OldTech // May 15, 2014 at 2:41 pm

    This indeed is good news and it is way past time!

    Four months ago I was diagnosed with type II. I knew very little about diabetes then, but I had the feeling that I should turn down my doctor’s suggestion that I see a nutritionist. Instead I told myself that I would do my own research and make my own decisions.

    The first thing I tried with my new meter was the glycemic index diet, but that quickly failed when I ate, as I had been doing for several years, one half of a ‘heart healthy’ apple with an glycemic index of 39 and watched my glucose spike to over 200. I did not really understand the significance at the time, but I did know that 200+ was not good.

    So I needed a new plan. I had heard that Atkins diet was a good choice for diabetics. So I printed out the induction guidelines and showed it to my wife. She went ballistic. That diet would kill me. It was not balanced. Fat and no fruit were her main objections. I understood since we had been on the so called heart healthy diet for the last 7 years. Still I saw no real choice and convinced her that I should give it a try. (As an aside she had two friends die of type I diabetes when she was young so she was horrified and in denial at my diagnosis.)

    In the succeeding days I read everything I could find on diets for diabetes eventually finding Bernstein, blood sugar 101, and yes even your site.

    After normalizing my glucose and bringing my h1c down to 4.9, I have gone on to try to understand why did I get it and why do we have an epidemic of diabetes and obesity? Potential answers became much clearer after I read Taube’s Good Calories, Bad Calories.

    So slowly my wife started thinking that a low carb high fat was indeed the diet for diabetes. And much to her surprise, she too started losing weight and saw improvement in her own health (her lifelong battle with gum disease was won). She is still not on the very low carb diet that I am on, but she now thinks that everyone is eating way too many carbs.

    Changing minds is really hard when you have been told all your life (we are in our late 60’s) to cut out the meat and fat and increase your consumption of healthy whole grains and fruits. Some will do it because they do not really have a choice. Many others will remain in denial for a long as possible. Still others, unfortunately, will resist with all their might.

    What I worry about is the reaction of the food giants. Today our grocery stores are largely just markets for carbs. They will not like this news.

    P.S. I also feel bad for those of us who believe that we cannot feed the world on anything but carbs. Perhaps with a better understanding of what it takes to be healthy we will find different options. I still remember the excitement of our successes with the green revolution and the solution embodied in “Diet for a Small Planet”.

  • 4 David Mendosa // May 15, 2014 at 4:05 pm

    Dear Chet,

    So many thanks for sharing the story of your path to diabetes management and good health. Your experience and deep understanding of the problems we face in convincing others needed to be shared here. I hope that you will go on to spread the word so that many more of those of us who have diabetes will be able to follow in your footsteps.

    Namaste,

    David

  • 5 David Brown // May 16, 2014 at 4:27 am

    Hi David,

    Excellent article! I’ll be interested to see what you say about polyunsaturated seed oils. along those lines, I think you’ll find this interesting. http://www.journalofanimalscience.org/content/37/6/1419.full.pdf

  • 6 David Mendosa // May 16, 2014 at 9:03 am

    Dear David,

    Thank you. Yes, I have often written about polyunsaturated fats and their impact on our omega-3 levels. The usual polyunsaturated fats in our diets are soybean oil, safflower oil, sunflower oil, corn oil, and canola oil. All of these are high in omega-6 that compete for the cells of our bodies with omega-3 oil, of which we all need more.

    Namaste,

    David

  • 7 Marcos T. // May 21, 2014 at 2:55 pm

    Dear David,

    The whole craze of eating too much carbs. came around in the 60’s and along with that the cardiovascular exercises as being the holy grail of health. Now we know that the story is not so simple. The Inuit people have been eating nothing but meat and blubber for eons and have no heart disease what so ever. When I started to eat more fat and more protein I was able to control my energy expenditure and glucose levels much better. Even though I’m not diabetic I had episodes of low blood sugar before meals. I was eating too much carbohydrates. Exercises specially strength ones also help with the proper utilization of fat intake.

    The Inuit people have been eating

  • 8 David Mendosa // May 22, 2014 at 8:22 pm

    Dear Marcos,

    You are right. We have known for about 80 years that the Inuit people did very well on almost no carbs.

    Namaste,

    David

  • 9 VEPA A MURARI // May 27, 2014 at 9:26 pm

    Dear David,
    I am 79 and have learnt a lot from your Website from Jan 2014 when diagnosed with Diabetic Neuropathy complications. Have been a Diabetic from 1980 AND Cardiac from even earlier.. Have lost 12 lbs and 3 in around waist after going Low Carbs, 900 cal diet, from Jan 2014.But now planning LCHF diet and your comments on Sat Fats very encoraging. Am getting tested for AopB,Aop A1, AND hsCRP, to assess Lipid Profile for my Cardilogist satisfaction, that it is safe to increase intake of fats. Thanks for your service to the Community.
    Namaste
    VEPA

  • 10 David Mendosa // May 28, 2014 at 7:22 am

    Dear Vepa,

    I appreciate your writing and telling of your success so far. Thank you. I’m glad to help.

