What About Fats?

Posted 11/3/2001

Today we are beginning our discussions of dietary fats. In this new series of articles, we will be discussing the answers to the following questions: What are fats? What are oils? How are fats and oils digested by and absorbed into the body? We'll also be talking about how dietary fats relate to body fat. At the very start, though, let's consider how it is that so-called 'nutritional science' seems to tell us that every condition known to mankind is in some way related to dietary fat. How and why has fat been relegated to the position of being the "evil food?"

It will take several articles to fully explore these questions, so let's get started.

When Did Dietary Fat Become Unfashionable?

The attack on dietary fat has been going on for more than 50 years, and hundreds of millions of dollars have been spent on research trying to prove that if you eat a low fat diet, you will be healthier and live longer.

For most of the past 50 years, we have been told that eating healthily means avoiding dietary fat, and an entire industry has grown up around this idea. The creation and marketing of reduced-fat food products has become such big business that there are now some 20,000 products on food store shelves that identify themselves as low-fat or free-free. There are hundreds of food science laboratories dedicated to developing and manufacturing fat-free substitutes for dietary fats.

With such a large industry having much to gain if people believe that less fat in the diet is good, it is no wonder that billions of advertising dollars are spent every year trying to sell the message. And the message is constantly reinforced by many doctors, nutritionists, journalists, health organizations, and consumer advocacy groups, each group repeating what the others have said. And, I might add, each pointing to the other as the authority for the information.

But it wasn't always like this. In the 1940s, during World War II, the American government circulated posters for public information. Among these posters were some concerning foods to keep children healthy during the war years. The posters pointed out that children need fats to grow, and told mothers not to cut their children's butter allowance to less than one pound per week! This, from the same American Department of Agriculture that now circulates Dietary Guidelines and the Food Guide Pyramid, recommending that fats and oils be eaten only sparingly.

What changed? How did we go from 'at least one pound of butter each week' to 'at most, one ounce a day'? It started in the 1950s with the idea that high cholesterol levels increase heart disease risk. Despite the facts that in all previous years, dietary fat was higher and heart disease was lower, and despite the fact that the human body produces cholesterol regardless of the amount of dietary fat eaten, the idea that cholesterol in the diet causes heart disease was easy and appealing. But the original study only measured the total amount of cholesterol in the blood, without taking into consideration that cholesterol is carried in many ways:

All of these cholesterol-containing particles were said to have some effect on heart disease risk. But although fats, carbohydrates, and proteins in the diet have varying effects on all these particles, those effects were not part of the factors that were considered!

All Fat Is Not The Same

The 1950s story was that saturated fats in the diet, by themselves, increase total cholesterol, while polyunsaturated fats decrease total cholesterol, and monounsaturated fats are neutral. But by the late 1970s it was shown that monounsaturated fats are not neutral at all. Rather, they raise HDLs and lower LDLs. From the "Cholesterol is Evil" point of view, monounsaturated fats should be an ideal nutrient!

Then there is the matter of saturated fats, per se. While they appear to elevate LDL, which is said to be bad, they also elevate HDL, which is said to be good. Some saturated fats also appear to be neutral. Some fats raise HDL levels, but do little or nothing to LDL levels. Then, there are the so-called trans fatty acids, which raise LDL, just like saturated fat, but also lower HDL.

Although none of these facts are highly controversial in the low fat world, many of them appear to be contradictory. And the most important fact of all, the influence of high levels of carbohydrates on the actions of fats and cholesterol, has been largely ignored. The upshot is that "fat is bad and needs to be rigorously controlled," continues to be the common wisdom.

Not All Scientific Studies Are Produce Valid Information

The results of all the testing and studies have become enormously convoluted. Among the major factors that complicate the issues are: Who does the research? Who pays for the research? What questions are being asked in the research? What questions are not being asked in the research? Which research is considered when making reports to the media? Which research is ignored when making those reports? How much ego or prestige, and how many university positions are invested in one opinion or the other?

We will talk more about these issues as we go along, but for now, let's consider an example that illustrates the problem. Let's consider a steak with a thin layer of fat along one side.

After cooking, the steak is almost equal parts fat and protein. Half the fat in the steak is monounsaturated, the same type of fat that is in olive oil. Saturated fat makes up most of the rest of the fat, but a third of that is one of the fats that it said to be neutral in its effect on the heart. And about 5% of the fat is polyunsaturated, which is said to improve cholesterol levels. In other words, 50% to 70% of the fat content of the steak, according to the anti-fat people's own reasoning, will improve cholesterol levels compared to what they would be if bread, potatoes, or pasta were consumed instead. The remaining 30% to 50% will raise LDLs, but will also raise HDL. All of this suggests that eating a steak rather than carbohydrates might actually improve heart disease risk! But, have we heard any of the low fat pundits saying this?

Why A Low Carbohydrate Diet Is A Healthy Diet

In the low carbohydrate world, we are certain that the problems of diet-related diseases are associated with high intake of carbohydrates, not high intake of fats. Although it is probably true that those who began pushing low fat diets had hoped the populace would replace dietary fat with fruits and vegetables, it didn't work out that way. The food industry has no incentive to advertise generic food items such as green vegetables. Instead, the food advertisers sell their own brands of low fat fast food and snacks, all high or very high in carbohydrates.

A low fat diet is nearly always a high carbohydrate diet. In point of fact, the low fat authorities advocate the high carbohydrate alternative, pushing pasta in place of meats. But numerous studies now suggest that high carbohydrate diets can raise triglyceride levels, create small, dense LDL particles, reduce HDLs, and result in insulin resistance, along with the condition that has come to be known as "Syndrome X." In other words, the more that carbohydrates replace saturated fats in the diet, the more likely the end result will be Syndrome X and an increased risk of heart!

Posted 11/16/2001

In our last conversation, I began our discussion about fats by initially considering about why it is that "nutritional science" blames dietary fats for so many illnesses, especially the various forms of heart disease.

This fifty-year attack on dietary fat has involved hundreds of millions of dollars being spent to try to prove that low fat diets are better for everyone, and has resulted in the spending of many billions of dollars by food manufacturers who are trying to sell the public various food products that are low in fat, and consequently, high in carbohydrates. "Non-Fat" and "Low-Fat" became the buzz words of good health, or so we have been led to believe.

However, since we in the low carbohydrate world know that, for the most part, we are a lot healthier since giving up the low fat plans, we have many questions about how and why fat became The Enemy.

There Are No Simple Answers

The program against dietary fat started in the early 1950s with the fairly simple observation that heart disease seemed to be more likely to occur in certain men who had high cholesterol levels in their blood. But, over the years, the research began to get complicated when it was discovered that, while some fats may raise certain cholesterol fractions, other fats lower them.

[Karl Note: Apparently Dr. Gruber is not familiar with the studies that show that high cholesterol is NOT a risk factor for heart disease -- never was and that these claims were based on fraudulent research findings. That whole subject is thoroughly explored in my article on cholesterol.]

