Carbohydrate and Fat Controversies: Part 2
In Carbohydrate and Fat Controversies: Part 1, I begun an examination of the argument over carbohydrate and fat intakes in the human diet, explaining that, contrary to popular argument, most extremist stances in this debate are incorrect. In Part 2, I want to continue addressing the issue by looking at both sides of the debate.
Examining Both Sides of the Debate
As noted, the usual argument goes that high-fat diets cause high-cholesterol, heart disease, cancer, obesity and the rest, as evidenced by the high incidence of those disease in modern diets (which are typically high in fat). But that’s a questionable conclusion to draw.
Modern diets are also high in carbohydrates (and mainly the highly refined, high GI, low-fiber stuff that the body often doesn’t handle well), low in fruits and vegetables, and generally contain the wrong types of fats (an excess of saturated and trans fats with insufficient amounts of healthy fats). Such an intake is typically coupled with inactivity, the folks eating them tend to be overweight/obese, smoking and alcohol play a role, etc. That is, there are a number of inter-related factors at work here.
Pinning the blame entirely on fat intake or expecting only a reduction in fat to fix the problem is disingenuous: there are a lot of variables at work here. Some research suggests that the entirety of the problem rests with excessive saturated fat intake with the other variables (activity, fruits and vegetables, etc.) playing a relatively minor role. It’s awfully hard to tease out all of the relationships when there are this many variables at play.
Similar comments can be made in terms of obesity. Fat is more calorically dense than carbohydrates and studies comparing high-fat (40%) to low-fat (25%) meals find that people tend to eat more in the higher fat conditions; this is usually referred to as passive over-consumption and leads to excess calorie intake. These studies have problems, mind you, but that’s beyond the scope of this article. The point does stand, though, that dietary fat is tasty (giving food mouth feel) and folks do tend to eat more of foods that taste good.
But while it’s common to blame obesity on high-fat diets, not all researchers agree. Some cultures have fairly high fat intakes but have no problems with obesity and researchers are starting to realize that fat isn’t the ONLY problem. Increasing intakes of refined carbohydrates (contributing large numbers of calories to the diet), decreasing activity, increasing portion sizes and other factors all contribute. You can’t dismiss an excessive fat intake as part of the obesity problem; it’s simply not the sole factor. I don’t want to get into a massive discussion of the carb versus fat debate in terms of caloric intake, preferring to focus on the health issues here.
The fact is that not all studies link a high fat intake to an increased risk of disease. For example, recent analyses of our ancestral diet (what we ate during 99.9% of our evolution) suggests a much higher fat intake and much lower daily carbohydrate intake. Exact numbers vary depending on what assumptions you use but carb intakes of 20-40% (most of which came from low GI, high fiber fruits and vegetables; grains were almost non-existent), fat intakes of 28-60% (which had a significantly different quality than our current diet), and protein intakes of 19-35% of total calories are the current best estimates.
Studies of extant hunter-gatherer societies show little incidence of any of the diseases of modern society and it’s thought that our evolutionary diet was NOT atherogenic (promoting heart disease) despite the high fat intake.
The reasons for this are many-fold, of course and that’s the key to keep in mind when you consider fat intakes and potential health problems. In our ancestral diet, fiber intakes were monstrous, averaging 100-150 grams per day. As well, despite the high fat intake, the source of that fat was far, far different than our modern intake. Much higher intakes of polyunsaturated and mono-unsaturated fats and far lower intakes of saturated fat were fairly typical. Activity levels were also much higher and folks generally stayed pretty lean. Alcohol intake was low or non-existent, as was smoking. Although our ancestors dealt with various stresses, they didn’t deal with the kinds of chronic stress that occurs in modern societies.
Related to this, studies of the Mediterranean diet have found few problems in terms of heart disease and all the rest despite a relatively high fat intake (40% of total calories). Although the reasons are, as always, multi-factorial some of the contributing factors are that the fat intake is primarily from mono-unsaturated sources (e.g. olive oil).
As well, a tremendous amount of fresh vegetables are typically consumed (with far less reliance on refined carbohydrates). Other factors such as activity, bodyweight, moderate alcohol intake and lowered stress levels probably play a role. Studies of the Alaskan Inuit show similar results, despite an extremely high-fat intake, heart disease is almost unheard of. This has typically been attributed to the high intake of fish oils but there may be genetic adaptations as well.
Of course, some studies on low-carbohydrates diets (which are typically high in fat) will show a big improvement in blood lipid levels; this is especially true for individuals with insulin resistance. I’d note that this effect primarily occurs when weight is lost; in studies of very low-carbohydrate diets where weight is gained, blood lipid levels often get much much worse.
