The Many Faces of Fat

Contributed by Maggie Collins, MPH, RDN, CDCES, DipACLM

Fat has been a macronutrient surrounded by controversy. Some say minimize it at all costs, some say a high fat diet – aka a ketogenic diet – is the best solution for weight loss, diabetes, and other maladies. How do we sort through the scientific studies to find a balanced approach on this topic that will promote health to our bodies and bring glory to God?

Understanding this Macronutrient

Fat is one of the three macronutrients that yield energy, the other two being carbohydrates and protein. Of the three, fat is the most energy-dense. In other words, the one that concentrates more calories per weight (see chart below).

Besides being a major source of calories in the diet, fats have other important functions [1]:

• It helps to transport fat-soluble vitamins (vitamins A, D, E, and K) and carotenoids (yellow, red, and orange pigments found in plants that act as antioxidant in humans);
• It is part of cell membranes;
• The fat accumulated in adipose tissue helps to insulate against extreme temperatures, protect against shock, and secrete certain hormones;
• It enhances the taste and texture, and satisfaction of foods.

Types of Fat, their Health effects and Food Sources

1. SATURATED FATS

These fats can be obtained from foods, but can also be synthesized in the body [1]. For decades we have believed that a high intake of saturated fats has been associated with elevated low-density lipoprotein (LDL) cholesterol and insulin resistance, consequently leading to a higher risk of cardiovascular disease and type 2 diabetes [2-4]. However, in recent years, some studies started to question the well-established evidence about the impact of saturated fats on health, and to be fair to these studies they have highlighted other fats that can also be harmful to our health and in some contexts even more harmful than saturated fats, such as high intake of polyunsaturated fat in the form of vegetable oils [5]. Regardless of the controversy going on, and influences from food industries sponsoring some of these studies, the weight of evidence still points to saturated fats being harmful when consumed in excess, and organizations such as the American Heart Association, the American Cancer Society and the Dietary Guidelines for Americans continue to recommend to limit their intake [2, 6, 7].

The American Heart Association recommends limiting saturated fat to 5% to 6% of the calories consumed [8]. For an individual consuming an average diet of 2,000 calories per day, this amount would translate to 11g – 13g saturated fat per day.

Two tips to minimize the intake of saturated fats are:

1. Avoid or limit the foods that are naturally high in saturated fat (see list below);
2. When buying processed foods read the label and aim to get products that have 5% of less of the Daily Value for saturated fats (see example below).

Examples of foods high in Saturated Fats:

• Unprocessed, animal-based: high-fat meats such as fatty beef, lamb, and pork; poultry with skin; whole or reduced-fat (2 percent) milk;
• Processed, animal-based: beef fat (tallow); dairy products made from whole or reduced-fat (2 percent) milk; cocoa butter; lard, butter, and cream;
• Unprocessed plant-based: coconut meat;
• Processed plant-based: palm, palm kernel, and coconut oil and other products made from coconut.

2. MONOUNSATURATED FATS

Although you can get these fats from certain foods,  they are also synthesized by the body and because there is no known independent beneficial role in human health, they are technically not required in the diet [1]. However, some studies suggest that when replacing saturated fats with this class of fats it helps to decrease the risk for coronary heart disease and inflammation [9, 10].

Examples of foods high in Monosaturated Fats:

• Unprocessed plant-based: avocados, peanuts, almonds, cashews, pistachios, and olives
• Processed plant-based: peanut butter, peanut oil, avocado oil, almond butter, cashew butter, and olive oil

3. POLYUNSATURATED FATS

Omega-3 fatty acid (aka linolenic acid): this fat is part of the structure of membranes, particularly of nerve tissue and the retina, and is considered an essential fat as it cannot be synthesized in the body. Deficiency signs include neurological deficiencies and poor growth [1]. Deficiency of this nutrient is rare in the United States.

Omega-3 fatty acids have reported antioxidant and anti-inflammatory properties that can assist with the prevention and management of several chronic conditions, including cardiovascular disease, cancer, diabetes, Alzheimer’s disease, dementia, rheumatoid arthritis, depression, and periodontal disease [11, 12].

Examples of foods high in omega-3 fatty acids:

• Unprocessed, animal-based: fish (white fish such as cod and halibut; oily fish such as mackerel, menhaden, and salmon; also found in tuna, herring, and sardines).
• Processed, animal-based: fish oil, fried fish.
• Unprocessed, plant-based: sea vegetables (aka algae), flaxseeds, chia seeds, walnuts, and soybean products.
• Processed, plant-based: flaxseed oil, soybean oil, and canola oil, and algae-based supplements.