The problem then became even more complicated by the fact that the part played by carbohydrates in the diet was (and still is) largely ignored. More recent studies suggest that high carbohydrate diets contribute not only to heart disease risk, but also to the condition known as Syndrome X, which involves insulin resistance and an even greater increase in heart disease risk.

How did it happen that a mere suggestion that fats might cause heart disease in some men, became the low fat dogma that fats are absolutely bad for everyone because they cause or contribute to a whole host of disease conditions? How did it happen that a few people's point of view became the chant of modern health agencies?

The answers to these questions involve the demands of public health policy, the actions of the media who were eager to find fault with science, and the demands by the general public for simple, uncomplicated advice, despite the fact that real science is not so clear-cut.

A Sort History Of Heart Disease

In the early 20th century, heart disease was a relatively rare condition. There was no such thing as a heart specialist in those early years. Although some people (primarily men) died of heart attacks, it was not common. Most families had not even heard of heart disease.

After 1945 it became obvious that there was a definite increase in coronary heart disease throughout the country. Interestingly, the incidence of heart disease began to increase along with the rise in consumption of sugar and refined carbohydrates, but this was not seen as related at the time. Imagine how things would have been different if some scientist had seen and spoken up about that relationship at the time!

But such was not the case, and by 1952 a well-known biochemist was suggesting that dietary fats might be the cause of the increased rate of heart disease. He admitted there was very little evidence connecting diet to heart disease, but nonetheless, he put forth the suggestion that adults should reduce their fat intake to 30% of total calories, or less. He (and at his urging, the American Heart Association), began advocating low fat diets, which at that time meant not eating meat more than three times a week!

Studies through the 1950s and 1960s showed some link between high cholesterol blood levels and heart disease, but cholesterol levels in the blood do not relate directly to the amount of cholesterol in food. Consequently, as late as 1969 (some twenty years after the beginning of the initial anti-fat suggestions), all the known facts could still be summarized by this single statement: "It is not known whether dietary changes have any effect whatsoever on coronary heart disease."

Scientists On The Other Side Of The Fence

Meanwhile, a prominent panel of scientists which had been doing research on fat and cholesterol became concerned that eating too little fat could also have harmful effects on the body. They pointed out that the brain is 70% fat, and that fat is the primary substance making up all body cell membranes.

These scientists were concerned that changing the proportion of saturated to unsaturated fats in the diet (which changes the fat composition in the cell membranes), might change the permeability of those membranes. This, they said, might alter the transportation in the body of sugars, proteins, hormones, and disease-causing bacteria and viruses. This could result in health problems of unknown proportions.

Why Scientists Didn't Just Run Clinical Tests?

Since there were seen to be both potential benefits and potential problems from low fat diets, scientists realized that the issue could only be settled by testing whether low fat diets actually prolong life. Further, it was clear that such a test would require tens of thousands of people to switch to low fat diets, and their subsequent health compared for years to the health of equal numbers of people who continued eating fat to alleged excess.

At the time (thirty years ago), such a test was estimated to cost $1 billion and take at least ten years. But this was considerably more money and more time than anyone was willing to spend. The data on fat and health remained unclear, and the scientific community retreated into camps, depending on their viewpoint on the issue.

The scientific community remained at polar positions for some time, but when the deadlock was finally broken, it was not by any new science, not by any new studies, not by any proof. The deadlock was broken by politicians!

Vital Information

By Dr. Beth Gruber, CarbSmart Contributor

Posted 11/30/2001

In our last two discussions, we looked at how it came to be that so-called nutritional science blames dietary fats for many illnesses, especially heart disease. We saw that, over some fifty years, 'nonfat' and 'low-fat' have become synonymous with health, and the suggestion that fats might cause heart disease became the dogma that fats are absolutely bad for absolutely everyone.

Nutritional Guidelines By Committee

This dietary dogma came about despite the fact that there was very little evidence connecting diet to heart disease, and despite the concern of some scientists that eating too little fat could also have harmful effects. And it happened, not because of any new science, but by the actions of a governmental committee.

This special government committee was formed in 1968 with the stated mission "to eradicate malnutrition in America." The committee acted to institute a whole series of federal food assistance programs, but after doing that it ran out of things to do. Rather than disband, the committee members decided to take up a new cause: dietary excesses.

Some of the members were personally very taken with an extremely low fat diet plan advocated by Nathan Pritikin. With Pritikin's ideas as a foundation, the committee held a few days of hearings in mid 1976. But the hearings did not ask for input from the varying points of view, since the committee had basically decided that the low-fat position was the one it wanted to advocate.

The committee issued its report in January of 1977, making the blanket declaration that everyone should cut total fat intake to 30% of calories eaten, and that everyone should cut saturated fat to 10% of calories eaten.

The report acknowledged that cutting fats in this way was originally only recommended for men who were at high risk for heart disease, and it admitted that there was a huge controversy over the recommendation, but the report writers insisted that people had nothing to lose by following the advice. The report actually said "it is not a question of why we should change our diet, but why not"! And then they went on to completely ignore the arguments that cutting fats might not be such a great idea.

The Response To The Committee's Recommendations

It is interesting to note that much of the initial response to the first committee report was unfavorable. There were those who emphasized that no one even knew if eating less fat or lowering blood cholesterol levels would prevent heart attacks. Others pointed out that the suggestion was setting up a huge nutritional experiment with the public as guinea pigs, and with no controls on how the experiment would be done. Even the American Medical Association protested.

But along with those dissenters, there were objections from the egg, dairy, and cattle industries. And, this is where the media jumped on board. They said the contrary opinions issued from these food industries were "merely self-serving," and then they lumped the scientific criticisms together with the criticisms from the industries.

The media being what it is, it pushed all the scientific criticisms aside, and stood behind the simple, easy-to-understand but incorrect idea that less fat equals longer life. The public was able to understand this, even if it wasn't necessarily true. People believed what the media reported, and since the media didn't report the arguments from the other side, those ideas didn't get heard.

With a consensus among the committee members, the media, and much of the public, all the alternative opinions to the committees recommendations were swept under the rug. Once the committee's recommendations became "The Official Opinion," few people questioned it, and even well-intentioned professionals passed it along as gospel.

Legitimate Scientific Studies Were Ignored

Nonetheless, there was some action on the questions asked by the dissenters. The National Institute of Health funded some studies beginning in the early 1970s. The results of four of these studies, published ten years later, showed no evidence that men who ate less fat lived longer or had fewer heart attacks. A fifth study suggested that eating less fat might actually shorten life. But the results of these five studies did nothing to alter "The Official Opinion." Instead, it was generally considered that there must have been faults in the methods used in the studies themselves.

Then there was a sixth study. This study sought to determine whether or not a certain drug would lower blood cholesterol levels, and whether heart disease rates would be lowered at the same time. The results showed a small decrease in the heart disease rate among the test subjects. This study was a drug trial, not a diet trial, but since the results were seen as supporting "The Official Opinion," that was good enough.

