Walk into the dairy aisle of any supermarket and you will be dizzy with the number of options. 2% milkfat. 1% milkfat. Skim. Fat-free half and half (a true feat of engineering). Peaches and cream, key-lime, raspberry-chocolate. You have to squint and go row by row to finally find the 3 tubs of yogurt that say ‘plain whole milk’. Meanwhile, the tub of non-fat vanilla yogurt has 15 grams of added sugar. How did we get here? When did fat become so scary?
Traditional cuisines around the world have always incorporated fat from natural sources. People (with little regard to dietary guidelines) lived long and healthy despite the generous use of fat - examples include animal lard, olive oil, butter, nuts and coconut oil. In Indian cooking, many dishes involve blooming spices in oil or ghee and adding to the dish (‘tadka’). This adds a layer of fat to the vegetable or rice dishes which is a big source of flavor and also promotes satiety. Growing up in India, skim milk wasn’t an option. The milkman dropped off a ‘bucket’ of fresh whole milk at the door. You boiled the bad bacteria into oblivion and then drank it, put it in your coffee or made yogurt.
Fat keeps us fuller, for longer. Adding fat to carbs actually blunts the blood sugar spike after the meal - for example - that cream cheese on your bagel or that parmesan on your pasta (however, if you’re eating a bagel every day, all bets are off). The hunter-gatherer diet is thought to be quite high in fat, including saturated fat, due to the large amounts of meat consumed.
In 2002, the journalist Gary Taubes took the world by storm when he published a New York Times magazine article What if It’s All Been a Big Fat Lie (also the reason I had to opt for a different idiom to title this post). Since then, there have been many prominent journalists, researchers and doctors that have echoed his views, initially to backlash and eventually growing acceptance. I try to present the evolution of the arguments per their findings below. Buckle up, it’s a bumpy ride.
Traditional wisdom from publications as early as the 1800s had advocated to avoid sugars and starches as fattening. In the mid-1950s, however, things started to change. It was believed that there was an epidemic of heart disease on the rise with some research beginning to link it to dietary fat. Interestingly, this time period also coincided with the increased use of sugar. An influential researcher, Ancel Keys, is largely credited with presenting the correlation between heart disease, cholesterol in the blood and saturated fat in the diet.
This diet-heart hypothesis became institutionalized with the American Heart Association (AHA) and the National Institutes of Health (NIH) throwing their weight behind it, with billions of dollars in funding for subsequent research. Initially, fears were mainly about the links between saturated fat and ‘bad’ LDL cholesterol, which was found to be a bio-marker for heart disease. Over time, in sync with the rise of calorie counting, all fats would be urged to be minimized. Fat has 9 calories per gram compared with carbohydrates and protein which have 4 calories per gram. The energy-balance theory therefore would prescribe that we cut out the densest source of energy and thereby lose weight.
There was a certain intuitive ring to this ‘Fat makes us fat’ principle and it became nutritional orthodoxy, despite plenty of holes being poked in the research. For example, it later came to light that there were 21 countries for which data was available for the Keys study, and if they were all taken into account, then the findings would have been a lot less clear - Keys was accused of cherry-picking 7 countries to fit his hypothesis. The AHA had initially rejected his hypothesis citing lack of strong evidence but 3 years later, reversed its position when Keys and an ally were on the committee. More troubling is that when researchers expressed the opposite opinion, such as John Yudkin (author of Sugar: Pure, White and Deadly), they were silenced and it is accused that many had their research funding taken away. Nina Teicholz in her best-selling book The Big Fat Surprise, writes about major studies that found no correlation between saturated fat and heart disease that were never published or just buried, because the researchers were disappointed in the result.
The final nail in fat’s coffin was in 1977, when this ideology became nutritional policy in the US. A Senate committee convened a hearing on the dietary links to heart disease. The expert advice at the time was in line with the AHA - which then lead to to the pronouncement of the Dietary Goals - recommending that all Americans reduce their fat, saturated fat and cholesterol consumption, and increase their carbohydrate consumption to 55-60% of daily calories. This later evolved into the famous pyramid (below) and today’s MyPlate which play a huge role in nutritional education, school lunches, etc.