Omega-6 fatty acid (aka linoleic acid): this fat is also considered essential as it cannot be synthesized in the body. Signs of deficiency on this nutrient include rough and scaly skin and dermatitis [1]. Deficiency of this nutrient is rare in the United States. There is evidence that replacing saturated fat with polyunsaturated fats, such as omega-6,  improves insulin resistance [13].

Examples of foods high in omega-6 fatty acids:

• Unprocessed plant-based: soybean products, sunflower seeds, and pumpkin seeds, peanuts.
• Processed plant-based:  corn oil, safflower oil, soybean oil, sunflower oil, cottonseed oil, peanut oil.

How Much Total Fat Should We Consume per Day?

The acceptable intake of fat is set to be at 20% to 35% of the calories we consume (while limiting saturated fat and trans fats)[6]. Sticking to the lower or the higher end of this range will depend on the outcomes you want to achieve. For healthy individuals with a normal BMI (Body Mass Index) who eat a balanced WFPB diet and practice regular physical activity being a bit more liberal with their fat intake may not be an issue, especially if the bulk of the fat consumed is from unprocessed sources.

For those who suffer from chronic conditions such as heart disease, obesity, or type 2 diabetes, a lower-fat intake may be beneficial. Clinical trials have demonstrated the reversal of coronary artery disease (CAD) using either a low-fat vegan diet, a low-fat vegetarian diet, or a Mediterranean diet supplemented with ~ 1oz of nuts per day [14-17].

A low-fat WFPB diet can also be very successful for weight loss, improvements on blood lipids, and improvements on blood sugars, being one of the approaches accepted by the American Diabetes Association for the management of diabetes[18-20], and in some cases to reverse type 2 diabetes [19, 21].

Is a high-fat dietary approach such as the Ketogenic diet also healthy?

The ketogenic diet (KD) promotes 55%- 60% of calories coming from fat [22] and yet those who follow this diet perfectly experience rapid weight loss, improvements on blood sugars and blood lipids [23]. How can we explain this success? The simple answer is this apparent success is not lasting and the potential negative health impact long-term proves that this diet is not safe.

Some important downfalls of the KD are: poor sustainability, insufficient evidence that this plan is superior for weight loss or blood sugar management when compared to low-fat diets, and a long list of adverse effects.

Studies on the KD indicate sustainability is a common issue [22, 24]. People initially lose weight quickly, but they have a hard time sticking to this diet and eventually go back to their old habits, regaining the weight.

When comparing this plan to low-fat diet plans, a review of 13 studies lasting longer than a year, showed that the KD was associated with less than 1 Kg of additional weight loss over the low-fat diets. They also found no difference in blood sugar control among persons with type 2 diabetes, when comparing these two diets [18]. Another review of 32 controlled feeding studies found that calorie expenditure and fat loss were greater with low-fat diets when compared with the KD [25], favoring the latter approach for weight loss.

In terms of adverse effects from the KD there is a long list [22]:

• Keto flu: which may include symptoms of nausea, vomiting, dizziness, headache, fatigue, insomnia, and struggles with exercise tolerance. These symptoms may last from a few days to a few weeks.
• Constipation
• Fatty liver
• Osteoporosis
• Vitamin and mineral deficiencies
• Elevated LDL cholesterol
• Kidney stones
• Dehydration
• Electrolyte disturbances
• Low blood sugars
• Low levels of protein in the blood
• Diabetes Ketoacidosis for those taking certain diabetes medications
• Impaired growth in children

Finally, perhaps as a consequence of all the potential adverse effects listed and unknown harmful effects long-term,  low-carbohydrate plans such as the KD are associated with a significant increased risk of all-cause mortality [26]. Therefore, we cannot call the KD approach healthy or safe.

What does the Bible say about Fat?

The Bible mentions a few dietary fat sources. Some are endorsed by God as safe and some were forbidden.

• Fat in meats: when talking about the flesh of the clean animals consumed as food, God ordained that those who partake of this food should not eat the blood or the fat associated with the meat (Leviticus 3:17, Leviticus 7:22-27);
• Olive oil: oil or olive oil are mentioned many times in the Bible as a common source of food among the people and was used in preparations to be consumed by the priests ministering in the sanctuary (Ezekiel 16:19, Exodus 29:23, Deuteronomy 14:23, 1 Kings 17:16, Ezekiel 16:19);
• Nuts, seeds, olives, avocados, and coconut: these fat-dense foods are mentioned as healthy food sources as they were planned to be part of the human diet before sin entered the world (Genesis 1:29, Genesis 43:11).

