New Nordic/Scandinavian public recommendations on diet and nutrition will be published this autumn. According to an article (English version-Google translation) published in a Swedish newspaper last week the new guidelines will underscore the risks of animal-derived saturated fats. The article is written by three Swedes, two of whom are experts in the field of health and nutrition.
The three start by saying that Swedish scientists and experts on the relationship between diet and health have recently warned about the risks of diets rich in animal fat, often termed LCHF (low carb high fat) and its relationship with the risk of heart disease and stroke. They write: “The message from the experts is clear: The fat diets are a threat to public health in Sweden“.
Furthermore they write: “Studies of few hundred thousands people who have been followed for more than 30 years have lead the experts to a final agreement: The consumption of food products rich in animal fat, and refined animal products must be reduced substantially. A question should be asked whether licensed physicians should be allowed to prescribe LCHF, which is not supported by scientific studies”.
Metabolic Syndrome – A Man-made Pandemic
The metabolic syndrome is characterized by three of the following: 1) elevated blood sugar 2) high blood pressure 3) elevated blood triglycerides 4) Low levels of HDL-cholesterol (the good cholesterol) and 5) abdominal obesity. The common denominator in the metabolic syndrome is insulin resistance.
Individuals with metabolic syndrome are at increased risk of developing diabetes, coronary heart disease, stroke, fatty liver disease and cancer.
The prevalence of metabolic syndrome has increased dramatically in recent years, paralleling the obesity epidemic. In the United States, where almost two thirds of the population is overweight or obese, more than one fourth of the population meets diagnostic criteria for metabolic syndrome. In a study published in 2008, the prevalence of metabolic syndrome was around 15 percent in a middle aged Swedish population. Among these individuals obesity is a dominant characteristic.
A systematic review and a meta-anaysis published less than a year ago indicates that carbohydrate restriction has a favorable effect on cardiovascular risk factors. Such a diet leads to weight loss, reduces abdominal obesity, lowers blood pressure, elevates HDL-cholesterol, lowers blood levels of triglycerides and lowers blood sugar. Blood levels of hsCRP are reduced indicating less inflammation.
Another systematic review of randomized controlled trials compared low-carbohydrate vs. low fat/low calorie diets in the management of obesity and related conditions. There were significant differences between the groups for weight, HDL-cholesterol, triglycerides, and systolic blood pressure, favoring the low carbohydrate diet.
So, is there a reason to question whether licensed physicians should be allowed to recommend carbohydrate restriction which most commonly involves increased consumption of dietary fats?
Maybe we should ask ourselves whether licensed physicians should be allowed to not inform individuals with metabolic syndrome about this effective approach.
Will Nordic Experts Lead the New Demonization of Saturated Fat?
The three Swedes point out that new Nordic guidelines written by Scandinavia´s most renown experts will be published this autumn. “The recommendations will highlight the risks of consuming animal-derived fats, which is in line with recommendations from public authorities in the United States, and the European Union. The Nordic guidelines will focus less on the amount of fats and carbohydrates consumed, but more on which types of fats or carbohydrates are good for our health and which are not. Right sorts of fats are oils and other plant based fats, but not animal-derived fat from meat, butter and cream. ”
Furthermore they believe that “with the new Nordic recommendations, the Nordic scientific community will have had their say on the LCHF issue“.
Then they go on to suggest that a special tax should be put on products containing animal and diary fat: “In March 2011, the Danish government started to tax 16 DK for every kilogram of saturated fat in dairy and meat products. Such a tax is needed in Sweden in order to be able to deal with chronic diseases such as heart attacks, strokes and other cardiovascular disease. Now it is time for our politicians to react“.
The Usual Suspects
Once again it seems that public recommendations on diet and nutrition are heading down a narrow road in order to try to establish dietary recommendations that suit everybody. Individual variation and individual needs are not taken into account. Why should we recommend the same type of diet for a young healthy, exercising, normal weight university student, and a fifty year overweight person with abdominal obesity, high blood pressure and pre-diabetes.
Nobody can deny that the obesity epidemic coincides with the initial dietary recommendations put forward almost forty years ago. These guidelines recommended that total fat consumption be reduced and carbohydrate consumption increased. We were led to believe that if we eat less fat we won´t get fat, and we won’t be hit by heart disease.
