America’s Love/Hate Relationship with Saturated Fats By Dr. Megan Holt, DrPH, MPH, RD


Let’s start off with an overview of saturated fatty acids, and how they differ from poly or monounsaturated fatty acids.

Saturated fatty acids (SFA’s) have the following characteristics distinguishing them from other fatty acids (trans, monounsaturated & polyunsaturated):

  • solid at room temperature
  • occur naturally in foods
  • referred to as ‘saturated’ due to their having no double bonds along the carbon chains that comprise these saturated fatty acids

Unsaturated oils, on the other hand, are liquid at room temperature, primarily found in higher concentrations in plant sources (with the exception of fatty fish) and have one (mono) or multiple (poly) double bonds along the carbon chain.

Contrary to popular belief, foods do not consist of one type of fatty acid. Rather, foods are composed of varying percentages of unsaturated and saturated fatty acids.

For example, SFA’s comprise roughly 13% of the fatty acids in olive oil, and 65% of the SFA’s in butter.

SFA’s are found in higher amounts in dairy products (ex: cream, butter, milk, cheese) as well as in meats (bacon, sausage, chicken fat, mutton), ghee, suet and lard.

Palm oil, palm kernal, coconut and cottonseed oils contain a larger percentage of SFA’s (relative to the other plant based fats), though they lack the cholesterol contained in animal sources.

Examples of SFA’s include:

  • lauric (palm kernal oil, coconut oil, vegetable shortening and is also used in )
  • palmitic (palm oil, tallow, processed foods to enhance texture)
  • myristic (palm kernal oil, coconut oil, butter)
  • stearic acids (cheese, sausage, bacon, ribs, beef/ground beef, candy, cocoa butter)

These fatty acids are also commonly used in conjunction with sodium hydroxide, creating a product commonly found in soaps, shampoos and cosmetics (ex: sodium laurate and sodium palmitate).

For several decades, foods high in SFA’s were demonized by public health and nutrition experts, citing numerous studies suggesting that SFA’s were disease promoting.

Saturated fats were linked to increased LDL (‘bad’ cholesterol), a primary risk factor for heart disease.

Current American Heart Association guidelines suggest limiting calories from saturated fat to less than 7% per day (or roughly 16g or 140 calories).

SFA’s were somewhat vindicated when evidence emerged several years ago suggesting that trans fatty acids (partially hydrogenated oil) were more offensive, as they not only raise LDL, but decrease HDL (or ‘good’ cholesterol).

Recently, however, results of a meta-analysis of 72 studies (including both observational studies and randomized controlled trials) on saturated fat intake and heart disease published in the Annals of Internal Medicine found no association with SFA intake and risk of heart disease – basically stating saturated fats were found to have no influence, positively or negatively, on heart disease.

The results were highly publicized, and largely misconstrued by media.

Results of the published study actually read as follows:

“Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Critics of the study, including nutrition experts from the Harvard School of Public Health (one of whom actually authored the study) are calling for a retraction or revision of the paper.

Critics have pointed to the limitations of meta-analyses as one potential problem, as numerous studies are combined and summarized, despite vast differences in methodologies (particularly across nutrition literature).

They also cite conflicting findings from numerous large scale population studies that link plant based/vegetarian diets (and lower intake of animal products) with health and longevity (Framingham, Adventist Health Study, China Study).

Another author (there were fourteen) has stood by the study’s findings, but insists that the conclusion of the meta analysis only suggested that we need further research to better understand the relationship between SFA’s and heart disease.

She has also supported continued adherence to American Heart Association’s parameters for SFA intake, stating that relaxing the guidelines would be premature at this point.

There are a number of studies in progress looking at the influence of particular saturated fatty acids on health outcomes, inspired by recent findings that suggest that all fatty acids are created equally.

The results of Annals of Internal Medicine study are intriguing indeed, and warrant further attention.

But until we have more evidence, the large majority of experts recommend continuing to keep SFA intake to a minimum and acquiring dietary fat from plant based sources (examples include olive oil, avocado, nuts and seeds). We must also consider the steep environmental cost of meat consumption (10-15 pounds of grain is required to produce 1 pound of meat).

Bottom line: It’s a bit too soon to begin piling meat and cheese on your plate, but the results do suggest that more work needs to be done before we fully understand the relationship between SFA’s and heart disease.