    Namaste,

    David

  • 11 Shirley // Jun 3, 2014 at 8:11 am

    Dear David,

    Wonderful article–amost brought tears to my eyes!
    Am wondering if you’ve investigated sugar substitutes such as Xylitol and your findings.

    Thanks, Shirley

  • 12 David Mendosa // Jun 7, 2014 at 2:52 pm

    Dear Shirley,

    Thank you so much. Yes, I have looked into sugar substitutes and prefer stevia to any other. It has no carbs or calories and is a natural product. I have written about the sugar alcohols like Xylitol too, however. Please see my article at:

    http://www.mendosa.com/netcarbs.htm

    Namaste,

    David

  • 13 VEPA A MURARI // Jun 8, 2014 at 10:43 pm

    Dear David,
    I am referring to Chet’s comment. I am having the same experience with my wife horrified by yhe LCHF diet. The Doctors i India have more faith in basic Lipid Profile, and not sub- Lipiprotein testin. T have only slightly higher LDL-C, But sub fraction testing very safe,This is because of = I would refer readers to this 1. Advanced Lipoprotein Testing and Subfractionation Are Not (Yet) Ready for Routine Clinical Use – by which I fall into the 3% who may require re classification TO LOWER RISK for Choletorol. THIS AFTER 5 months on LCHF. My Doctor is worried. LDL-C has incresed from earlier.
    If I am not intruding on Chets privacy, may I ask what were the Lipid Profile figures before and after the diet change, AND his Doctors reaction
    On the subject of Saturated Fats and even LCHF diet -see this – Fats and Cholesterol Out with the Bad, In with the Good The Nutrition Source Harvard School of Public Health. There is already support, but it still worries Doctors, who do not want to cross AHA guidelines. Any feedback on these comments
    Vepa A Murari

  • 14 vepa A Murari // Jul 2, 2014 at 12:54 am

    Dear David,
    After seeing old Tech comment, who is a newly diagnosed diabetic, has not specifieddetails, how he normalised, I am not so lucky with my wife. About adopting low carb. She is happy as she is. Thinks it is all fad.

    Anyway Indian cooking is very difficult to change to low carb.. It is usually 190gms carb minimum / day.snd very difficult for Vegetarians, to attempt LC HF without adding one egg minm /day. First horrified no/no from Doctor I have explained in other blogs.
    Now I have managed a 1000 Cal for last 6 months LCHF KEEPING LC at 34% and below (as I see from my Diet Diary Analysis.). That is say 330 Cals or 82 gms against 60 gms calculated from GL the main items.(With Indian items a 1000 Cal / day can also be 190 gms carb.)

    Now my weight is stabilised (In all the comments above there have not been too many comments about wtloss – seems more a relief at being able to take saturated fats without guilt or feeling unsafe), I am trying to increase the fat intake from 60/70 gms/day. Without digestive distress. A Vegetarian(at my age, especially) unlike a non-vegetarian, his Bile function is not accustomed to handle such volumes of fat. And energise involved (known as TEF).

    I am also checking if the Carb Diverting Diab Medication I find so convenient for sugar has any role in causing difficulties. Because most Saturated and other other fat, are digested in the Intestines, EXCEPT COCONUT AND possibly PALM OIL..

    Therefore in a MY CASE the Intestines have to digest BOTH Diverted Carbs AND Fats in the Intestines. (In this respect I found the DPP-4 mechanism better than Acarbose/ Vovobibose mechanism causing less digestive discomfort reported in the other blog GI is important)

    Moreover the European diet / customs of taking bitters and etc before meals and certain other food items customarily but absent in Indian diet, makes for easier fat digestion, when taken in larger quantities.

    This question of Indian additives to better digest fats is what I am studying. How to make a habit naturally without enzyme medication – which also I do not know.

    In any meal if 2000 cals, if Crbs are held to less than 50 gms/day, athe bance of 2000-200 = 1800 has to come from Protein and Fat. If Protein is held to say 70 gms max, or 280 cals, Fat provides 1520 cals or almost 170 gms.

