Saturated Fatty Acids and Risk of Coronary Heart Disease: Modulation by Replacement Nutrients

Abstract

Despite the well-established observation that substitution of saturated fats for carbohydrates or unsaturated fats increases low-density lipoprotein (LDL) cholesterol in humans and animal models, the relationship of saturated fat intake to risk for atherosclerotic cardiovascular disease in humans remains controversial. A critical question is what macronutrient should be used to replace saturated fat. Substituting polyunsaturated fat for saturated fat reduces LDL cholesterol and the total cholesterol to high-density lipoprotein cholesterol ratio. However, replacement of saturated fat by carbohydrates, particularly refined carbohydrates and added sugars, increases levels of triglyceride and small LDL particles and reduces high-density lipoprotein cholesterol, effects that are of particular concern in the context of the increased prevalence of obesity and insulin resistance. Epidemiologic studies and randomized clinical trials have provided consistent evidence that replacing saturated fat with polyunsaturated fat, but not carbohydrates, is beneficial for coronary heart disease. Therefore, dietary recommendations should emphasize substitution of polyunsaturated fat and minimally processed grains for saturated fat.

Dietary intake of antioxidants and fats in the context of coronary heart disease prevention among elderly people

“…Saturated fat should be replaced by a combination of poly-and monounsaturated fat; however, the benefits of polyunsaturated fat appear to be stronger. Little or no benefit is gained if saturated fats are replaced by carbohydrates, because carbohydrates, particularly refined carbohydrates and added sugars, increase the levels of triglycerides and small LDL particles, and reduce high-density lipoprotein cholesterol [33]. Therefore, Willet [31] claims that in practice, reducing red meat and dairy products in the food supply and increasing the intake of nuts, fish, soy products, and non-hydrogenated vegetable oils, will improve the mix of fatty acids and have a markedly beneficial effect on the rates of CHD.…”

Dietary Weight Loss Advice in US Health Magazines and its Relation to Ancestral Diet

“…The highly conflicting prescriptions are likely a result of recent findings exonerating saturated fat in the development of cardiovascular disease juxtaposed with past governmental recommendations. [18,19] Numerous recent best-selling books geared toward the general public and in many ways contrary to past governmental guidelines, including David Perlmutter's Grain Brain [20], William Davis's Wheat Belly [21], and Nina Teicholz's The Big Fat Surprise [22] may have contributed to confusion surrounding grains and fats in a weight-loss diet.…”

Western lifestyle and immunopathology of multiple sclerosis

“…Of interest, SFAs, such as palmitate (C16:0) and laurate (C12:0), can also directly activate TLR‐mediated proinflammatory signaling pathways in innate immune cells 100. Finally, while feeding dietary monounsaturated fats reduces low‐density lipoprotein (LDL) levels, SFAs are reported to elevate circulating LDL 110. Elevated levels of LDL may stimulate inflammatory innate and adaptive immune responses 111, 112.…”