And please be cautious when relying on media to interpret results of complex studies.

What can we conclude from the referenced study and other similar studies on SFA’s and health?

  • It seems that not all SFA’s are ‘equal’, and the way that they influence disease risk is not well understood and deserves further attention, so avoid dogmatic teachings around good food/bad food.
  • While we seek to better understand the SFA/health relationship and await further study results, please still proceed with caution when adding SFA’s to your intake.
  • Foods that are high in SFA’s (meats, dairy) are also often high in preservatives (and other artificial fillers) and sodium. Quality of meat/dairy DOES have a meaningful effect on the nutrient density, so going organic/grass fed IS worthwhile if you’re able.
  • Good nutrition is a complex picture with many shifting parts, and research is moving away from studying the influence of single nutrients on health outcomes, so be wary of these kinds of studies.
  • Lean on a plant based diet for necessary fats and proteins such as beans, lentils, nuts, seeds and whole grains (budget friendly AND protective), and supplementing with high quality (organic/grass fed) meat and dairy products when you do want to include animal fats.

Questions, thoughts and reflections? Please post them below. I look forward to continuing this important discussion with you.

In good health –

Megan


Study Reference:
Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A. Ward, Laura Johnson, Oscar H. Franco, Adam S. Butterworth, Nita G. Forouhi, Simon G. Thompson, Kay-Tee Khaw, Dariush Mozaffarian, John Danesh, Emanuele Di Angelantonio; Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 2014 Mar; 160(6):398-406.

Unpacking 5 Common Questions on Exercise and Wellness with Megan Holt, DrPH, MPH, RD

NoteRespect is looking at soreness

Note from Rebecca: The word “exercise” is often used in conjunction with the word “diet”. Exercise is indeed an important and necessary part of anyone’s wellness lifestyle. Yet the word itself is often misunderstood and loaded with expectations, shame and fear. Megan Hold, DrPH, MPH, RD unpacks some common questions and misunderstandings around exercise and how to care for our body when we are moving it and the importance of developing an intuitive relationship with exercise.

Q: Exercise is always a good thing, right?  I often read and hear that exercise makes our immune systems stronger.

A: Exercise is one of many stressors the body receives, and like other stressors, produces ill effects when introduced at a time when the body is overloaded.

Intermittent (spontaneous) very high intensity exercise and continuous over training (even if done at lower intensity) can compromise immune function.

For example, 90+ minutes of high intensity exercise may result in days of dampened immune function.  (“Intensity” can also look different from one person to the next, as we must consider baseline fitness levels).

During exercise, we experience an increase in cortisol ‘stress hormone’, which in turn increases blood pressure and cholesterol.  These effects are transient when exercise is balanced and appropriate, but over training can result in chronically high levels of cortisol, decreasing our immune function.

Other risk factors for infection include:

  • inadequate sleep,
  • weight loss,
  • poor quality of diet,
  • under nutrition/low calorie intake,
  • stress.

All of these things, including exercise, challenge homeostasis and therefore, can contribute to increasing susceptibility to illness.

On the flip side, exercise also attenuates stress, which bolsters our immune systems, though this occurs after the exercise but and in the scheme of a balanced training regimen.

Those who engage in moderate intensity exercise 4 days per week are nearly half as likely to use sick time relative to their sedentary and their ‘over trained’ counterparts.

Exercise stimulates phagocytosis, which can essentially be described as the gobbling up of illness producing bacteria by macrophages (the ‘big eaters’ of the immune system).

Immune parameters are enhanced for hours after exercise (and even longer if program is balanced and ongoing/continuous) but the benefits are compromised when one pushes too hard and denies themselves the rest that they need.

Q. What does research tell us about exercising when feeling under the weather?

A. Generally, if symptoms are ‘above the neck’ (i.e. the common cold) low intensity exercise is OK, such as walking or gentle yoga, though listen to your body and rest when symptoms are at their worst.

Wait at least 5-7 days before reintroducing moderate to high intensity exercise.  Cold weather does not increase risk of catching a cold…it simply results in close contact to a greater number of people, which increases transmission of bugs.

When symptoms are ‘below the neck’ or more involved, wait 1 ½ to 2 weeks before reengaging in workouts of moderate or high intensity.

Q. What are overuse injuries, and what are the primary risk factors for overuse injuries?

A. Overuse, in short, result from a culmination of ‘too much too fast’, repetitive movements, improper training techniques, inadequate rest and musculoskeletal system overload.

