Ghee Wiz! Fat In Not Fat Out

Also titled: How misinformation about fats is killing our food and health:

The low-fat diet is endemic in India. After seeing old people, young people, nice people, bad people, with a diagnosis of high cholesterol (most often with a co-diagnosis of high blood sugar) religiously shunning fats, and substituting carbs, it was time to unfurl the research (if there was any). 

I had started off assuming that all fat was ok, based on the intake of traditional diets around the world, going off on a further assumption that traditional diets were usually right, (especially, in the geographical location that invented the diet, i.e., South Indian diets are good, and more definitely so in South India). I was very relived to find that a lot of research supports this, and I finally had content for my next post. Note: not all research does. It sees and it saws. But the trend is swinging steadily and solidly back to say that fats are ok, and refined carbs are the culprit in heart disease.

Note: The one thing I do feel uncomfortable about is being in the position of "telling people what to eat". And this post is not intended to do that. It is intended to show how a section of possibly biased research combined with new-fangled food processing techniques has completely reversed our eons of traditional understanding of how and what to eat.

Rap to the beats of:

Eat what your Ma ate. 

If you don’t live there, then wait...

Eat what your neighbor’s Ma ate.

If you neighbor is not a a nate (ive)

Eat what his neighbor’s Ma ate.

If she didn’t eat all that great,

Eat what your Ma’s Ma ate.

If that was a moderately similar plate,

Eat what your Ma’s Ma’s Ma ate.

Myth 1: Eating fat increases cholesterol, risk of heart disease, etc.

Even the younger brother of this myth (eating fat makes you fat) is false. There is NO evidence pointing to this. Gram for Gram, fat packs more calories than carbs. So if you overdose on fats, you can gain more calories that if you overdose on carbs. But there is nothing else in fats that “makes you fat”. In fact fats are very satiating (make you full more easily), and may reduce calorie consumption.

Coming to the older brother, cholesterol. The guy that started this myth was called Ancel Keys. He is really famous in the nutrition community (and even graced the cover of Time in the 70s). He published a very famous study called the “Seven country study” where he studied people in seven countries and tried to draw correlations between fat intake and heart disease. And he found that higher fat intake correlated with higher incidence of heart disease. 

Even in those days, a significant portion of the scientific community discredited his work. Recent analysis has found that he had data available from 22 countries. If he had included all that data, he would have found NO correlation. There are allegations that Ancel Keys cherry picked his data. Gary Taubes, an eminent science reporter, and author of “Good Calories, Bad Calories” has a great summary of Mr. Keys’s research methods.

This is a classic case of a hypothesis being repeated so often that it has come to be regarded as truth.

An excellent summary of available historical data (available in youtube) by Andrea Garber, Associate Professor in the Division of Adolescent Medicine at UCSF actually shows that most studies have found no changes in weight loss, or cholesterol levels in people that follow low-fat diets (50,000 women were followed over 8 years).

In fact studies have found that low-fat diets may increase LDL cholesterol levels relative to low-carb diets.

Myth 2: Saturated fat is heart-unhealthy

Back to Mr. Ancel Keys. The data on this is so contradictory that it is a wonder it is accepted as truth. Yes, there is some data showing that saturated fat increases cholesterol levels. But there is a some data showing that it makes no difference at all, and actually has the same risks as excess refined carbohydrate intake.

Harvard school of Public health has 10 years worth of studies proving that total fat intake has no correlation with heart disease. And they also found that increasing saturated fat intake has the same effects on heart health as increasing refined carbohydrate consumption.

A collaboration between Harvard School of Public Health and the Children’s Hospital Oakland Research Institute analyzed data spanning 5-23 years and 350,000 people, and saw.... guess what? NO correlation between saturated fat intake and cardiovascular disease.

Myth 3: My doctor says to avoid saturated fat. He must be correct.

Oh, the things your doctor doesn’t know about nutrition would fill a book... Nutrition and medical science seem like they should go hand in hand. But, they don’t. Nutrition is just not taught sufficiently in medical schools. Also, the field is evolving. You'd be better off consulting your grandmother for diet advice.

So listen to your doctor when he is reading test results, but do your own research when looking up diet-based solutions.