Thus, whether or not you’re gaining or losing weight probably impacts on whether or not dietary fat is a health risk. I’d note that studies in cyclists find that high intakes of saturated fat don’t pose a health problem as long as the athletes are in calorie balance. As I mentioned above, activity (which will affect whether ingested dietary fat is stored or burned off) plays a big role here.
Studies in diabetics are finding that higher mono-unsaturated fat intakes (and lowered carbohydrate) intakes may be healthier than the converse. This, of course, only holds if calories are strictly monitored and controlled to avoid weight gain. When weight is gained, from nearly any dietary approach, blood sugar control in diabetics worsens.
Of course, there’s a flip side to the anti-fat dogma and reducing fat to extreme levels can cause its own set of problems. First and foremost, most people find extremely low-fat diets to be tasteless and this tends to limit adherence in the long-term (as I mentioned above, high-fat diets tend to be very tasty and people frequently eat too much).
And while caloric intake typically goes down in the short-term, folks frequently end up increasing caloric intake because they are hungry all the time. Dietary fat slows gastric emptying (keeping food in the gut longer) although some work suggests that this effect is lost with chronically high-fat diets. Extremely low-fat diets tend to leave people hungrier for this reason.
There is also evidence that the fat-soluble vitamin absorption may be impaired when fat intake is taken too low. And while total cholesterol typically decreases when fat intake is lowered, the decrease occurs in both the good (HDL) and bad (LDL) sub-fractions so overall health risk may not be improved. From a body recomposition or performance standpoint, some studies show a lowering of testosterone with very low fat diets.
There is another set of issues that crops up as well. Again, it relates to the simple fact that people have to eat something. In reducing fat intake, most people increase carbohydrate intake. Most researchers would say that this is just fine as long as the increase comes in the form of unrefined, high fiber, complex carbohydrates. I would say that most researchers need to get out of the lab and look at the real world for a while.
The simple fact is that the majority of people who reduce fat do NOT increase carbohydrate intake from unrefined, high-fiber, complex sources. This is especially apparent in the US (I can’t speak for other countries) where companies rapidly jumped on the ‘fat is bad’ bandwagon and brought tons of ‘low-fat’ high-carbohydrate sources that were highly refined to market.
Such foods may have as many, if not more, calories than the same higher-fat items. Even when they don’t, humans play a cute psychological game, tending to eat more of a given food when they are told it’s low or no-fat.
Recent studies are finding that, when carbs are increased from those sources, other problems show up. In addition to the changes in blood cholesterol I mentioned above (both the good and bad subfraction decrease), the increase in refined carbohydrate intake causes an increase in blood triglyceride levels and small LDL particles; both of which are independent risk factors for heart disease and all the rest. The chronically high insulin levels which commonly occur with such a diet cause other problems including insulin resistance and all of the issues that accompany it.
I should probably note, and this could certainly be an entirely separate article, that the new scapegoat for obesity and all of the health problems in the world is excessive carbohydrate intake, with a lot of the focus on insulin release. I don’t have space here to address that side of the argument, a future topic for another day.
Sufficed to say that while there is certainly an element of truth to this (in that excessive intakes of any nutrient, and that includes refined carbohydrates, is bad), it’s still true that simplistically arguing that ‘fat is good and carbs are bad’ is just as moronic as arguing that ‘carbs are good and fat is bad’. Again, it depends on the context.
Now, I want to make it very clear that I’m not trying to make this either a pro-fat or anti-carbohydrate article or trying to make a low-carbohydrate diet the default choice for anybody. My point is simply that the idea that ‘fat is bad’ and ‘carbs are good’ (or the opposite) is too simplistic to be meaningful.
Not all fat is bad and not all carbs are good. The source, the composition of the rest of the diet, the total amounts you’re eating of each, your activity level and other variables all factor in. Whether you’re talking about health risk or obesity, you can’t simply pin the blame on one factor or the other.
So, under conditions of high caloric intake, with a high intake of refined carbohydrates (meaning chronically high insulin levels), poor quality fat choices (too much saturated fat and/or too little unsaturated fats), little activity, minimal fruit and vegetable intake, etc. a high-fat intake is probably very detrimental from a health standpoint. Sadly, this describes a fairly typical diet in the modern world (especially the US).
In contrast, with reduced or even controlled caloric intake (such that bodyweight goes down or is maintained) and most of the fat coming from unsaturated sources (note: excessive polyunsaturated fats has its own set of problems), a high fruit and vegetable intake, reasonable activity levels, keeping body fat levels down, etc. higher fat intakes may be no problem at all. In some situations, an increased fat intake (again, from healthy sources within the context of activity and a high fruit and vegetable intake) may be beneficial compared to the alternatives (e.g. increasing carbohydrate intake).