The investigators concluded that the drug's action could be extended to diet, as well, without there being any data concerning diet whatsoever in the study. And although this sixth test only looked at middle-aged men who had cholesterol levels higher than 95% of the population, the test results were assumed to be a benefit that could and should be extended to everyone.

The small link between the cholesterol-lowering drug that was studied and better health was henceforth to be considered the same as a wished-for link between a cholesterol-lowering diet and health. This was viewed as the end of the dietary fat debate, and there was now said to be no doubt that low-fat diets would protect against coronary heart disease.

Then The Food Manufacturers And The FDA Jumped In

What followed was the creation and marketing of reduced-fat food products. It has become a huge business, and an entire research industry has arisen to create palatable nonfat fat substitutes.

The government publishes the US Department of Agriculture's booklet on dietary guidelines every 5 years, and so far the well-known Food Pyramid still recommends that fats and oils be eaten "sparingly." The low-fat message continues to be spread by physicians, nutritionists, journalists, health organizations, and consumer advocacy groups who truly believe that the message is well-founded in fact.

The Tide Is Turning

But it is becoming increasingly clear to everyone who looks closely that the science of dietary fat is much more complicated than it has been presented. Among the factors now showing themselves to be involved are the different forms of cholesterol, the influence of high levels of carbohydrates in the diet, the involvement of triglycerides, the effects of regional diets, the increased use of cholesterol-lowering drugs among the general population, the health effects of a diet too low in dietary fat, and the tremendous amount of money being earned and spent trying to influence what we buy and eat.

Vital Information

By Dr. Beth Gruber, CarbSmart Contributor

Posted 12/21/2001

The "Official Opinion"

Previously in these discussions, we saw how a government committee, supported by the media and some public groups, pushed the low fat idea into becoming The Official Opinion that low fat equals good health. Despite opinions to the contrary, the major health agencies began advising everyone to restrict fat intake. The president of the American Heart Association went so far as to announce to Time magazine in the mid-1980s that if everyone went along with the plan, "We will have atherosclerosis [hardening of the arteries] conquered by the year 2000." And, it was all said to be based on sound science - which it was not.

Then in 1988, the U.S. Surgeon General's Office decided to issue a comprehensive report on the dangers of dietary fat. It seemed like a simple-enough task: collecting all the information then available, having it reviewed by a new committee of experts, and presenting it in one volume under the auspices of the Surgeon General's Office. But it turned out not to be so easy.

The Report That Never Was Never Completed

Project managers and members of the Report committee came and went over the next ten years. There were drafts and more drafts of the document. Finally, in June 1999, some eleven years after the project began, the Surgeon General's Office quietly killed the Report project with no public announcement and with no press releases. The only explanation given was that the project administrators had "not fully anticipated the amount of additional external expertise and staff resources that would be needed." In other words, the subject was too complicated because, despite the preconceived opinions as to what the conclusions would be, the science behind those opinions didn't hold up.

There had been decades of research, but they found it was still debatable as to whether the consumption of fats would increase the likelihood of death from heart and blood vessel disease. And the issue is still being debated today.

Low Fat Eating Has Not Lowered Heart Disease!

Despite a 6% or more drop in average fat intake over the past 30 years, there is no real evidence that health has improved. The incidence of heart disease has not declined, and any decrease in deaths from heart disease has been attributed to more successful drug treatment and to additional intervention treatment such as arterial by-pass surgeries and procedures like balloon inflation of the cardiac arteries.

Consider this: the American Heart Association has reported that in the seventeen years between 1979 and 1996, the number of surgical procedures for heart disease increased from 1.2 million to 5.4 million per year!

Many Legitimate Studies Are Ignored

In more recent years, there have been newer clinical studies that indicate that fat is not the devil it has been made out to be, but the studies are routinely ignored.

There have been several so-called Harvard Nurses' Studies, involving the diets and health of some 300,000 people. Those results suggest that total dietary fat has no relation to heart disease risk, and that monounsaturated fats (like olive oil) actually lower the risk. The studies also indicated that trans-fatty acids, the type of fats in margarine, are unhealthful. This is the same margarine that was recommended to us by the folks who were telling us not to eat butter, lest we drop over dead!

Yet the governmental agencies continue to support the low fat regime. Why, you ask? This will floor you! The agencies say, "You really need a high level of proof to change the recommendations." But, the agencies set the recommendations in the first place, without even low levels of proof!

Meanwhile, as we were being encouraged to eat less fat for all those years, we were, at the same time, being encouraged to shift to high-carbohydrate foods instead. This change is increasingly seen as a serious health problem.

Low Fat Diets May Have Contributed To The Rise In Obesity

Obesity remained fairly constant during the years 1960 through 1980, but since then it has surged from 14% of the population to close to 25%. That the increase in obesity occurred along with the low fat message suggests the possibility that low fat diets might have the unintended consequence of weight gain.

The suggestion that low fat diets are required to achieve weight loss has also been taken as gospel. Those recommending the low fat regime reported (correctly) that fat has nine calories per gram compared to four calories for carbohydrates and protein. This said, they then went on to say that cutting fat from the diet would surely cut pounds. However, there is much data to suggest otherwise. The results of well-controlled testing have shown that people on low fat diets initially lose weight, but then the weight tends to return, so that after a few years, little has been achieved.

A low fat diet is, almost by definition, a high carbohydrate diet. After all, you must eat something! Numerous studies now suggest that high carbohydrate diets can raise triglyceride levels, create changes in the kinds of cholesterol circulating in the blood, and produce the condition known as insulin resistance, or Syndrome X.

Low Fat Diets May Have Contributed To The Rise In Heart Disease

The Syndrome X profile is associated with increased heart disease risk, bringing us to the likely suggestion that it is high carbohydrate diets that have accounted for the increased heart disease over the past 50 to 75 years, not high fat diets. Perhaps fats are not totally evil, after all.

In an earlier article in this series on fats, I pointed out that the increase in heart disease came right along with the increased use of sugar and other high carbohydrate foods. Recall that early in the 20th century, heart disease was a relatively rare condition, and consequently there weren't even any of the doctors that we now call 'heart specialists'.

Although some people did die of heart attacks, it was not common. But following 1945 it was clear that there were more cases of coronary heart disease. As the rise in the consumption of sugar and refined carbohydrates continued, so did the increased incidence of heart disease.

By Dr. Beth Gruber, CarbSmart Contributor

Posted 1/11/2002

The Official Option Revisited

So far in these articles, we have seen that a government committee seeking to alleviate malnutrition among the poor was largely at the root of The Official Opinion that low fat eating equals good health. We have discussed how, despite having no scientific proof, health agencies began advising everyone to restrict their fat intake. And that, even when the Surgeon General's Office tried to publish the science behind the low fat idea as late as 1999, they could not find clear supporting evidence for the low fat opinion!

