Putting the squeeze on saturates - reducing saturated fat in the diet - includes related articles

Nutrition Action Healthletter, May, 1993 by Bonnie Liebman, Jayne Hurley

If you could make only one change to your diet, what should it be?

Cut back on saturated fat. That's because the evidence is so solid that sat fats increase the risk of heart disease.

Scientists may argue whether the Asian diet (lowfat) is better or worse than the Mediterranean diet (high in monounsaturated olive oil). But they all agree on one thing: both diets are low in saturates.

Yet two stumbling blocks make it difficult for people to eat a diet that's low enough in saturated fat:

* Health authorities have so far refused to tell the public how much--make that how little--saturated fat offers the most protection against heart disease, because they're afraid it will scare people off.

* Even if the experts issued more honest advice, most people wouldn't know how to translate it into tonight's dinner.

DIET VS. DRUGS

How much sat fat should people eat?

If you've been paying attention to the National Cholesterol Education Program (NCEP), the American Heart Association (AHA), or most other health authorities, you'll know their answer: less than ten percent of your calories.

But that's not ideal.

Populations with rock-bottom-low rates of heart disease--like the Japanese fishermen studied in the 1950s--get only three percent of their calories from sat fat.

So do the diets devised by Nathan Pritikin or Dean Ornish, director of the Preventive Medicine Research Institute in Sausalito, California. They're very low in all fats, and even seem to clean out clogged arteries in people who already have heart disease.

No health experts have urged the general public to cut down to three percent. But four years ago, the National Academy of Sciences' Diet and Health report did inch closer. Although it, too, recommended ten percent, the report added: "It is highly likely that a further reduction, to 8 or 7 percent of calories or lower, would confer greater health benefits."

So why doesn't everyone recommend seven or eight percent...or lower? "We're afraid that people won't make any change if it's too drastic," says Scott Grundy, a leading heart disease researcher at the University of Texas Southwestern Medical Center in Dallas who chairs the NCEP's Adult Treatment Panel. The panel's charge is to help physicians treat patients who have high cholesterol.

Last January, 16 heart disease experts signed a letter urging Grundy's panel to recommend that all physicians do what many already do.

"We start people with high cholesterol or coronary artery disease on a diet that is seven percent of calories from saturated fat," says Virgil Brown of the Emory University School of Medicine in Atlanta.

Grundy's panel is likely to advise doctors to first figure out how much sat fat their patients are eating. "If it's 15 to 16 percent," says Grundy, "they should lower to ten percent and see if that's enough."

But that approach has two drawbacks. Even if physicians take the time to analyze a diet questionnaire, it's not clear that they'll get an accurate reading.

What's more, ten percent sat fat doesn't always work. And when that happens, patients are often too discouraged to switch to seven percent.

"It's easier to motivate people to make big changes than little ones," says Dean Ornish. "Moderate changes give patients the worst of both worlds. They feel diet-deprived, but they don't get the positive biological changes, so they feel disappointed."

And if diet fails, the next step is drugs.

AN IMPERFECT "10"

Few people expect Grundy's panel to start all patients out on a seven-percent sat fat diet. At best, it may recommend eight to ten percent as a "Step One" diet, and less than seven percent if that fails.

That's some progress. And at least it should clear up the confusion about the current ten-percent advice.

"Many people read ten percent as a target, when it's really an upper limit. Even the American Heart Association has been guilty of this," says Virgil Brown, who is an AHA past president.

"People should be in the seven to ten percent fat range--and below that if they have a problem."

But if the experts are afraid to tell patients to cut sat fat way down, you can imagine how uneasy they feel about telling healthy people to make that change.

"If you ask any dietitian, they'll tell you that it's incredibly tough for a person to stay on a seven-percent saturated fat diet," says Neil Stone of the Northwestern School of Medicine, who chairs the Heart Association's Nutrition Committee. "Because of the [limited] food choices, you'll get an incredibly high dropout rate."

Still, sooner or later health authorities will get up the nerve to tell people the truth: The less saturated fat the better.

But you could start today on a diet that's only seven percent sat fat (or less). To see how, turn the page.

"Squeeze Out the Sat Fat" System

Here are two ways for you to eat no more than seven percent of your calories from saturated fat. Alternative #1 is easier, but you pay for the simplicity by giving up more "splurge" foods than you do with Alternative #2.

ALTERNATIVE #1

Eat only "Free" or "Low Sat Fat" foods