Half of kids 6-18 engaging in athletics will incur an overuse injury, with highest risk going to runners. Other major risk factors include lack of a period (being on birth control doesn’t ‘count’ if the period is absent without birth control), prior injury and inadequate calorie intake, which stimulates muscle catabolism and hinders muscle recovery.

Q. I am feeling pressured (from self and/or others) to overdo my exercise? What can I do?

A. Give yourself permission to decrease intensity when you need to, and kindly thank yourself for showing up!

Increase the intensity again when you feel like you have the energy to challenge yourself. Resist adding intensity/weight/incline speed because someone else is doing so, or the instructor of your fitness class insists upon it if you know that it’s too much for you.

You’re there for you, not for them, and it’s OK to modify.  Remember, they won’t be around to nurse your injury, so it’s up to you to know your limits.

Believe it or not, cardio is not the only component of fitness. Equally important are flexibility and muscular strength building exercise, particularly for the sake of preventing overuse injuries and building/maintaining bone mass.

A ‘balanced’ regimen may include:

  • yoga,
  • strength training (‘sculpt’ classes)
  • swimming or running/hiking
  • bike riding (moderate to high intensity)

Try to engage other people in your workout regimen, even if this ‘compromises’ intensity just a little bit. Friends who move for fun and wellness can help to keep you from engaging in the craziness of calorie counting or compensatory exercise. Healthy relationships and interactions are also great for your health. =)

If you find that you’re worrying throughout the day about how you’ll fit in your workout, take a breather until you have time to make it a priority without adding to your already overfilled plate.

This is especially true if you’re active a few days/week, but feel inclined to stick to a rigid 5,6,7 days at any cost. If you’re exercising for health benefits, but obsessing daily about how to make it happen ‘perfectly’, the impact of the stress defeats the purpose.

Q. I missed my class and now I’ve blown it. I missed yesterday’s as well, and now I am in a real bind because I am going out to dinner, and I don’t feel like I have ‘earned’ the calories.

A. This is the picture of a not-so-healthy relationship with food and exercise.  Take a walk instead, even if it’s not what you had in mind, and thank yourself for being flexible.

Carbohydrate and protein are a MUST after exercise, as they serve to decrease muscle and joint tissue damage (and no, a low carb protein shake does not suffice, even if it has, like, fifty grams of protein).

This includes an adequate intake of grains. And grains are not the devil. We have decades of research supporting the health benefits of whole grains in the diet, including, but not limited to, their being a great source of antioxidants, fiber, and essential anti-inflammatory fats.

Finally, don’t neglect dietary fat. The anti-inflammatory benefits are tremendous (which means inflammation is buffered by protective qualities of fats, primarily the plant-based fats, which means lower risk of injury).

Don’t wait until you have an overuse injury and are stuck with a bandaid approach to ‘fixing’ it and explore the benefits of a few choice lifestyle modifications, which can prevent, delay onset or aid in healing. Aim for your intake to be at least 30% of calories consumed from fat sources.

How do you define your relationship with exercise?

Do your trust your body to tell you when you need to rest?

Thanks for reading and please post your questions below in the comments section regarding all things exercise and wellness.

In good health –

Megan

Q&A Series: Should We Care About BMI?

worthnotanumber

In our Q&A series we’ve unpacked the paleo diet, the gluten-free dietcleanses, and yoga therapy. This week, Kayla Walker, MFT Intern, spoke with Megan Holt, MPH, RD, Potentia’s Coordinator of Nutrition and Wellness to learn about using BMI as an indicator of health.

Note from Rebecca: The following post may be triggering for some who are early in their recovery or struggling with their recovery, so please pause here if this information will not be helpful for you right now. There is some frank talk about numbers in this post because we want to offer some accurate information about the BMI, what it is, why it is not an accurate or helpful indicator of health and how its use is fueling the disordered eating spectrum.

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Kayla: What is BMI?

Megan: BMI stands for body mass index. It’s an equation commonly used in healthcare venues to estimate risk of developing chronic diseases that often accompany increases in body fat, such as diabetes, heart disease, and many forms of cancer.

Kayla: How do you calculate BMI? How do you know whether your BMI is in a healthy range?