The incidence of heart disease has not declined, despite a decrease in fat intake. The most recent studies indicate that total dietary fat has no relation to heart disease risk, that monounsaturated fats (like olive oil) actually lower risk of cardiovascular disease, and that man-made trans-fatty acids (the type of fats in margarine) are the fats that are unhealthful.

Yet The Official Opinion continues to be supported by agencies and medical groups. There only can be two logical reasons for this. Some supporters apparently don't know The Official Opinion is not based on proof, and the rest of them have so much time and ego (or money) invested in supporting the low fat myth that they can't let it go.

Frightening The Public

Although The Official Opinion is weakening, and there is a lessening of the propaganda that all fats are bad, we still constantly hear about cholesterol. Just this very morning, I heard a so-called "public information announcement" on TV telling viewers how it is important to have their cholesterol levels checked every three years.

The public has become so frightened about cholesterol that most people believe it should be avoided like the plague. Even in casual conversation, people say things like, "I can feel the cholesterol clogging my arteries while I eat this!!" But cholesterol is not a devil. It is, in fact, essential to life. Cholesterol does not cause heart disease, and some experts have even gone so far as to say that the more cholesterol-containing foods people eat, the healthier they become!

Where Is Cholesterol Found?

Cholesterol is a substance found in animal fats, blood, nerve tissue, and bile. It is not found in any plant foods. Cholesterol is important for the structure of cell membranes throughout the body. It is vital to keep the membranes intact and permeable so that nutrients can pass into the cells, and waste products can leave them. When people radically restrict their cholesterol intake to the point that there is not enough cholesterol to repair and build tissue, cell growth is disrupted. Although there is not yet any proof, it is thought by some that a deficiency of cholesterol might contribute to certain cancers because cancer is a type of abnormal cell division.

What Does Cholesterol Do,
And What Happens If We Don't Get Enough Dietary Cholesterol?

Cholesterol is important to maintain normal hormone production and proper functioning of the immune system. It is part of the substance of Vitamin D, it is part of the make-up of the sex hormones in both men and women, and it is crucial to the manufacture of the important anti-stress factor, cortisol. Cholesterol is essential for nerve transmission and for brain function, and it is possible that it protects against multiple sclerosis. But here is the major evidence that cholesterol is not a devil, but is absolutely required: our own bodies will produce cholesterol if we do not eat enough of it in our diets.

The production of cholesterol in our bodies takes place under the direction of the liver, which makes it from carbohydrates we have eaten. This is normal metabolism, and no amount of calling cholesterol bad names will alter the fact. If you do not eat cholesterol, your body reacts as if you are living through famine conditions. In the presence of insulin, the liver produces a special enzyme that stimulates the production of cholesterol from carbohydrates. And since a low fat diet is nearly always a high carbohydrate diet, the amount of cholesterol produced from consumed carbohydrates is in excess of what is needed. This constitutes the dangerous cholesterol.

Cholesterol that is eaten in foods is regulated by the body. Dietary cholesterol doesn't contribute to excess cholesterol production in the body, since it does not stimulate insulin production. But, there is no mechanism for "turning off" the internal manufacture of cholesterol from carbohydrates when the person is following a low fat, high carbohydrate diet. High levels of carbohydrates mean more insulin production; more insulin with the high carbohydrates means more enzyme for excess internal cholesterol production. The only successful way to shut down the enzyme that triggers the excess cholesterol production is to eat cholesterol-containing foods.

In other words, when people restrict their dietary cholesterol and force their bodies to manufacture their own cholesterol, their bodies will make more than is needed, and this is especially true when carbohydrates make up a large percentage of their diets. Consequently, the way to be certain that you will have the type of high blood cholesterol that may result in serious heart problems and blood vessel disease is to eat a low fat/low cholesterol and high therefore a carbohydrate diet.

Cholesterol Levels That Are Too Low Can Be Dangerous

It is also becoming clear that low cholesterol levels are not a good thing. In Japan, doctors point to very low blood cholesterol as a cause of stroke. And when investigators tracked all deaths, instead of just heart disease deaths, they found that while men with very high cholesterol levels tended to die prematurely from heart disease and related conditions, men with low levels (below 160 mg) tended to die prematurely from cancer, and both respiratory and digestive diseases. Then, to make everything a little more complicated, in the case of women, it appeared that the higher their cholesterol was, the longer they lived.

Now, these study results can be interpreted in two ways. The interpretation preferred by low fat advocates is that the studies aren't meaningful at all. They claim that the excess deaths at low cholesterol levels must be due to pre-existing conditions and that chronic illness leads to low cholesterol levels, not the other way around. But the argument that the other conditions are pre-existing and are just coincidentally associated with low cholesterol levels leaves open the equally likely argument that heart disease is just coincidentally associated with high cholesterol levels, and that heart disease leads to high cholesterol levels, not the other way around.

However, the more likely interpretation of the effects of low cholesterol levels is that whatever a low fat diet does to blood cholesterol levels is only one factor of the low fat diet's effect on general health. In other words, while a low fat diet might help prevent heart disease, it might also raise susceptibility to other disease conditions.

We're Not Done Yet

The science of fat and cholesterol started in the 1950s as a simple story. Since then it has developed into a very complicated one, and we aren't finished yet.

Posted 3/9/2002

What We Have Already Learned

In the last article, we began our discussion about fats and oils as foods. We started by talking about just what are fats, oils, and related substances. We also made the important differentiation between fats (the substances themselves), dietary fat, and body fat (which is both the structural fat and the adipose tissue).

We learned that fats and oils are some of the compounds known as lipids, and are chemical combinations of a substance called glycerol with three of a number of differing substances called fatty acids. Different arrangements of the fatty acids produces the different kinds of simple fats, and simple fats join together in the construction of more complex lipid structures, such as cholesterol. Complex lipids break down into simpler fats.

Fats can join with phosphorus compounds to make phospholipids such as lecithin, and fats can also form loose combinations with certain proteins to make important compounds called lipoproteins. Lipoproteins are crucial because they are soluble in water, while fats are not. This water solubility means they can pass into and out of body cells more easily.

We learned that the difference between fats and oils is that oils are liquid at room temperature while fats are solid, and we saw that the difference between saturated and unsaturated fats has to do with the amount of hydrogen in the fat structure. Now we are ready to talk about the various functions of fats.

The Caloric Value Of Fat

Fats have had so much "bad press" that many people forget that they are absolutely needed for life. Among the many functions of fats in the body is that they provide a lot of energy in the form of calories. To understand this, we need a short detour here to talk about calories.

Calories are a measure of the heat produced by the utilization of foods in the body. Carbohydrates and proteins produce four Calories. (***See the note at the end of the article.) of heat per gram. Carbohydrates, proteins, and fats are all composed of hydrogen, oxygen, and carbon, but fats don't have enough oxygen built into their structures to allow for breakdown. Oxygen has to be added into the mix from the oxygen in the blood.