For the last 35 years fat consumption in most developed countries has diminished. Nobody denies that the prevalence and mortality from coronary heart disease has decreased at the same time. This is due to multiple factors, one of which may be a change in dietary habits. However, despite the dietary recommendations, we have an epidemic of obesity and terrible metabolic disorders threatening to seriously increase the prevalence of many chronic diseases of modern society.
We probably all agree that the consumption of trans fats and refined meat products should be diminished. However, there is no scientific evidence that reducing the consumption of saturated fats will make us live longer or reduce the risk of dying from heart disease.
Furthermore, LCHF is not synonymous with eating more saturated fats. Although you cut down on carbohydrates and increase total fat consumption, you could very well avoid saturated fats and choose mono-and polyunsaturated fats and protein (fish, nuts, legumes and poultry).
Taxing food products in order to improve public health has been debated for many years. Of course, the first thing you have to be sure of is that the product you are taxing is unhealthy. Who’s decision is that? Let’s say a person with overweight and metabolic syndrome loses weight and improves his health by avoiding sugar and eating more fats, including saturated fats. Is it fair to charge him/her extra taxes? By the way, I believe the Danes have abandoned the fat tax, partly because it drove customers to buy food in Sweden and Germany.
If you ever saw the movie The Usual Suspects from 1995 you may remember the phrase “The greatest trick the Devil ever pulled was convincing the world he didn’t exist“. The saying may be traced to the French poet Charles Baudelaire.
And actually, I haven’t mentioned sugar in this article. But it’s not because it doesn’t exist or because it is innocent. For the last four decades, paralleling the decreased consumption of dietary fats and the obesity epidemic, the consumption of refined sugars, fructose in particular has skyrocketed. If you don’t think sugar plays a role in the obesity epidemic and all the metabolic and inflammatory diseases of modern society, the saying that “the greatest trick the Devil ever pulled was convincing the world he didn’t exist” might actually be true.
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You have already mentioned the ‘fat tax’ in Denmark. Today I read an article with the headline ‘why bacon fat makes you fat’ which is obviously because its saturated fat whereas unsaturated fat was fine. Moreover, it hadn’t anything to do with what else you might be eating etc. because we all know that eating fat makes you fat.
This is like turning a supertanker 180 degrees.
…and eating vegetables turns you into a vegetable?
I’m not sure how I should understand your comment but my point is that I don’t believe saturated is killing us.
Sorry – misunderstanding!
Ah, bacon fat. An interesting fact about bacon is that it becomes mushy if pigs are fed distillers dried grains with solubles (DDGS). Excerpt: “Some producers believe that feeding pigs saturated fats will undo the fat-softening effects of DDGS. Firmer fat means longer-lasting pork. But researchers from the University of Illinois found that including saturated fats in DDGS diets makes no difference in fat quality. The researchers formulated six corn-soybean meal diets to test the effects of saturated fat additives on carcass fat quality in pigs. Five of these diets contained DDGS. According to the researchers, pork produced from pigs fed DDGS have reduced shelf life and increased susceptibility to oxidative damage. Oxidative damage affects texture, color, juiciness and the overall flavor of pork products. ‘Distillers dried grains contain unsaturated fatty acids and those fatty acids are deposited into the fat of the animal,’ said Hans-Henrik Stein, study co-author and Department of Animal Science professor at the University of Illinois. ‘From a health standpoint, that’s a good thing, but it can be a problem when producing pork products like bacon.'” https://www.sciencedaily.com/releases/2013/05/130528143731.htm
You see what happens when pigs consume a diet rich in unsaturated fatty acids? Oxidative damage. Same thing happens to humans when they consume inordinately high amounts of polyunsaturated fatty acids. It’s called peroxidation. https://en.wikipedia.org/wiki/Lipid_peroxidation
Yes… I very rarely eat bacon for exactly that reason.
Bacon fat is nowadays liquid at warm room temperature and rich in omega-6 fatty acids, at least with most bacon I’ve bought over the last 20 years in the USA. It’s the diet the pigs get. I’m eating more beef now: ruminant fat depends less on diet.
Since there’s never been a truly scientific study that verified the lipid hypothesis, on which all the low fat insanity was based, what studies do these people claim is the basis for their fat tax argument?
Its always about the tax, not the policy objective.