Myth 4: Saturated fat is bad, so ghee and coconut oil must be bad. 

Nope. Saturated fat can be short-chain, medium-chain, or long-chain fatty acids. Now, short-chain and medium-chain fatty acids are converted into energy very quickly. The process of metabolism is VERY different and much shorter than that of long-chain fatty acids (typically animal derived).

Coconut Oil is almost all medium-chain, and there is research showing how quickly it is metabolized, and how it can actually help with increasing HDL (good cholesterol), decreasing LDL (bad cholesterol) and lo and behold: decreasing weight.

Research on animal husbandry operations has shown that animals that are fed coconut oil lost weight and became toned, which made it necessary for feedlot owners to feed them unsaturated fats like corn oil, sunflower oil, etc to fatten them.

Ghee

The numbers: Ghee is only 65% saturated (well the only is my take), and 25% short- and medium chain fatty acids. So it is also more easily metabolized than most other saturated fat of animal origin.

I can’t emphasize this enough: there is NO evidence (at least that I have seen) showing any association of increased ghee consumption with cardiovascular disorders. There have been tons of studies in India. Ghee has been shown to be anti-carcinogenic, good for HDL, anti-inflammatory, and a host of other good things. But high and bad LDL cholesterol? Nope.

Myth 5: Unsaturated oils are good for health. Saffola, Sunola, Canola, etc.

They are unstable at high temperatures, easy to oxidize, have actually been shown in some studies to be carcinogenic if heated to high temperatures.

Most of the “refined” oils that we use are already heated to extract them from the seed efficiently. Heating heated oil, is like re-using your deep-frying oil for cooking. 

These oils are best used cold-pressed, and un-refined, and when used for low to medium temperature cooking.

Summary of stuff above (not in rap format, though I can try on request):

• 85% of the cholesterol in your body comes from ... your body. Only 15% comes from your diet. So eat that egg, drink the full fat milk. It is ok, in moderation.
  
• A side note on the milk: homogenized, ultra-pasteurized milk is not real milk, especially non-fat. Vitamins in milk are fat-soluble. If there is no fat, there are no vitamins. Most lactose intolerances can be traced back to homogenization.
  
• Just as egg-whites alone are not real eggs.
• Cholesterol in your blood is glue or healing ointment to heal inflammation in arteries. If you have high cholesterol, you have high inflammation due to some stressor, either dietary, environmental or otherwise.
  
• Low-fat diets do not reduce cholesterol: there is very little research to prove this and abundant research to disprove this. Replacing fat with sugar and refined carbs increases risk for cardiovascular disease.
  
• Saturated fats are not bad, in moderation.
  
• Remember, refined carbohydrates, not fats have a higher association with risk of cardiovascular disease (cholesterol, triglycerides, other indicators).
  
• Heart disease risk is related to diabetes and pre-diabetes risk, both common in populations very dependent on carbohydrates (especially refined), and skimping on fats and proteins.
  
• Coconut oil is different from saturated fats (westerners usually mean animal based saturated fats when they use the term). Coconut oil is awesome. It gives close to instant energy, and is NOT stored in your body as fat. There is a ton of research chronicling the cardiovascular and other health benefits of coconut oil.
  
• Ghee is awesome too. High smoke point (can tolerate high temperatures), anti-carcinogenic, increases HDL, does not increase LDL, can soothe wounds, the list really goes on.
  
• Final caveat: everything in moderation. Eat as your ma (or her ma) ate. 
• This is what my Ma’s Ma’s Ma ate when she was young:

1. Unrefined groundnut oil
2. Coconut Oil
3. Ghee
4. No hydrogenated fats (Dalda and the like)
5. Milk from the milkman (no hormones, not homogenized or pasteurized, no milk powder)
6. Organic vegetables
7. Rice that was hulled, not polished
8. Whole grains, like wheat and millet.
9. Minimal sugar (a lot of it was unrefined jaggery)

References:

