Forget saturated fat, focus on total calories instead!

Continuing to malign saturated fat as the main dietary villain in cardiovascular disease is a big mistake.

Because it draws attention away from the real dietary culprit: excess total calories.

The government recommends that we limit saturated fat to 10% of total calories in order to reduce our risk of cardiovascular disease (CVD) – the leading cause of death in the UK and the rest of the world. But the evidence for this is murky at best.

The concern about saturated fat originated in the 50s from observation research (which looks at associations between two variables, in this case saturated fat intake and CVD). The problem is, observational studies are plagued by confounding variables, which means they can’t tell us much about causation. And, anyway, when we look back now at the body of evidence from observational studies, there is no association between saturated fat intake and CVD.

But what about randomised controlled trials (RCTs) – the type of study that can tell us about causation? Following the observational findings in the 50s, several large RCTs were carried out in the 60s, 70s, and 80s. These studies allocated large groups of men to either a high saturated fat diet or a high polyunsaturated fat (vegetable oil) diet and then tracked deaths from CVD over several years. The results are a very mixed bag. And when all the data (including previously unpublished data) is pooled and analysed, we can see that saturated fat does increase serum cholesterol, but it does not increase the risk of death from CVD (when compared to polyunsaturated fat).

Now, I’m not saying we should never care about saturated fat. It can increase LDL-cholesterol in some people, and in some people this can be problematic. But for most people most of the time, saturated fat is probably a secondary consideration. Because, the primary dietary risk factor for CVD is a sustained excess of total calories, which manifests as excess body fat (the evidence for this is clearer and the mechanisms are better understood). Where those calories come from matters less.

So, getting your long-term calorie intake right is the key to reducing your CVD risk. And you already have a well-honed mechanism for doing this. It’s called appetite regulation.

A properly regulated appetite will match your calorie intake with your calorie expenditure, taking into account any excess calorie storage (fat) that needs using. It’s clever stuff.

How can you improve your appetite regulation?

Exercise and sleep play a big role here. But when it comes to diet, the two most impactful things you can do are:

  • Increase consumption of protein to at least 1.2g-1.6g of protein per kg of body weight per day (high protein diets not only reduce calorie intake, they also help preserve muscle mass during weight loss)
  • Reduce consumption of ultra-processed foods (UPFs) as much as possible and, ideally, to zero (UPFs are typically very calorie-dense and highly-palatable, a combination which drives us to overeat)

When it comes to improving your health – as with improving at anything else in life – you’ll get better results faster if you focus on the smallest number of things that make the biggest difference. In reducing CVD risk, most people will do better by increasing protein and eliminating UPFs than by reducing saturated fat.

There is another problem with demonising saturated fat (or any other individual food molecule for that matter). It encourages the food industry to create and push ‘healthier’ alternatives, which can sometimes be much worse for us. Remember margarine?

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