Well said. The anti-saturated fat campaign, as Mary Enig terms it, is an amazing and appalling phenomenon that probably can be explained in terms of institutional arrangements involving corporations, academia, and government. I commented on the matter a while back. https://www.drjaywortman.com/blog/wordpress/2012/06/14/this-is-how-it-works/
When Ancel Keys declared saturated fats a health hazard back in the 50s the edible oils and sugar interests eagerly publicized the idea. And thanks to corporate influence in academia, nutrition textbooks of the era emphasized the connection between saturated fat intake and total cholesterol and ignored the link between sugar intake and total cholesterol. I find this peculiar because these same textbooks contained tables of foods that affect cholesterol. Both sugar and saturated fat raise total cholesterol but nothing was mentioned about reducing sugar intake to lower cholesterol.
I’ve been deliberately consuming a very high-saturated fat diet for decades with emphasis on dairy. Here is the latest analysis regarding the impact of saturated fats on endothelial function: https://ajcn.nutrition.org/content/98/3/677.full
Flash back to 2006 when Australian researchers “proved” that saturated fats damage arteries. They did this by feeding subjects carrot cake and a milk shake. https://www.lifeclinic.com/fullpage.aspx?prid=534205&type=1 I’ve noticed, over the years, that negative findings about saturated fats get publicized widely.
Then there’s the recent “breakthrough study” that New Zealand public health authorities are using to justify a fat tax in that country. https://health.msn.co.nz/healthnews/8698196/fat-tax-mooted-by-new-nz-study
A few years back I tried to confront professor Rod Jackson, a New Zealand public health authority, with evidence that saturated fats are not a health hazard but to no avail. https://freetheanimal.com/2009/11/saturated-fat-and-coronary-heart-disease-part-i-introducing-professor-rod-jackson.html
Yes, many seem to claim that use of sugar and refined carbs has skyrocketed. But can you provide solid European data to support that claim? Look at these balance sheets based data, and you’ll be surprised.
Tables 6 &7 https://goo.gl/n4n6B4
There is no skyrocketing use of sugar or refined carbs in Europe. Hard to belive. Yes, US is but different once again. If anyone has reliable data showing skyrocketing trends of sugar consumption in Europe I’d be glad to see them.
Reijo.
Looking at table 6 there appears to be an upward trend in many of the countries when it comes to glycemic load. Look at Sweden for example. Of course there is a lot of inconsistency in the date. Europe as a whole seems to have had an increase of 8% in forty years which can´t be considered much. The report shows that many non-European countries have experienced much higher increase in glycemic load. Unfortunately the table doesn´t show data for the last ten years.
But I assume the European countries are still behind US when it comes to sugar consumption. Europe is also still behind US when it comes to obesity, metabolic syndrome and type-2 diabetes. But the European countries are catching up. So, maybe the European countries can learn from the US experience instead of getting stuck in the same trap. What do you think?
In Iceland the consumption of sugary beverages doubled between 1980 and 2000. In the last 15 years the number of individuals with obesity (BMI>30) has almost doubled. Fat consumption decreased between 1990 and 2003. In 1990 it was 41% of total energy consumption, in 2003 it was 35%.
Well, I still would be happy to see data that support *skyrocketing* claims regarding sugar or carbs in European situation 🙂
Obesity pandemic has gotten it’s grip in Europe too, but here neither share of carbs nor sugar consumption has increased. You cannot dismiss this data by pointing out that it’s only forty year data. This is the era when people has gotten fat. Newer data is available online for fee.
I’m all for reducing consumption of sugar and refined carbs but also for evidence based statements, also when referring to food consumption.
Reijo. I never said that sugar consumption has skyrocketed in Europe. The increased consumption of refined sugar is a world-wide issue. The word “skyrocketing” can indeed be used for many countries around the world.
By the way, sugar consumption has increased in Europe according to your reference, at least partly explaining increased energy consumption among Europeans.
No, you did not mention about Europe. Nor did you mention non-European countries. Peace.
Here is an interesting figure showing sugar consumption per capita in different continents, comparing 1996-1997 with 2010-2011. As pointed out by Reijo, no increase in Europe but a clear increase in all other continents. Doesn´t cover high fructose corn syrup and other refined sugars though which may be misleading. You´ll have to scroll down to the second graph in the figure. Can´t really tell you anything about the reliability of the data.
Without looking at any stats,it sounds completely unbelievable that sugar consumption has not risen in europe. At least candy consumption must have sky rocketed in finland:) Do we consume less some other sugar products then…? I wonder could fructose corn syrup & artificial sweeteners explain the stats partially?
Yes it’s difficult to belive. In Europe high fructose syrup is not an issue, I guess. HFCS is mainly American phenomenon related to agricultural policy. Artificial sweeteners may explain overall impression little.