    What is the Fat in the diet of the readers of the Blog, when in Low carb mode.? I would be happy to know it. of course I may never go beyond 1300-1400 cakls or 700 cals fat or 70 to 80 gms – a little more than what I am consuming now. But it will indicate a comparison.
    I will report on Indian equivalents I find for better digestion of fat. For Indian readers of the blog.
    Namaste
    Vepa

  • 15 vepa A Murari // Jul 2, 2014 at 11:55 am

    Dear David,
    I forgot to add in the last comment I made that I will be getting the 1Ac test done in a couple of days to see the effect of the new Diabetic Regimen involving Carb diversion since the last test.
    I will inform the results in this blog.
    Last few days from 25th, the LCHF diet has got disrupted. Because of guests, travel, and still not settled in. The results,
    01/07/2014 cals 1389 carbs 121
    30/06/2014 1150 181
    29/06/2014 1284 213
    28/06/2014 1926 199
    27/06/2014 1125 92
    26/06/2014 1180 143
    25/06/2014 985 79 (net carbs 64 as eg )

    The surprise to me also is the sugar control is steady (between meals occasionally checked) or mornings. Around 120 to 145 before meals, and about 110/145 mornings. With the DPP-4 mechanism. With such wild variations. Very little different from earlier to 25th when my LCHF diet was better controlled, Cals and high Fat.
    I had not tried out the effect of high carbs with Janumet this extensively EARLIER.

    WHAT ARE THE FIGURES THE BLOGGERS CONSIDER AS PROPER CONTTROL? OR ATTEMPTING?

    This is what a new Doctor I consulted who prescribed them early June told me. When I asked him if there was any risk continuing with LCHF diet because of opposition. He told me I was perfectly OK. Based on my reports, But asked me why I want to go to so much trouble.

    This was something never possible 6 Months earlier, with the 2 or 3 tablet combinations, without worry, and the reason I opted for LCHF from 1st Jan 2014.-not that I regret it. I understand it NOW as a very healthy diet. The LC part is very valid as protection against Heart attach. Important in my situation. But Carb diversion medication has its advantages. As I find IN A VARIETY OF DIET SITUATIONS.

    I am very curious how many of the Bloggers here have taken to LC and Saturated Fats are doing it because of these Diab and Cardiac problems or as healthy diet by hearsay. Or to stop need for Diab medication.
    While that was a distant motivation, the immediate was better sugar control by reducing Carbs, Scientifically by reading Mendosa. com as advised by my son.

    For which you must be thanked profusely.

    In this connection, the TP by AHA as advised for above 75yo, the sugar figures are relaxed, regarding peaks and POST PRANDIAL. There is no doubt LC helps to keep peaks and postprandial lower than with high Carbs. But I find the lower and higher figures variations less worrying with the Carb diversion medication.

    However, in spite of this new surprising info, I wanted to share, I am still interested in continuing with HF diet. How to digest fats. The HC diet, avoiding sugar etc, even if manageable with no change in medication, long term is not advisable for several reasons. From what I know now.

    In Indian circumstances, snacking on Cheese blocks, Nuts, and Dried Coconut (Khopra) is very easy to add Fat. Can be carried on person. Leaving Butter, Ghee,for use with meals, and Coconut oil added to any liquid taken – Cofee, Tea, Water etc. Spread Fat consumption throught the day. Rather than taken at one time.

    The PP after night meal (3rd) is 183. This is normal with HC. By morning it will drop. Today is a High carb , and possibly 1300 cal day.
    From tomorrow plan to get back to HF discipline again.

    Namaste
    Vepa

  • 16 OldTech // Jul 2, 2014 at 2:51 pm

    I am attempting to follow Dr Bernstein’s advice of a BG of 85 mg/dl. Since I am type II the only control I have, except for metformin, is to control my carbs and protein. So I cannot expect to keep my BG at 85 mg/dl at all times, so I am attempting to keep my BG under 110 mg/dl max. My FBG is in the 70’s mg/dl. My target for A1c is from 4.2% to 4.6%.

    Jenny at blood sugar 101 says to keep it 140 mg/dl (7.8 mmol/L) Post Meal Blood Sugar Target. Others have different targets. The article when_to_test at this site says:

    “Several different organizations have set targets for blood glucose levels two hours after a meal. The ADA has the easiest target, less than 180 mg/dl (10 mmol/l). The International Diabetes Federation and the World Health Organization recommend a target of less than 160 mg/dl (8.9 mmol/l). The American Association of Diabetes Educators, the AACE, and the American College of Endocrinology have the most aggressive targets, under 140 mg/dl (7.8 mmol/l).”

    Since I understand that people without diabetes rarely exceed 130 mg/dl I have chosen to error on the low side. After all most normal people eat a diet high in carbohydrates so normal is not likely optimal.

  • 17 David Mendosa // Jul 2, 2014 at 3:09 pm

    Dear OldTech,

    Thank you for your input to the conversation, here and earlier. You and I are marching down the same path.

