#033 Does Saturated Fat Cause Heart Disease?
This episode explores the complex link between saturated fat and heart disease, concluding that refined sugar and individual genetics play a more significant role. It highlights the dangers of refined sugar and trans fats, offering insights into personalized dietary approaches.
Deep Dive Analysis
15 Topic Outline
Revisiting the Link Between Saturated Fat and Heart Disease
Observational Studies vs. Randomized Controlled Trials
Impact of Refined Sugar on LDL and Inflammation
Understanding Large Buoyant vs. Small Dense LDL Particles
The Role of Apolipoprotein B (APOB) in LDL Uptake
Atherogenic Dyslipidemia and Heart Disease Risk
Importance of Genetic Variation in Dietary Response
Specific Genetic Polymorphisms Affecting Saturated Fat Response
FTO Gene and Obesity/Diabetes Risk with Saturated Fat
PPAR-alpha Gene and Lipid Metabolism
PPAR-gamma Gene and Fatty Acid Storage/Glucose Metabolism
APOE4 Gene and LDL Cholesterol Recycling
Negative Repercussions of Saturated Fat Reduction Guidelines
Broader Harms of Refined Sugar Consumption
Key Takeaways: Saturated Fat, Genetics, and Refined Sugar
7 Key Concepts
Small Dense LDL Particles
These are a type of LDL cholesterol that tends to be dangerous. Unlike large buoyant LDL, small dense particles circulate longer, are less easily endocytosed by cells, and are more prone to oxidative stress and inflammatory transformations, which can lead to plaque formation in arteries.
Apolipoprotein B (APOB)
APOB is a protein found in LDL particles that acts as a ligand for LDL receptors on cells, facilitating the uptake of LDL particles into cells. In smaller LDL particles, the receptor recognition site on APOB can be partially obscured, hindering their proper utilization and removal from circulation.
Atherogenic Dyslipidemia
This is a pattern of lipid abnormalities strongly associated with heart disease. It is characterized by elevated levels of triglycerides, increased small dense LDL particles, and low levels of large buoyant HDL cholesterol.
Genetic Polymorphisms
These are variations in genes that cause them to operate slightly differently from similar versions in other individuals. These variations can significantly influence how a person's body responds to specific foods and nutrients, such as saturated fats.
FTO Gene
This gene encodes for the 'fat mass and obesity associated protein.' Certain polymorphisms in the FTO gene can increase obesity risk, particularly when combined with a high saturated fat and low polyunsaturated fat intake, and may negatively affect blood glucose and insulin levels.
PPARs (Peroxisome Proliferator Activated Receptors)
These are nuclear receptor proteins that function as transcription factors, regulating genes involved in metabolism of carbohydrates, lipids, and proteins. Specific PPAR genes, like PPAR-alpha and PPAR-gamma, are relevant to how individuals respond to saturated fats.
APOE Gene
The apolipoprotein E gene has different versions, with APOE4 being a common one. APOE4 is associated with the liver not recycling LDL cholesterol very well, leading to higher concentrations of LDL particles circulating longer, increasing their chance of inflammatory transformations and forming small dense or oxidized LDL.
7 Questions Answered
The link between saturated fat and heart disease is not straightforward; while some observational studies found a link, randomized controlled trials suggest that a diet high in saturated fat but low in refined sugar and processed foods may not cause heart disease and can even improve risk factors.
Large buoyant LDL is considered beneficial as it transports fatty acids and cholesterol for cell repair and creation, while small dense LDL particles are dangerous because they circulate longer, are less easily utilized by cells, and are more prone to inflammatory transformations that lead to plaque formation.
Refined sugar consumption can lead to an increase in small dense LDL particles and systemic inflammation, creating a state known as atherogenic dyslipidemia, which is strongly associated with heart disease.
Yes, you can ask your doctor for an advanced test like the ion mobility test, which measures the particle size of LDL and HDL, though it is not yet part of standard care.
Genetic polymorphisms can significantly alter how an individual's body processes and responds to saturated fat, affecting factors like obesity risk, blood glucose, insulin levels, and the risk of developing small dense LDL particles.
The guidelines led people to increase their intake of refined carbohydrates and processed foods, and also resulted in the widespread appearance and consumption of deadly hydrogenated oils (trans fats), which significantly increase heart disease risk by making cell membranes rigid.