There must be other reasons too. Perhaps sugar is used currently more as candies, ice cream, drinks and less in baking, juicing and conserving at homes? I also suspect that stats mask polarization of sugar consumption. Teens and young females consume more than ever and health consious adults less than ever. Just a guess.
If you only look at sugar consumption based on the use of sugar cane you will obviously not count high fructose corn syrup and other refined sugars.
In his book “Fat Chance: Beating the Odds Against Sugar, Proceessed Food, Obesity, and Disease Dr. Robert Lustig writes: “Okay, America is sugar-dipped and candy-coated. But that´s not true elsewhere is it? World sugar consumption has tripled in the last fifty years, while the population has only doubled. That means our global per capita intake of sugar has increased by 50 percent, commensurate with the (obesity) pandemic.The upper threshold of 200 calories per day by the American heart Assiciation in its scientific statement for optimal cardiovascular health, has been exceeded in virtually every country on the planet“.
Why restrict the viewing to only ‘sugar’? when carbohydrates do convert to glucose after digestion? (percentage). Surely it can be seen that high carbohydrate intake is a serious factor in all of this? Add to that the large consumption, by default, of seed oils rather than natural animal fats and you have a case …. more carbohydrates more non natural/processed fats and diabesity. I choose to eat LCHF to keep my BGL’s in check… that stops insulin spikes too…. so am I to be taxed because I eat for a specific medical problem (rhetorical) Tax me or demand I take drugs? Unfair and basically wrong I say. My opinion.
Thank you for a great article! One of the approaches I find quite fascinating are Dr. Donald Leyman´s writings about the Metabolism diet with a focus on healthy proteins replacing to much carbs (not FAT instead of carbs). Any comments on this?
https://www.wellnessresources.com/tips/articles/how_protein_helps_weight_loss/
Thanks Ásdís. I don´t have much experience with high protein diets.
I know some researchers believe that higher-protein diets help people better control their appetites and calorie intake.
Diets higher in protein and moderate in carbs may provide more satiety so you won´t be sidetracked with constant hunger. There may be fewer insulin spikes and less fluctuation in blood sugar, similar to low carb high fat diets. This could work against cravings.
However, I have to admit that I haven´t read any recent scientific papers on the issue. Maybe I should 🙂
Ásdís. In regard to you comment I ran in to this blog article published today on Dr. John Briffa´s blog. Might be interesting for you to take a look.
Doc,
the fat consumption in US has not declined in absolute numbers (g’s per capita) it has diluted because of sugary drinks. The overwhelming evidence indicates that metabolic syndrome (elevated triglycerides and low HDL-C) together with abdominal obesity are the result of over-eating, not sugar per se (Stamler 2010). Countries such as Cuba, Ecuador, Costa-Rica, etc. have traditionally showed very high table sugar intakes, yet obesity, diabetes and CHD have been rare in these populations, ecologic fallacy? I don’t think so.
Kempner’s rice-fruit diet which was based on rice, fruit, fruit juice and sugar resulted in weight loss in his patients.
DIETARY TREATMENT OF HYPERTENSION. CLINICAL AND METABOLIC STUDIES OF PATIENTS ON THE RICE-FRUIT DIET
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC436162/
Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss.
Kempner W, Newborg BC, Peschel RL, Skyler JS. Arch Intern Med. 1975 Dec;135(12):1575-84.
PMID: 1200726
In fact, Kempner’s renown rice program is still going strong.
http://www.ricediet.com
In the Women’s Health Initiative the control group who were advised to lower fat intake significantly increased the intake of sugar and showed trends towards lower body weight and waist circumference. If anything there was a slight trend towards a lower risk of diabetes in the control group.
Low-fat dietary pattern and lipoprotein risk factors: the Women’s Health Initiative Dietary Modification Trial
https://ajcn.nutrition.org/content/91/4/860.full
Of course this is not to suggest that sugar is a health food, but does cast doubt on the suggestion that a sugar is the primary driver of metabolic syndrome, caloric imbalance and saturated animal fats in particular seem to be better culprits. .