For the food industry, this was an opportunity. Subsidies for corn, wheat and sugar created an environment where they could spin out processed foods loaded with cheap calories in the form of refined carbs (Special K with a glass of skim milk, anyone?) However, when you took fat out of food, it tasted worse. So they added in some things - sugar, high-fructose corn syrup, emulsifiers, thickeners and other additives and marketed them as ‘heart-healthy’. Even sugar, for decades, was treated just like any other carbohydrate. The unfortunate unintended consequence of the low-fat guidelines was that we replaced the fat in our diet with processed carbohydrates, with trans fats or with unstable vegetable oils that were later found to be inflammatory and deeply linked with cancer. You probably won’t be surprised to hear that this coincided with an explosive increase in type 2 diabetes, obesity, and insulin resistance.
In subsequent years, the research on cholesterol got more nuanced - with studies pointing out the a low incidence of ‘good’ HDL cholesterol was more strongly linked to heart disease than high LDL, and saturated fat was actually found to increase HDL. The LDL sub-fractions mattered - small, dense LDL particles are more atherogenic than large, buoyant LDL particles. Increasing research on saturated fat shows weak links to heart disease and often to the contrary. The famous French Paradox (the French are found to have lower rates of coronary heart disease, despite consuming more saturated fat than Americans) has lead to many theorizing that this is because the French consume fat from whole foods. The Women’s Health Initiative was a large study that found no evidence that a low-fat diet lowers the rate of heart disease. In fact, another Stanford study found that when you put people on a low-carb, high-fat diet like the Atkins diet, their lipid profiles actually improved significantly.
To be clear, advice to eat more fat is still relatively unpopular. We may never get a mea culpa from the authorities because that would make all the advice we got for the past half century, wrong. Some changes have been made. The dietary guidelines now ask us to eat whole grains and not just all carbs. Olive oil, nuts and avocados have been vindicated. It is now starting to be widely recognized that refined carbs and added sugar are predominantly responsible for a lot of evils, including heart disease. While there is certainly still debate on the topic - I suspect, a decade from now, what is now considered the minority position will become more mainstream, as the thinking on metabolic health matures.
I recognize that many of my readers may find this post a little hard to digest (pun intended), because you don’t usually hear advice to eat more fat in the mainstream media or at your doctor’s office. It is often deemed part of a ‘fad’ diet such as Atkins or Keto (a topic for a later post). The story is also troubling, as you don’t expect nutritional science to be biased or blinded in favor of a certain position. Nevertheless, I urge you to read the Recommended Resources, if you have the time, or just this article from The Guardian if you have 10 minutes. It is worth hearing the other side out.
So what’s the moral of this post? Do we all need to go on a high-fat diet? No. But when you eat a food, eat the real thing. The way your great-grandmother did. The way nature made it. That means the whole egg, not just the whites. That means full-fat yogurt. It’s okay to add a little cream to your coffee or butter on your paratha. Cut out refined vegetable oils (canola, soybean, safflower) and margarine and replace them with natural sources of fat such as avocado oil, coconut oil, nuts, olive oil and grass-fed butter. And here’s a recipe for ghee (a.k.a. liquid gold).
Melt unsalted butter in a saucepan over medium-low heat. Bring to a simmer and stir often. You will see milk solids get frothy and float to the top. Keep going (you can remove them with a slotted spoon if you like). In 10-12 minutes, the ghee will clear up and milk solids will settle to the bottom. When the solids at the bottom turn amber in color (helpful to use a light colored or stainless steel saucepan), it’s time to turn off the stove. If you like it nuttier, heat for a few minutes more. Let cool and then pour into a glass or steel container using a strainer.
120 calories and 14g fat per tablespoon
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Taubes, Gary. 2008. Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health. New York: Anchor Books.
Teicholz, Nina. 2014. The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet. New York: Simon and Schuster Paperbacks