    Namaste,

    David

  • 18 vepa A Murari // Jul 2, 2014 at 7:07 pm

    Dear David,
    My following morning FPG to last nights comment is 112.
    This is what I expect without worry,anxiety. With this medication. The Cal was 1239, carbs 151 gms, and carbs contribution 44%. Even so, Sat Fat is 14g. (not a day passes without exceeding the 7% AHA limit ) Before Dinner it was less than 1000 cals.I had thought of not taking any dinner or a light dinner. But was persuaded by my better half with something tasty.AND I also thought I will finish thisSHORT study of HC DIET.
    Thanks to Old Tech, for informing the targets. I presume with diet alone. And 85 in the morning.

    I have managed such figures for a few days during my med dose expts and carbs reduction, surviving on eating 12 Crackers/day or 60 carbs/day.
    It is both a practical diet and not a practical diet, in the everyday sense. I can manage with no cooking items in the house, or travel adding snacks to it. Now that I have a Diet Diary, I can reduce number of crackers by the carbs in the Fat/Protein Snacks.
    But after seeing the evidence of attempting strict control, after so many years (33) of diab desease, I have decided on maintain a HF diet with a cal as dictated by wt loss and maintenance requirement. Leaving the figures to the Carbs diverting Medicine. Which comfortably meets the ADA requirements, as pointed out by Old Tech. Thanks for bringing together the different standards at one place.

    I have not read Dr Bernstein books. I have read the methods are not for Vegetarians. I have therefore preferred the relaxed figures of various sources including ADA for comfort. As what is feasible for Vegetatarians. Adding an Egg/ day. I do have discomfort regularly adding 2 eggs / day, or more than 40 gms Cheddar Cheese per day, or 45 gms Almonds etc. or a combined total of 70 gms, Adding Coconut Oil to this list. Reducing the trouble giving fats intake.

    I will wait for the 1ac test results of this Carb bypass medication with interest. And mostly LCHF during the last 3 months.

    Will be happy to know the targets others persue, and if it is age and duration of desease dependant. And Hb1Ac when the efforts began.

    Now with having to decide to increase Cals or not. If so can it be sticking to a fixed Carbs 60gms /day, or % of total etc are what is crossing my mind.As a Vegetarian.
    Can I continue at this BMR level of Cals appx 1300, without getting unhealthy. Again the experience of readers will be welcome.
    Namaste
    Vepa.

  • 19 vepa A Murari // Jul 2, 2014 at 7:10 pm

    Dear David,
    My following morning FPG to last nights comment is 112.
    This is what I expect without worry,anxiety. With this medication. The Cal was 1239, carbs 151 gms, and carbs contribution 44%. Even so, Sat Fat is 14g. (not a day passes without exceeding the 7% AHA limit ) Before Dinner it was less than 1000 cals.I had thought of not taking any dinner or a light dinner. But was persuaded by my better half with something tasty.AND I also thought I will finish thisSHORT study of HC DIET.
    Thanks to Old Tech, for informing the targets. I presume with diet alone. And 85 in the morning.

    I have managed such figures for a few days during my med dose expts and carbs reduction, surviving on eating 12 Crackers/day or 60 carbs/day.
    It is both a practical diet and not a practical diet, in the everyday sense. I can manage with no cooking items in the house, or travel adding snacks to it. Now that I have a Diet Diary, I can reduce number of crackers by the carbs in the Fat/Protein Snacks.
    But after seeing the evidence of attempting strict control, after so many years (33) of diab desease, I have decided on maintain a HF diet with a cal as dictated by wt loss and maintenance requirement. Leaving the figures to the Carbs diverting Medicine. Which comfortably meets the ADA requirements, as pointed out by Old Tech. Thanks for bringing together the different standards at one place.

    I have not read Dr Bernstein books. I have read the methods are not for Vegetarians. I have therefore preferred the relaxed figures of various sources including ADA for comfort. As what is feasible for Vegetatarians. Adding an Egg/ day. I do have discomfort regularly adding 2 eggs / day, or more than 40 gms Cheddar Cheese per day, or 45 gms Almonds etc. or a combined total of 70 gms, Adding Coconut Oil to this list. Reducing the trouble giving fats intake.

    Will be happy to know the targets others persue, and if it is age and duration of desease dependant. And Hb1Ac when the efforts began.

    Now with having to decide to increase Cals or not. If so can it be sticking to a fixed Carbs 60gms /day, or % of total etc are what is crossing my mind.As a Vegetarian.
    Can I continue at this BMR level of Cals appx 1300, without getting unhealthy. Again the experience of readers will be welcome.
    Namaste
    Vepa.

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