This process is called oxidation (ox-e-DAY-shun), and it gives rise to a great deal more caloric heat than is involved in the breakdown of carbohydrates or proteins, which do have sufficient oxygen. The heat value of a pound of fat is equal to the heat value of two and 1/4 pounds of carbohydrate or protein. This is why we say that fat has 9 Calories per gram while carbohydrates have only 4 Calories.

Body Fat As Storage of Energy

Body fat provides the most important reservoir of stored energy as adipose tissue. Even in a person who is not overweight, body fat still makes up about 10 percent of their body weight. From a survival standpoint, this is absolutely critical, since in periods of low food availability or during a famine situation, a person must live off his/her stored body fat or perish. The fact that we are all alive today is proof that our ancestors had bodies that were efficient at storing, and later retrieving, the energy in the body fat.

This is how we obtain energy from the stored body fats. As we have seen, fats are made up of glycerol combined with fatty acids. The glycerol is broken away from the fatty acids, and can then be converted into glucose for immediate use, and to glycogen for storage and later use. About 10 percent of the fat we eat converts to sugars in a process called glyconeogensis (gly-co-KNEE-oh-gen-e-sis).

If you have not read the series of articles I have written on carbohydrate metabolism, go to the Vital Information section of CarbSmart Magazine and read those articles for a better understanding of how glucose and glycogen are used for energy.

Fats Also Serve As Transporters

Another very important function of fats is the transportation and use of vitamins A, D, E, K, and for other substances which are fat soluble. Without fat in the diet, those vitamins would not be able to function. This would result in severe problems with eyesight, skin, nail formation, blood clotting, kidney function, bone growth and repair, reproductive functions, and cellular energy. Additionally, some of the fatty acids that make up fats are absolutely necessary for life. They are called essential fatty acids (or EFAs), because they must be eaten.

Fats slow stomach digestion and passage of foods through the intestinal path. This important fat function gives the body the necessary time to absorb the essential nutrients in the protein food, which historically has been in shorter supply.

Today, Western societies have more food than we need, so we tend to forget that in times of food scarcity, the body needed to get everything it could from every bite.

Additional Functions Of Fat

There are other vital functions of fats which I have not mentioned, but from these you can see that, contrary to being a bad thing, dietary fat is very necessary, not only for optimum health, but for life itself.

Next time, we'll continue talking about fats. We will look at bile and its relationship to dietary fat, and perhaps we'll have time to start talking about fat digestion.

Join me, won't you?

*** Note: In the body of the article, you will see several times where the word calorie is spelled Calorie. The capital 'C' is required on those words because I am talking about kilocalories.

Posted 2/9/2002

In the past several articles, we have been talking about how it is that fats and cholesterol became the enemies of the table. But after going through the entire story, we can see that the science of dietary fat is much more complicated than it has been presented by The Official Opinion.

Among the issues said to be involved are the different forms of cholesterol, the levels of carbohydrates in the diet, triglyceride levels, regional diets, the increasing widespread use of cholesterol-lowering drugs among the general population, the health effects of a diet too low in dietary fat, and the huge amounts of money available from food manufacturers for influencing what the public buys and eats.

Additionally, there are doubtlessly other factors which have not been looked at very closely, such as the likely effect of smoking on cholesterol levels.

So as we look at all we have discussed, what is our best position, relative to all that has been said? What have we learned from the information presented in the past six articles? The information you want to have about the subject can be summed up by these twelve facts:

In final summary, we can be fairly confident that low fat diet plans are not the smartest approaches to good health.

Now we are ready to begin looking at fats and oils as foods. Next time, we will start by asking these questions: "What are fats? What are oils? How are fats and oils digested and absorbed into the body?" And then we'll talk about how dietary fats relate to body fat.

Posted 2/23/2002

Today we are starting our discussion of fats and oils as foods. In this article, we will explore the definitions of the words fats and oils, and we will talk about the characteristics of these substances.

A Definition Of Terms

To make sure we are always on the same page, we have to make a differentiation between the words 'fat,' 'dietary fat,' and 'body fat.'

The Composition Of Fats And Oils

Fats and oils are one of the three kinds of substances known as lipids. In addition to fats, lipids include the compounds known as phospholipids (FOS-fo-lip-ids), and those known as steroids. We will talk about phospholipids and steroids as we go along, but for now, we are focusing on fats.

Fats, like carbohydrates, are composed of the same basic elements: carbon, hydrogen, and oxygen. However, the smallest units of fats (called molecules of fat) are larger than molecules of carbohydrates, and the relative proportions of carbon, hydrogen, and oxygen to each other in fats is different from those in carbohydrates.

One molecule of fat is formed by the union of one unit of a substance called glycerol, with three units of substances called fatty acids. There are a great many different types of fatty acids, but the dietary fats found in our foods and in our body fat are, for the most part, formed from only three kinds of fatty acids. (For those who are keeping notes, these are known as oleic acid, palmitic acid, and stearic acid, and they form fats known as olein, palmitin, and stearin.)

Glycerol (GLIS-er-all), sometimes called glycerin or glycerine, has three "arms." Each of the three arms joins with one fatty acid to make a single molecule of fat. This explains why fats are referred to as tri-glycerides (usually spelled triglycerides, without the hyphen). These are the simplest fats.

The Composition Of Fats And Oils

Dietary fats are mixtures of the three fats mentioned above, olein, palmitin, and stearin. Differing amounts of each of the three result in the different characteristics of each type of dietary fat. For example, more olein and less of the other two lowers the melting point of the fat. When a fat has such a low melting point that it is liquid at room temperature, it is called an oil. Among these are olive oil, canola oil, and cod liver oil.

Human body fat contains from 70 to 80 percent olein, and therefore has a melting point below normal body temperature. As a result, simple body fats are found in the form of droplets of oil in body cells. In addition, nearly all body cells contain at least some body fat.

Pure fats are odorless and tasteless. The smell that we associate with fats, especially when cooking them, is due to foreign materials that have been absorbed into the fat. The smell of bacon cooking is due to the pork, not the fat. Rancid or spoiled fats smell bad because of bacteria action acting on the fats.

Fats are not soluble in either hot or cold water. Fats that are hard at room temperature can be melted, but they still don't mix with water any more than oils do. You can shake oil and vinegar together in a jar, but as soon as you stop shaking, the water-soluble vinegar separates from the oil.

In order for fats and oils to be able to be mixed with water, they must undergo a process known as emulsification (E-mull-se-fa-KAY-shun). Emulsification is a process by which each droplet of fat is surrounded by a droplet of the emulsification agent. This holds the fat in solution long enough for it to be used.

The reason we can wash our dishes in water is that we use soap, which is an emulsifier. Soap holds the grease (the fats and oils) long enough for them to be washed away. We will talk more about emulsification when we talk about fat digestion.

The Difference Between Saturated And Unsaturated Fats

In large part because of the great Fat Versus Low Fat controversy that has been going on for half a century, many people tend to think that the only thing anyone needs to know about fats is whether they are saturated or unsaturated. The essential difference between saturated fats and unsaturated fats is that the one is hard at room temperature, and the other is liquid at room temperature.