Megan: The formula for BMI is:

BMI = weight in pounds/(height in inches x height in inches) x 703
or
BMI = weight in kilograms/height in meters squared

CDC recommendations categorize BMI in ranges of underweight, ideal weight, overweight, and obese, as follows:

Below 18.5 = Underweight
18.5 to 24.9 = Ideal
25.0 to 29.9 = Overweight
30.0 and above = Obese

Note from Rebecca: In 1998, the FDA changed the ranges for the BMI and overnight millions of people became “overweight” and “obese.” In his movie America the Beautiful, Darryl Roberts noted this changed was approved by a board that was directly connected to the dieting industry. Given the annual 50+ billion dollars which are spent on diets and diet related products, the BMI is regularly used as a marketing tool to support the use of various products in this industry. And since diets do not work – and in fact set you up to regain the weight and often more within 1-2 years – it seems the BMI is more of a marketing tool than a predictor of true health.

Kayla: Where did the idea of using BMI as a marker of health originate?

Megan: A mathematician (not a clinician) from Belgium by the name of Lambert Adolphe Jacques Quetelet came up with the BMI in the early 1800’s. His aim was to come up with an inexpensive proxy for measuring degree of obesity. Named the Quetelet index (and later BMI), it was used as a means of assessing “appropriateness” of weight for height.

Kayla: Why is BMI used?

Megan: After WWII it was noted that obese and overweight life insurance policy holders were at higher risk for morbidity and mortality were getting increasingly fatter.

It’s easy to understand and compute, it’s inexpensive, and gives us some helpful feedback in terms of anthropometric assessment, though this holds true mainly in the extremes (very underweight and very overweight/obese).

Note from Rebecca: Recent studies are showing a lower death risk for those who are considered “overweight” according to the BMI  furthering doubt the BMI ranges are not helpful in indicating true health.

Kayla: What are the limitations of using BMI as a marker of health?

Megan: BMI does not account for differences in bone mass/structure, fat mass and lean body (muscle) mass, nor where fat is stored (visceral vs. subcutaneous).

Visceral fat (fat around the abdomen/vital organs) is much more inflammatory and problematic in terms of health risks than subcutaneous fat (under the skin).

It implies that thin or normal weight individuals are healthy and have lower risk of developing preventable disease relative to their overweight (according to BMI) counterparts, and this just isn’t the case.

Athletes are an excellent example of persons who tend to have higher BMI’s but carry lower disease risk. Similarly, body fat is underestimated in the elderly, as they typically carry very little lean body (muscle) mass. Remember, one can be thin and simultaneously unfit and/or unhealthy.

Kayla: What should we be using instead, or at least in conjunction with BMI, to predict health risks? What are other markers of health?

Megan: Waist to hip ratio, for one, needs only a measuring tape, and has more predictive power than BMI. Women should have a waist-to-hip ratio of 0.8 or less, and men 0.95 or less. Women are advantageously pear shaped, and thus carry lower risk for preventable diseases. Think of this next time you’re cursing your curves, and please STOP hating on your body!

Other methods exist that are quite costly and/or intrusive, but may be more accurate, such as requesting a lipid panel (which requires blood work) from your physician, or assessing body fat through use of skin fold calipers, underwater weighing, or bioelectrical impedance. However, assessment of percent body fat alone still does not account for ‘location’ of fat-visceral versus subcutaneous.

Kayla: How do you assess your clients? Do you use BMI as a health indicator?

Megan: I rarely, if ever, calculate BMI when working with clients, whether they are athletes or people struggling with disordered eating.

Rather, I use an assessment of their current diet and lifestyle behaviors and blood work results from their physician to measure risk.

When working with individuals who do fall in the extremely obese category, I find that they are well aware of where they fall in terms of BMI categories, and that calling attention to this is not helpful.In fact, it often deters these individuals from wanting to make changes to lifestyle, as they likely will remain in the ‘obese’ category even with a fairly significant weight loss.

We know that even mild weight loss, 5-10%, for example, is enough to significantly decrease risk of “Western” diseases, such as diabetes, heart disease, and numerous cancers.

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Thanks for reading our Q&A on BMI!

What are your thoughts about using BMI as an indicator of health? Has it been helpful or harmful in your journey to health? What additional questions do you have about health, weight, or body image?

We would love to hear from you and address your questions on health and wellness in a future Q&A blog post.

In good health –

Kayla & Megan