Saturated Fatty Acid-Mediated Inflammation and Insulin Resistance in Adipose Tissue: Mechanisms of Action and Implications1
https://jn.nutrition.org/content/139/1/1.full
Fatty acid–induced NLRP3-ASC inflammasome activation interferes with insulin signaling
https://www.nature.com/ni/journal/v12/n5/full/ni.2022.html
Saturated Fatty Acid-Mediated Inflammation and Insulin Resistance in Adipose Tissue: Mechanisms of Action and Implications1
https://jn.nutrition.org/content/139/1/1.full
A High level of serum palmitate is indeed problematic. But a diet rich in saturated fat does not necessarily elevate serum palmitate. https://rdfeinman.wordpress.com/2012/02/22/saturated-fat-on-your-plate-or-in-your-blood/
Some useful sugar stats here:
https://www.sucden.com/statistics/4_world-sugar-consumption
World average ca. 23kg/yr
(somewhere I found Europe: average 32-33kg/yr & USA 40+kg/yr, alternatively 62-63kg/yr; can’t immediately lay my hands on those refs).
Thanks Kevin.
There is a second figure in the link you provided (you have to scroll down) which shows a comparison between 1996-1997 and 2010-2011 respectively. All continents show an increase in sugar consumption, except Europe. However, it is important to realize that this is sugar cane and sugar beet. Refined sugar such as high fructose corn syrup is not accounted for in these figures.
Approximately 80% of sugar is produced from sugar cane, which is largely grown in tropical countries. The remaining 20% is produced from sugar beet, which is grown mostly in the temperate zones of the northern hemisphere. 70 countries produce sugar from sugar cane, 40 from sugar beet, and 10 from both. The 10 largest sugar producing nations represent roughly 75% of world sugar production. Brazil alone accounts for almost 25% of world production.
Axel:
“Taxing food products in order to improve public health has been debated for many years. Of course, the first thing you have to be sure of is that the product you are taxing is unhealthy. Who´s decision is that?”
I suppose it comes down to whether there’s evidence to back up the health claims or not. Or what do you think? I’d say that if we want to tax foods, taxing foods with high fat & high sugar contents and very little vitamins & minerals, combined with high palatability (e.g. fast food), would be the best option.
Or perhaps it’d be more beneficial to drop VAT for healthy foods? For instance vegetables, fruits, berries, nuts and fish. Or combine this with added taxes for fast food, sugary snacks and sodas?
“Let´s say a person with overweight and metabolic syndrome loses weight and improves his health by avoiding sugar and eating more fats, including saturated fats. Is it fair to charge him/her extra taxes?”
I suppose you’ll have to look at both isocaloric comparisons and situations where one’s weight is kept stable to get a proper picture. Losing weight improves risk markers, e.g. blood lipid levels and inflammation markers, despite the dietary changes used to achieve the weight loss (an oversimplification, but more or less accurate unless we’re talking about really extreme options).
Reducing the tax (and price) of healthy foods would mostly likely be effective. Problem is that almost no country has willpower and courage to introduce tax reductions because there is enourmous pressure to increase overall taxation in this dire economic situation. Norway could do it, why they don’t 😉
I’d like to see heavy taxes imposed on fish. Sweden, Finland & Lithuania are not even allowed import their fish to other EU countries because of toxicity, these countries “negotiated” special deal for their fish producers to be allowed sell their toxic fish to domestic consumers. Fish should be replaced by healthy starches, plant-based omega3 sources and if necessary by algae made, plant-based omega3 supplements.
Then again, tax exemption should be provided to those grain producers who sell their grains directly to consumers (not to animal factories). and of course to potato farmers.
..export, that is. Finland, Sweden & Lithuania are prohibited to export their fish.
Great aricle Axel, keep up the good work :=))
Doc,
have you seen these new studies:
1) Plasma Fatty Acid Composition and Incident Ischemic Stroke in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study.
“Conclusions: In this US cohort of whites, we found significant positive associations of plasma saturated and monounsaturated fatty acids, especially of palmitoleic acid, with ischemic stroke. We also found an inverse nonlinear association between linoleic acid and ischemic stroke.”
https://www.ncbi.nlm.nih.gov/pubmed/23920478
2) Serum Fatty Acids and Incidence of Ischemic Stroke Among Postmenopausal Women.
“These findings suggest that individual serum trans, saturated, and monounsaturated fatty acids are positively associated with particular ischemic stroke subtypes, whereas individual n3 and n6 polyunsaturated fatty acids are inversely associated”.
https://www.ncbi.nlm.nih.gov/pubmed/23899914
3) Elevated Remnant Cholesterol Causes Both Low-Grade Inflammation and Ischemic Heart Disease, While Elevated Low-Density Lipoprotein Cholesterol Causes Ischemic Heart Disease without Inflammation.
https://www.ncbi.nlm.nih.gov/pubmed/23926208