I am a GP, trained to recommend low-fat diets and when these fail, to prescribe the medications that reduce cholesterol, lower blood pressure and tame unruly blood glucose.
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My journey to thinking otherwise has involved unlearning decades of unhelpful and often frankly wrong information.
I had to learn how our bodies use energy. Basically, if you eat fat and have low insulin levels, then you burn fat. If you eat sugar and carbs, the resulting spike in insulin signals your body to store excess carbs as fat. And it's super-easy to overeat sugar and carbs.
For me personally, a low-fat diet with less meat, lots of whole grains, and legumes in volumes normally associated with sainthood didn't work. I experimented with what I ate, while I read and read and read nutritional science.
I stopped trusting the official dietary advice that extols the virtues of the rainbow. I focused on whole, nutrient-dense, real foods like meat (with the fat), chicken and fish, eggs, cheese, and non-starchy vegetables.
What I don't do is scoff lots of deep-fried food. Nor is what I eat obviously greasy. I've learned it's OK to sauté in butter or other animal fat and leave the skin on the chicken and the fat on the chop. Pork crackling and baked chicken skin are treats that needn't be feared. I prioritise real food and leave the processed junk well alone.
I note how I feel (better) and that I enjoy food (immensely). Fat equals flavour, as celebrity chef Kylie Kwong used to say. I feel satisfied and I don't snack. Sometimes it still feels a little bit naughty cooking with lard or coconut oil, but it tastes great while my weight is stable and my energy good.
It has been quite a journey, unpacking the myths of saturated fat, cholesterol and heart disease. There's still much to learn about the mysteries of dietary fat, but most importantly, my food world is rich and tasty. I'm no longer afraid of the good fats.
Overcoming fat phobia
For decades many people have been terrified of fat. Not just body corpulence, but dietary fat. There are few things scarier than your GP saying "Your cholesterol is a bit high". In our collective minds, eating fat = cholesterol = imminent heart attack. The cure is obvious: go on a low-fat diet, lose weight, lower your cholesterol, live forever.
Since 1984 or so, we've had low-fat dietary guidelines which recommend don't-eat-the-chicken-skin, cut the fat off your steak and chops, use low-fat dairy, and if you must, a scrape of cholesterol-lowering margarine. All this is supposed to keep us healthy. When it doesn't, cholesterol lowering medications in the polypharmacy (many pills) will keep our hearts ticking.
So how come we have record levels of chronic disease, including type 2 diabetes, obesity and fatty liver disease? And why are we seeing these once adult-only problems in children? In the US, it's estimated that only 12 per cent of the adult population is metabolically healthy. So, almost nine in every 10 adult Americans have at least one metabolic problem, such as obesity, high blood pressure, cholesterol problems, diabetes or pre-diabetes or fatty liver.
And Australian adults are not far behind the US. What went wrong?
Frankly, the low-fat dietary guidelines are wrong. Eating less fat does not help when that fat is replaced with sugar, or things soon-to-be sugar, such as bread, rice, pasta and cereal. Lots of carbohydrates are a fast-track to the blood-glucose-insulin rollercoaster, leaving you hungry sooner.
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Trying to eat less fat doesn't work if you eat ultra-processed refined carbs designed to trigger food cravings. Low-fat has not stopped the nation's metabolic health crisis. Let's have a brief tour through some of the science which suggests that low-fat guidelines are part of the problem.
Less fat, more obesity
Twenty years ago, prominent American dietary guru and academic Walter Willett observed that a substantial decline in dietary fat consumption had corresponded with a massive increase in obesity. His 2002 paper concluded that diets high in fat do not appear to be the cause of obesity and reductions in dietary fat are not the solution.
But the dietary guidelines didn't change. In 2010, a team of scientists conducted a meta-analysis of epidemiologic studies that showed no significant evidence for concluding that dietary saturated fat is associated with an increased risk of heart disease or stroke. That same year, the team showed replacing dietary fat with carbohydrate exacerbates all the metabolic problems associated with insulin resistance and obesity, such as increased triglycerides, small LDL particles, and reduced HDL cholesterol. They concluded that limiting dietary carbohydrate improved all features of metabolic disease.
In 2020, a review for the Journal of American College of Cardiology examined the recommendation to limit dietary saturated fat. Sifting through the evidence, the authors found no benefits from reducing dietary saturated fat for cardiovascular disease and total mortality. Additionally, they noted the protective effects of saturated fats against stroke. Among their conclusions: full-fat dairy and unprocessed meat are not associated with heart disease. Meanwhile, the US Dietary Guidelines (to which Australian guidelines kow-tow) still recommend limiting saturated fat.
Despite the evidence, the myths persist. We all know that butter and fatty meats will kill you. But it's the sugar we should be scared of - and the fries, pizza, donuts, soft drinks, sweets and icecream - the cheap, convenient junk that sort of resembles food but provides little nutrition. Meanwhile, it's a national tragedy that our dietary guidelines continue to scare us away from real foods such as meat, eggs and full-fat dairy.
- Liz Fraser is a Canberra GP and a member of the Defeat Diabetes advisory panel.