When considering our food choices, including fats, we should also apply the biblical principle of temperance, so we not only think of selecting healthy fats, but also of consuming them in the right amount according to our individual needs (Exodus 16:15, 16; Galatians 5:22-23, I Corinthians 3:16, Philippians 3:19, I Corinthians 10:31).

Fat considerations in the Adventist Health Message

The compilation book “Counsels on Diet and Foods,” by Ellen G. White, has a chapter dedicated to Fats, which all should read to better understand this important topic and its applications to physical, mental, and spiritual health. Interestingly enough, the discussion on this chapter starts with butter, a highly controversial fat, and it has the following advice:

“Let the diet reform be progressive. Let the people be taught how to prepare food without the use of milk or butter. Tell them that the time will soon come when there will be no safety in using eggs, milk, cream, or butter, because disease in animals is increasing in proportion to the increase of wickedness among men. The time is near when, because of the iniquity of the fallen race, the whole animal creation will groan under the diseases that curse our earth.

God will give His people ability and tact to prepare wholesome food without these things. Let our people discard all unwholesome recipes.”

Testimonies for the Church 7:135, 1902

Notice the emphasis on progressive changes considering each individual’s learning curve and the focus on quality of these foods as the disease in animals increase in proportion to the increase of iniquity among men. The Bible paints a similar picture in Hosea 4:1-3, in the context of the latter days (Hosea 3:5). You may ask, have we gotten to this point in this world’s history yet? Each individual needs to come to their own conclusion. We do have irrefutable evidence that disease in animals is indeed increasing, especially as we consider the conditions these animals are being raised for food as in the common modern practice of factory farms. Public health experts point to several issues with this practice, including zoonotic diseases, food born illnesses from fecal contamination, and antibiotic resistance as these animals receive massive doses of antibiotics. It is important to also note that even the current COVID-19 pandemic has been attributed to be probably of zoonotic origin[27], demonstrating the devastating effects contaminated animals can cause in humans.

It is certain that the more we approach our diets to the original diet promoted on Genesis 1:29, the safer we are and the better health outcomes we will experience (Daniel 1), each one seeking the Lord for direction and strength to do the best they can with the means they have while considering their life circumstances and the type and quality of food available where they live.

Cooking Considerations

Fat can greatly contribute to the flavor and texture of foods, and it is evidence that God wants us to enjoy our foods too, although never in the detriment of health, so it is important to find the right balance.

Fried foods have well-establish negative effects on our health when habitually consumed. The excessive amount of oil used in this cooking method contributes to increasing the calories in the fried foods exponentially (as each tablespoon of oil has approximately 120 calories) but also the high temperature those foods are exposed to can produce harmful components. Consequently, fried foods contribute to obesity, insulin resistance, inflammation, and chronic diseases [28]. Better cooking methods are steaming, boiling, roasting, and grilling.

Some people decide to avoid oils and animal fats altogether to either lean on the side of caution to prevent chronic diseases or to reverse them. In this case, they only utilize plant-fats in their unprocessed or minimally processed form.

For those who choose to use oils, olive oil seems to be the best choice, both from a biblical records perspective as well as from a scientific evidence of its health benefits [29, 30]. It is important to use it in small amounts as olive oil is a caloric-dense food, like any other oil, and it lacks fiber.

As fats-dense foods from plant sources have a better health profile and concentrate more nutrients in their more unprocessed forms, we should explore recipes that promote the use of nuts, seeds, tofu, olives, and avocados to create nutritious and appetizing dishes.

Summary

Eat fats, not too much, ideally from unprocessed or minimally processed plant sources. Small portions of healthy fats go far to add flavor and essential nutrients to our diet.

Aim to get a daily dose of omega-3 fatty acids, and the rest of the fat choices being a combination of monounsaturated fats and omega-6 fatty acids.

Limit saturated fats and avoid fried foods.

Eating healthy is a wonderful journey. God intended for this journey to be full of colors and amazing flavors as evidenced by the bountiful variety of foods He created for us to enjoy. We should all encourage each other in this journey by sharing dishes and recipes we learn that use healthy ingredients, while avoiding the spirit of criticism towards those who may not see things in a similar way or may be at a different stage in their journey.