The word 'saturated' means 'filled to capacity.' When talking about saturated and unsaturated fats, we are really talking about the amount of hydrogen in the chemical make up of the particular fat, compared with how much hydrogen that fat is capable of holding.

Once a fat is fully saturated, it cannot be made unsaturated, but an unsaturated fat can be converted to a saturated fat. This is done by heat, or by other chemical means, in a process known as hydrogenation (high-DROG-gen-nation).

What Are Partially Hydrogenated Oils?

The familiar phrase 'partially hydrogenated oil,' which appears on a great many labels, particularly fast food labels, means that the unsaturated liquid oil was partially converted to a more solid fat. This is done to make the food item more substantial.

New studies appear to indicate that the partial-hydrogenation process is not good for health because it produces changes in the chemical structure of the fats that are unsafe.

By Dr. Beth Gruber, CarbSmart Contributor

Posted 3/22/2002

The last time, we talked about the functions of fats in the body, and why it is necessary that dietary fat be included in our meals. Today we'll be looking at how dietary fats enter the body; in other words, how dietary fat is digested.

Although some initial fat digestion is done in the stomach, most digestion and virtually all nutrient absorption of fats takes place in the small intestines. Both animal fats and vegetable fats appear to be equally well-digested and equally well-absorbed. The digestive actions are facilitated by an enzyme secreted by the pancreas, and by an important substance that comes from the liver.

We are most familiar with the pancreas as the organ that secretes insulin, but the pancreas (a long, narrow gland that lies below and behind the stomach) also produces several enzymes for the digestion of proteins, carbohydrates, and fats. The pancreatic enzyme, called pancreatic lipase or steapsin, is the major fat-digesting substance. It functions to split the dietary fat back into its component parts, glycerol and fatty acids. The digestive substance from the liver is called bile, and it works hand-in-hand with the lipase.

Since fats and oils cannot be mixed with water or water soluble substances, they must be altered before they can be digested. The alteration is done in a process known as emulsification. (Recall that we first talked about this process in a previous article when we talked about how soap makes it possible to wash grease from dishes.) In the process of emulsification, each droplet of fat is surrounded with a droplet of the emulsifying substance, which holds the fat in solution long enough for it to be used. The primary emulsification substance in our bodies is the bile produced by our livers.

Bile is a greenish or yellowish liquid that serves two major purposes in our bodies, as it is basically composed of two kinds of compounds. These compounds are called bile pigments and bile salts.

Bile pigments are a waste product that comes from the normal destruction of red blood cells, as the older cells die and are replaced by new ones. The bile pigments give color to the bile, and they give normal coloration to the feces. The pigments enter the small intestines, and are then passed out of the body with bowel movements. If the bile pigments build up in the liver because they are being produced too fast (such as when there is a disease that is causing red blood cells to be destroyed in an abnormal way), or because the bile can't be excreted due to a blockage (such as gallstones), many body tissues, including the skin and the whites of the eyes, turn yellow. This condition is called jaundice.

The other important factor in bile is the bile salts. They are the chemicals that act in fat metabolism to emulsify dietary fats. The emulsified fat droplets present a lot of surface area for the action of the enzymes, which are water soluble. As a result, fat and fat-soluble vitamins are able to be absorbed through the walls of the small intestines. After the bile salts do their work, the liver reabsorbs them from the blood so that they can be used again.

The liver is the largest organ in the body and is located to the right of the upper part of the stomach. Among its many functions is the production of bile. The formation of bile is continuous, as much as 1000 ml per day, but since it is not needed unless there is undigested fat present in the upper small intestines, the bile is stored in the gallbladder between digestive periods.

Bile leaves the liver and flows down a tube that enters the small intestines. But on the way, most of it is diverted into a side channel called the cystic duct. This duct leads to the gallbladder, a small sack located under the liver. The gallbladder has only one function: it collects and concentrates the bile. And since it has no other function, we can be entirely certain that fat belongs in the human diet. In other words, if fat was not a natural part of our diet, human beings would not have a gallbladder.

During the period of time that the bile is being stored in the gallbladder, water from the bile is absorbed into the blood, thereby making the bile more concentrated and improving its action.

In a person who has had his/her gallbladder removed, bile from the liver runs directly into the small intestines as it is produced. It may or may not encounter any fats that need digestion when it gets there, but even if there is fat present, the bile will be less than optimal in its function since it will not be of the concentrated strength gained by bile that has been stored in the gall bladder for a period of time. And if fats can't be acted upon by sufficient bile, much of them will proceed through the intestinal tract undigested.

Now, this may seem like a good idea at first blush, since most undigesteddietary fat will not provide dietary calories, but if fat is not digested, much of the fat-soluble vitamins A, D, E, and K, much of the calcium, and much of the essential fatty acids will be lost. People who have had their gallbladders removed should strongly consider taking a product containing bile salts as a food supplement with each meal.

Once the dietary fats have been digested and absorbed through the walls of the small intestines, some of the fatty acids reform with the glycerol that was separated from them. These simplest-form fats are now referred to as triglycerides.

As we have already seen, since both fats and fatty acids are insoluble in water, special conditions must exist to transport the fat in the blood. A large proportion is transported as triglycerides, some binds with protein to make lipoproteins, and some binds with cholesterol.

Some fats are stored in the liver for a time, where they are used to form more complex lipid structures, such as cholesterol and other steroids, or lecithin and other phospholipids.

And just in case the whole process is starting to seem understandable, here's a little complication to keep you on your toes: unlike carbohydrates and protein, which must be fully digested before they can be absorbed, not all fats needs to be fully digested before they can be absorbed.

Some dietary fats enter the lymphatic system, which is a sort-of secondary blood system, without being digested. We will talk more about the lymphatic system as we move along.

By Dr. Beth Gruber, CarbSmart Contributor

Posted 4/6/2002

Summing It Up

So far in our discussion of fats, we have learned that fats are made up of a substance called glycerol in combination with other substances called fatty acids. We have learned that saturated fats are hard at room temperature, while unsaturated fats are generally liquid at room temperature.

We have seen that unsaturated fats are often called oils. But the term oil can be confusing, because it is also used for substances having no relation to lipids or dietary fats, such as mineral oil or lubricating oil. To keep this clear in your mind, remember that the word oil indicates the physical state of a substance, not its chemical nature.

Adding to the potential confusion is the fact that the hardness or consistency of a fat, which is related to its melting point, can't be fixed too precisely because fats are generally mixtures rather than pure substances. Dietary fats often contain some of both saturated and unsaturated fatty acids.

Also, the color of a fat has nothing to do with the issue. Animal fats, for example, derive their color from the pigments present in the diet of the animal.

The Difference Between Adipose Tissue And Structural Fat

When we talk about body fat, we differentiate between adipose tissue and structural fat.

