Helping Patients Reduce Saturated Fat Intake to Prevent Heart Disease and Counter Weight Gain

James Meschino DC, MS, ROHP
One of the things that stands out for me in my experience teaching nutrition-related programs to individuals and groups, is the under appreciation of the damaging effects that saturated fat has in promoting heart and vascular diseases. This article reviews key aspects of saturated fat and lipoprotein physiology to help clarify the matter, and allow you to share this important message with patients.

Saturated Fat: Digestion, absorption and 
fter digestion, saturated fat enters the bloodstream and travels to the liver within a chylomicron (a lipoprotein formed within intestinal epithelial cells). In response, the liver turns on cholesterol production in order to make the very-low-density-lipoprotein (VLDL) that transports saturated fat through the circulation. In turn, the VLDL is secreted into the bloodstream where the saturated fat is extracted from the VLDL and stored in our fat cells, making us fatter. Some of the saturated fat is extracted from the VLDL by our muscles and burned for energy during light and moderate activity, including aerobic

As the saturated fat gets removed from the VLDL in this manner, the VLDL then becomes known as the LDL, which still contains cholesterol (about 50% of the LDL is cholesterol). The LDL particle is then extracted by all the cells of the body and the cholesterol is used to make the cell membrane, and is the building block from which certain tissues make vitamin D, bile acids, estrogen, progesterone, cortisol and other steroidal hormones. However, once the cells of the body have an adequate amount of cholesterol, they close the door to further uptake of cholesterol from the bloodstream.

LDL-Cholesterol and 
In this case the extra cholesterol-rich LDL particles circulate through the

bloodstream for 3-5 day, on average, and have a propensity to stick to the walls of the artery causing narrowing and obstruction to blood flow. As our arteries become more narrowed from this process occurring day after day, it sets us up for a fatal or non-fatal heart attack, stroke, kidney failure requiring dialysis, peripheral vascular disease that may lead to gangrene and amputation, and cerebrovascular disease contributing to dementia. (

The evidence is overwhelming that we should consume no more than 10 -15 gm per day of saturated fat, which is a key strategy to help to maintain a total fasting blood cholesterol below 150 mg per dl (3.9 mmol/L). According to the Framingham Heart Study, a cholesterol reading below 150 mg/dL provides substantial protection against heart and vascular disease from atherosclerosis. Eating too much saturated fat (and deep fried foods) is also a key factor in weight gain, which carries its own associated risks for heart attack, diabetes and some cancers. (3,4)

How To Lower Saturated Fat In Your 
Limit your animal products to skinless chicken and turkey breast, Cornish hen, fish, non-fat or 1% milk and yogurt and cheeses that are less than 4% milk fat (unfortunately, there aren’t many). You should also avoid butter and items prepared with too much palm and coconut oil, and minimize your intake of foods containing hydrogenated and trans fats as well, as they act much like saturated fat. Don’t consume deep fried or heavy pan-fried foods and use olive oil in salads, and to sauté or brown foods. As well, even if you have good genetics and your cholesterol is low, eating saturated fatty foods increase the stickiness of your platelets, increasing risk of a thromboembolism or deep vein thrombosis, both of which can be life-

In the end, limiting your intake of saturated fat is one of the most vital lifestyle choices you can make each day to reduce your risk of vascular diseases. (1-6)

Getting The Protein You Need Without Saturated 
When reducing your intake of saturated fat (as well as transfats and deep fried foods), it can be a challenge to still acquire the protein your body needs to support its muscle mass, bone mass, immune system and other functions served by dietary protein. As a rule, most adults require at least one gram of protein for every kilogram they weigh. For example, if you weigh 70 kg, then you need to consume at minimum of 70 grams of protein per day (to find your weight in kilograms, divide your weight in pounds by 2.2). The more physically active and athletic you are, the more protein you require. Thus, most active people require between 1.25 and 1.5 grams of protein per kilogram of body weight each day. To help you achieve this goal by consuming protein foods that contain very little saturated fat and transfats, refer to the table below. Remember that there are also many protein shake mixes in the market place (e.g. whey protein, egg white protein, soy protein) that can help you obtain your protein requirements if you have difficulty reaching your desired protein intake from the foods listed on the following table alone. Most shake mixes provide 20-25 grams of protein per scoop, with virtually no fat and only a few grams (e.g. 5-6 grams of carbohydrate). Check out the table below and use these foods to acquire the protein your body needs each day. If you still can’t get to the desired number of grams your body needs, then consider adding a protein shake to your daily fare to make up the difference. (7)

Low Fat Protein Foods and Grams of Available Protein Per Serving Size

Final 
Some researchers argue that saturated fat intake is not related to vascular disease, citing populations that consume moderate to high levels of saturated fat, and yet have vascular-related mortality rates lower than would be expected. In regard to this argument, German and Dillard reference the scientific literature indicating that there is a multitude of risk factors that contribute to vascular disease, in addition to LDL-cholesterol. They state, “Factors that are known to contribute to this disease include intake of carbohydrates with high glycemic indexes, homocysteine, C-reactive protein, lack of exercise, high blood pressure, a family history of heart disease, oxidative stress, smoking, and obesity and diabetes” (6). In addition, in developed countries where smoking rates are high and/or alcohol consumption is immoderate, cancer rates tend to be higher, and thus, fewer people die from vascular disease (8,9). Finally, it should be recognized that the recent obesity (with extension to diabetes) epidemic in North America has increased mortality rates from vascular disease, cancer and other health problems (10).

In a comprehensive sense, the rise in LDL-cholesterol due to saturated fat intake is a major contributing factor to premature atherosclerosis and related vascular disease, but other lifestyle and genetic risk factors also contribute to the overall risk profile. Practitioners should perform a global vascular disease risk assessment and provide patients with a lifestyle program involving diet, exercise, supplementation, weight reduction if necessary, and stress-reduction. The program should be customized to the patients unique risk profile, and aimed at helping them lower their risk for premature heart disease, stroke, and related vascular problems.  In most cases, helping the patient consume less saturated, trans-fats and cholesterol are a significant component of the lifestyle plan.

References

1. Modern Nutrition In Health And Disease -10^th edition (Shils ME et al). Lippincott Williams & Wilkins 2006. Pages 96-110 (Lipids, Sterols and Their Metabolites)
2. Katan MB, Zock PL, Mensink RP. Dietary oils, serum lipoproteins, and coronary heart disease. Am J Clin Nutr 1995;61(suppl):1368S–73S.
3. Esselstyn Jr. C B. Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition, Preventive Cardiology 2001; 4: 171-177
4. Castelli, WP, Garrison, RJ Wilson, PW, et al. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham study. JAMA 1986; 256(20) 2835-
5. Grundy SM. Dietary fat: at the heart of the matter. Science 2001;293:801–2.
6. German JB, Dillard CJ. Saturated fats: what dietary intake. Am J Clin Nutr 2004;80;3:550-559
7. Optimum Sports Nutrition (Colgan M) Advanced Research Press 1993.Pages 143-166
8. http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-
9. http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer
10. http://www.surgeongeneral.gov/news/testimony/obesity07162003.htm