Refined sugar consumption is linked to increased risk of cancer, changes in brain reward pathways similar to drugs of abuse, altered neuron structure, brain atrophy (even in prediabetes), impaired brain repair, shorter telomeres, and contributes significantly to daily caloric intake for many adults.
14 Actionable Insights
1. Eliminate Refined Sugar
Make a significant dietary change by eliminating refined sugar, as it is a ‘mess’ and its removal is one of the best ways to quickly achieve major health improvements for everyone.
2. Avoid Trans Fats
Strictly avoid hydrogenated oils (trans fats) like margarine, as they are deadly and significantly increase heart disease risk by stiffening arteries.
3. Reduce Refined Sugar & Processed Foods
Prioritize a diet low in refined sugar and processed foods, as this combination has been shown to reduce fat storage, improve triglycerides, blood sugar, insulin sensitivity, and lower blood pressure.
4. Avoid Sugar-Sweetened Beverages
Do not consume sugar-sweetened beverages, as they can significantly increase small, dense LDL particles and systemic inflammation (60-100% increase in C-reactive protein), leading to negative biological consequences.
5. Get Genetic Test for Diet
Obtain your raw genetic data from a service like 23andMe and analyze it with tools like Promethease.com or foundmyfitness.com/genetics to understand your specific gene polymorphisms and personalize dietary choices.
6. Request LDL Particle Size Test
Ask your doctor for an ‘ion mobility test’ (available from Quest Diagnostics) to determine your LDL particle size, as small, dense LDL particles are dangerous and strongly associated with heart disease risk.
7. Tailor Fat Intake to FTO
If you have FTO gene polymorphisms that increase obesity risk, prioritize a higher intake of polyunsaturated fats (e.g., fatty fish, nuts) and a lower intake of saturated fat.
8. Tailor Fat Intake to PPAR-alpha
If you have a PPAR-alpha gene polymorphism linked to lower activity and higher disease risk, consume more polyunsaturated fat and less saturated fat, especially if on a ketogenic diet.
9. Tailor Fat Intake to PPAR-gamma
If you have certain PPAR-gamma gene polymorphisms, increase your intake of monounsaturated fats (e.g., avocados, olive oil) and polyunsaturated fats while lowering saturated fat intake.
10. Moderate Saturated Fat with APOE4
If you have the APOE4 gene variant, it is wise to moderate your saturated fat intake, as it’s associated with less efficient LDL recycling and increased risk of harmful small, dense LDL.
11. Consume Saturated Fat Wisely
While saturated fat can increase large buoyant LDL, it’s crucial to avoid consuming refined sugars alongside it, as sugars convert large LDL into dangerous small, dense LDL and increase inflammation.
12. Consume Whole Fruit
Differentiate between fructose from whole fruit and added high fructose corn syrup; consumption of whole fruit is not considered a vice and is different from consuming added sugars.
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6 Key Quotes
Not all LDL cholesterol is created equal and specifically not all LDL confers the same risk of heart disease.
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By staying around in the circulatory system longer, the particle is able to undergo transformations as a consequence of oxidative stress and inflammatory processes. And this is ultimately the beginning of the formation of a plaque in the artery.
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The variability of the glucose response shown in this study, on the whole, undermined the entire concept of a glycemic index.
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While refined sugar makes for a nice scapegoat for these observational studies linking saturated fat perhaps more directly to heart disease than it should be, I believe that genes play a significant enough role that population biasing may be a part of this problem of observational studies blatantly contradicting each other.
Host
These are deadly, quite literally. They significantly increase the risk of heart disease in small amounts.
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All of us should do everything that we can to avoid refined sugar. That stuff is a mess and removing it is one of the best big dietary changes each of us can make if we're coming into this healthier living thing, cold turkey, and trying to make some big improvements quickly.
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1 Protocols
How to Learn About Your Genetic Polymorphisms
Host- Obtain a genetic test from a company like 23andMe, ensuring you get access to your raw data (even their most minimal package should include this).
- Run the raw data through a third-party report service like Promethease (Promethease.com) to analyze against thousands of single nucleotide polymorphisms.
- Alternatively, for curated, actionable genetic information focusing on specific polymorphisms like FTO, PPAR-gamma, and PPAR-alpha, use the genetic tool on foundmyfitness.com/genetics.