Structural fat is the body fat that is essential for the protection of the internal organs, for building parts of the brain, and for the development and maintenance of body cells and hormones.

Adipose tissue is made up mostly of simple fats, while the structural fat is present as more complex lipids, such as phospholipids and cholesterol.

Ketone Production

When fats are absorbed through the walls of the small intestines, the glycerol is separated from the fatty acids, and the fatty acids are broken into pieces in the liver. The pieces are known as ketone bodies.

Ketone bodies are used as a source of energy, and like glucose, ketone bodies eventually become carbon dioxide and water. The production of ketone bodies is a part of normal fat metabolism, and it is the way that fat is used.

The amount of ketones formed in the liver depends on the amount of glucose or glycogen (stored glucose) available for use as energy. This reverse ratio means that fewer ketones will be produced in the presence of a lot of glucose. The reason for this is that insulin depresses the formation of ketone bodies. When glucose is being used for energy, ketones are not needed in large amounts. On the other hand, in the absence of adequate insulin, the body metabolizes stored fats to produce the energy that the body's tissues require.

The action of the pituitary gland on the formation of ketones is just the opposite. Pituitary hormones mobilize fat, and favor the formation of ketones in the liver, thereby decreasing the power of tissues to consume glucose.

What Is Ketosis?

As we have seen in previous articles, when the glucose available for energy use exceeds the tissues' needs, the glucose, under the influence of insulin, is converted to glycogen and to body fat. But when there are more ketone bodies available for energy use than are needed by the tissues, they cannot be converted into fat storage. They accumulate in the blood, and are excreted in the urine. This is called ketosis.

One of the ketone bodies is called acetone, and it is the chemical that is detected on urine ketone dip sticks.

Ketone production results from the breakdown of body fats. The excretion of the excess ketones in the urine is important because the presence of large amounts of ketone bodies in the blood threatens to upset the acid-alkaline balance of the blood, and thereby, the balance in the tissues.

If you follow a very low carbohydrate diet, and thereby reduce the amount of glucose and insulin circulating in your blood, your body will manufacture increased amounts of ketones, as it uses your stored body fat for its energy needs. In this case, we generally consider the ketosis to be a good thing because excess adipose body fat is being used and discarded.

Some authorities have referred to this kind of ketosis as benign dietary ketosis, or lipolysis ketosis. Lipolysis means fat destruction.

The Controversy

The ketosis controversy stems from the fact that there is another kind of ketosis, more properly called ketoacidosis (keto-ACID-dough-sis). This type of ketosis occurs in serious diabetes, in the total or almost total absence of insulin. It is quite dangerous, and is associated with kidney disease and with certain blood and brain dysfunctions.

Confusion between these two types of ketosis leads some scientists and some doctors to consider all ketosis to be inadvisable. Since the production of ketones can be prevented by the presence of carbohydrates, some consider the low carbohydrate diet to be dangerous, as well.

In this regard, a very famous phrase was repeated for decades, and is still repeated among those who advocate a high carbohydrate, low fat diet. The phrase is "Fat burns in the fire of carbohydrates." This means that fat is utilized when carbohydrate is metabolized. But one of the major problems with this viewpoint is the well-known fact that fats are always used by the cells, no matter how abundant - or how meager - the supply of carbohydrates may be.

Fear of ketosis is really fear of 'fat burning in the weak fire of reduced carbohydrates'. However, readers of these pages have learned that dietary carbohydrates are not required for life, if enough of the proper kinds of protein and fats are eaten.

As we have discussed in previous articles, some of the protein will become glucose, and, additionally, some 10% of the dietary fat will also convert to glucose. This conversion will control the amounts of ketones produced, since the converted glucose will stimulate the release of insulin.

If fat burns in the fire of carbohydrate, the glucose produced by the conversion of the protein and fat will provide enough fire. Consequently, unless there is complete or nearly complete absence of insulin, there will be no ketoacidosis problem arising from the formation of ketones.

If you have not read my series of articles on carbohydrates and protein, you will want to go to the CarbSmart website archives and take a look at them. http://stores.yahoo.com/carbsmart/vital.html

Vital Information

The Effects Of Dietary Fats On Disease By Dr. Beth Gruber, CarbSmart Contributor

Posted 4/20/2002

In my last article, I explained the formation of ketone bodies, and we discussed the controversy over ketosis. We learned there are two kinds of ketosis: one, called lipolysis-ketosis, is from normal metabolic processes, and the other, more properly called keotacidosis, is from disease. We noted that in the absence of preexisting kidney or liver disease, ketosis will not become a problem as long as sufficient and adequate protein and fats are eaten. This is because some of both proteins and fats become glucose, and the presence of glucose in the body prevents too many ketones from forming. The key here is the phrase "in the absence of disease."

For example, after dietary fat has been absorbed into the body, much of it travels to the liver. But if the liver is not working properly, the fat will arrive faster than the liver can make the ketones. If this happens, the fat accumulates and causes a rather serious condition known by the simple name, fatty liver. The accumulated fat crowds the liver's blood supply and causes the death of the liver cells. This leads to cirrhosis of the liver. So we can see that the problem is not a high protein diet, a high fat diet, or even high levels of ketones. The problem is a liver that doesn't work properly.

In a high carbohydrate diet, the high levels of insulin that are produced favor the storing of fat as adipose tissue, while lessening the liver's supply of the very fat that would be broken down into ketone bodies and used for energy.

Testing The Effects Of Dietary Fats On Disease

There is a rather large difficulty with testing the effects of fats on disease. When researchers reduce the amount of saturated fat in a test diet, they have to give the test subjects something to eat in place of the fats. What they choose to give instead makes a huge difference. Are they adding polyunsaturated fats? Are they adding carbohydrates? What kind of carbohydrates? Are they adding a single carbohydrate or mixed carbohydrates? Are they adding green leafy vegetables, or large quantities of pasta?

Each choice of a substitute food for the avoided fats adds a different factor that might alter the outcome. Tests hope to find what changes take place when fats are reduced, but how do we know that the results are actually answering the questions asked?

Food choices can influence the health of entire populations, regardless of whether or not any conscious effort is made to reduce fats and cholesterol. Consider that people who eat large amounts of meat and dairy products, and plenty of saturated fats in the process, tend not to eat a lot of vegetables and/or fruits. Assuming there is a health correlation, is the correlation properly drawn to the high levels of meat and dairy, or should it be drawn to the low levels of vegetables?

We are told of the heart protection offered by the so-called Mediterranean diet. But what is it about this way of eating that makes a difference? Is it the fish, the olive oil, or the fresh vegetables? Or, is it the absence of what people following this diet are not eating, instead of the fish, olive oil, and veggies that they are eating? The general opinion that it is what they eat rather than what they don't eat that offers the protection, is not supported by the data.

As the Mediterranean nations became more affluent since the 1950s, their people began to eat proportionally more meat and animal fat. Yet, their heart disease rates continued to improve compared to populations that consumed as much animal fat, but ate fewer vegetables throughout the year. Some think there may be heart protection available from fats known as omega-3 fatty acids that are found in fish and green leafy vegetables. There may also be factors in antioxidant compounds such as vitamins and certain trace minerals. It may be that as long as these factors are included, the amount of meat and saturated fats are not important.

So, in the final analysis, no one really knows how to change the diet for maximum success, or if changing the diet makes a true difference, or who will benefit the most, if at all.

Do All Roads Lead to Sugar?

Recently, a reader of these pages wrote me to say that her personal trainer had told her that everything we eat turns to sugar. While what he told her is not true, it may seem that way sometimes! As we have discussed in previous articles, 100% of carbohydrates, and 65-70% of proteins become glucose (sugar). In the case of dietary fats, about 10% turns to glucose.

When fats are absorbed into the body, the union of glycerol and the fatty acids is broken by digestive processes. Some of the glycerol is transported to the liver, where it, like protein, undergoes the change called glyconeogenesis. (This, you will recall, is the formation of sugar from other substances.)

Glycerol has about the same food value as sugar, and follows a similar course when it is utilized by the body. The good news is that dietary fat does not directly produce excess adipose body fat. But the portion that becomes sugar certainly does add to the adipose problem.

Other Lipids

As I have previously told you, fats are one of the substances known as lipids. Another member of the lipid group are the waxes. Waxes are not so easily broken down as fats, and they are not digested by the fat-splitting enzymes. Although some waxes may be added to highly processed foods, they are of no value from a nutritional standpoint.

For the most part, waxes are used for industrial purposes such as an ingredient of shoe polish, floor waxes, varnishes, and candles. Beeswax, which is secreted by the honeybee to form the comb, is removed from honey most of the time, since it has no nutritive value to humans, but does have economic uses in industry.

Posted 5/11/2002

As we have seen in a previous article, fats and oils are members of a category of substances known as lipids. Other lipids include the compounds known as waxes, phospholipids, and steroids. Last time, we spoke about waxes, and in this article, we'll discuss the other important lipids. Additionally, I'll have some more things to say about cholesterol, since cholesterol is one of these other lipids.

Lecithin

Lecithin is the most important phospholipid in the human body. It is called a phospholipid because it includes the substance known as phosphoric acid. Lecithin is found in all cells, and is essential for life. It is necessary for cell walls, and is involved in the selective permeability of membranes. (Recall that the walls of cells must control what passes in and out of them. The determination of what goes in and what goes out is called selective permeability.)

Lecithin and the steroid cholesterol are components of the body's cellular structure. They assist in the framework which supports the protein constituents of cell protoplasm. The most important steroid in dietary considerations is cholesterol, which takes its name from bile (chole means bile) since it was first discovered in gallstones. Steroids, which are also called sterols, are needed for life, and as I have mentioned before, cholesterol, too, is absolutely necessary.

Cholesterol

Cholesterol is absorbed from the intestinal canal along with dietary fat. Bile is necessary for cholesterol absorption as well as for fat absorption. (In a previous article, I discussed the role bile plays in the digestion of dietary fats. Check it out in the CarbSmart archives, if you missed it.)

Cholesterol is held in solution in the bile by the chemicals known as bile salts. If there aren't enough bile salts, cholesterol drops out of solution, and gallstones may form. But, you should be clear on this point: gallstones are not the result of the presence of cholesterol; they are the result of insufficient bile salts and other factors which allow cholesterol to drop out of solution.

Cholesterol serves as a precursor of various steroid hormones, and it is especially abundant in the nervous system, where it joins with lecithin to make the coverings that surround nerve fibers. It also helps to maintain the skin since it is not soluble in water and does not become rancid.

Since cholesterol is not soluble in blood (because it is not soluble in water), it is transported in the blood in links with certain proteins called lipoproteins. These lipoproteins are known as High Density Lipoproteins (HDLs), Low Density Lipoproteins (LDLs), and Very Low Density Lipoproteins (VLDLs). The HDLs, LDLs, and VLDLs are called the three fractions of cholesterol.

The amount of cholesterol in the blood is referred to as the blood level, which is measured in a series of related blood tests called a 'lipid panel.' The results of the lipid panel usually include blood levels for triglycerides as well as for total cholesterol, and the three fractional parts of cholesterol. The result numbers all relate to one another.

For example, total cholesterol is the sum of the HDLs, the LDLs, and the VLDLs. And, the VLDL value is one-fifth of the triglycerides number. Additionally, the fractional parts of cholesterol are proportional to one another. The higher your HDL level, for instance, the lower your VLDL level will be.

Total cholesterol is usually the number everyone focuses on, but since HDLs, LDLS, and VLDLs all perform different functions, it is not very useful at all to know a number representing their combined total. It's like thinking you can decide what you can afford to buy for cash by knowing the total number of currency bills in your wallet without regard for whether they are fives, tens, or hundreds. Furthermore, each combination of cholesterol fractions will mean something different. In point of fact, you gain almost no insight whatsoever from your total cholesterol level, and you certainly gain no information as to your risk of heart attack or other disease.

Cholesterol Stands Falsely Accused

The public is scared to death of cholesterol. People generally believe that it should be avoided at all costs. But, as we have seen in previous articles cholesterol is not a curse, and if we do not eat enough of it, we will manufacture it in our own bodies.

As early as 1979, one researcher described what he had learned in the previous 30 years of studying fat and cholesterol metabolism. "It is absolutely certain," he said, "that no one can reliably predict whether a change in dietary regimens will have any effect whatsoever on the incidence [the number of cases] of new coronary heart disease."

Preoccupation with cholesterol levels has not reduced any disease, and even the American College of Physicians has suggested that while cholesterol reduction may be worthwhile for those (usually men) at high risk of dying of coronary heart disease in the short term, cholesterol reduction is of much smaller or uncertain benefit for everyone else.

The Data On Cholesterol Is Skewed

Another thing to keep in mind is that much of the dogma concerning dietary fat and cholesterol came from studies done on drugs to lower cholesterol levels, not from studies on dietary changes to accomplish lower cholesterol levels.

Some researchers have started to caution that if studies look only at cholesterol levels, they are likely going to miss something very important. Even those who have been trapped in the idea that cholesterol is close to poison are having to admit that the connection between cholesterol and heart disease is not strong.

It is also becoming increasingly difficult to study the subject because of the effects of the drugs given to change cholesterol metabolism in so many people. Physicians are routinely prescribing drug treatment for patients with even slight risk of heart disease, and they routinely decide who is at risk by looking at total cholesterol levels.

The market for these drugs in the United States alone approaches 5 billion dollars a year as the definition of who "needs" the drugs continues to expand. While it is apparently true that the drugs reduce LDL cholesterol levels by as much as 30%, whereas diet rarely drops LDL by more than 10%, the question still remains as to whether or not it is a good idea to reduce any blood fraction of cholesterol by nearly one-third.

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