1. Henry Blackburn, MD. Overview: The Seven Countries Study in Brief.  
2. Gary Taubes. Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health.
3. Ravnskov, U. The questionable role of saturated and polyunsaturated fatty acids in cardiovascular disease. J Clin Epidemiol. 1998;51(6):443-60.
4. Sally Fallon. Nourishing Traditions. 
5. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial
6. Andrea Garber, UCSF. Fad Diets: what really works for Weight Loss. 
7. Andrew Weil. Fat or Carbs, which is worse. 
8. Harvard School of Public Health. Fats and Cholesterol, Out with the bad, in with the good. 
9. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91:535-46.
10. Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010;45:893-905.
11. Astrup A, Dyerberg J, Elwood P, et al. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr. 2011;93:684-8.
12. Feranil AB, Duazo PL, Kuzawa CW, Adair LS. Coconut oil is associated with a beneficial lipid profile in pre-menopausal women in the Philippines. Asia Pac J Clin Nutr. 2011;20(2):190-5.
13. Papamandjaris AA, MacDougal DE, Jones PJ. Medium chain fatty acid metabolism and energy expenditure: obesity treatment implications.Life Sci. 1998;62(14):1203-15.
14. Kumar, PD. The role of coconut and coconut oil in coronary heart disease in Kerala, South India. Trop Doct. 1997 Oct;27(4):215-7. 
15. Gupta R, Prakash H. Association of dietary ghee intake with coronary heart disease and risk factor prevalence in rural males. J Indian Med Assoc. 1997 Mar;95(3):67-9, 83.
16. Kumar MV, Sambaiah K, Lokesh BR. Effect of dietary ghee--the anhydrous milk fat, on blood and liver lipids in rats. J Nutr Biochem. 1999 Feb;10(2):96-104.

South Indians, low fat diets and the cholesterol drama

Let's start out with facts. South Indians (at least the majority of them), and in particular the Tamil vegetarian community have one of the lightest fat diets in the world, low in fat (high in simple carbs of course). And every aunty-uncle couple I have met has some combination of diabetes and cholesterol between them. Of course this has spread beyond the realm of aunties and uncles now to ages very uncomfortably close to my own. (We'll leave the discussion of whether I am an aunty myself to another time).

Yet, every reaction to the high cholesterol diagnosis has been to lower fat further, go to fat-free milk, remove whatever ghee was remaining, dismissing the tadka, etc.... you get the gist. I recently read in several places that Indians have among the highest rates of heart disease anywhere. Sally Fallon's "Nourishing Traditions" quotes from another study that North Indians who eat 17 times as much fat as South Indians have 7 times less heart disease! Both of these indicate that South Indians have the highest burden of heart disease in the entire world (yes, not the red meat eaters of Europe and North America, not the only-meat-eating Inuits, but the largely vegetarian South Indians). And while I don't have a reference for this statement by itself, I can state just by anecdotes that this is probably true.

So, do we have all of our nutritional science wrong? Is a low-fat vegetarian diet not the magic antidote we have been chasing? Well, from a few limited interviews of my mother and aunts, I gathered that in the olden days, "Madrasis" didn't really die that much of heart disease. My mother remembers several natural deaths. I can't say that I have seen even one (North or South, East or West). Sally Fallon, to prove her point against low-fat diets piles a whole lot of adjectives on "Madrasis" - puny, ailing, life span of 20 years (!!) and so on. A lot of this is from quite-suspect anecdotes by some pukka-sahibs in the early 1900s- suspect because I don't currently know very many puny and ailing Madrasis (oh, how I passionately hate this term, and the abuse that it has endured), and I won't even deign to comment on the life-span.

The point being that our traditional diet in our traditional climate didn't hurt us too bad. But that diet has changed. Our rice used to be hulled, not polished (making it a slightly more complex carb with some fiber than the ultra-polished white rice we ingest now), our oils were cold-pressed by chekku maadu-s (and didn't potentially oxidize at the high-heats that solvent-extracted oils are subjected to), our milk was raw, hormone-free, non-homogenized, and our vegetables and fruits were organic. Also this food gelled well with our super hot summers and non-existent winters.

Cholesterol, it turns out, is less of a final problem, and more of an indicator. It (LDL) is produced by our livers as a repair agent, to fix inflamed tissue, such as in arteries. High cholesterol is therefore an indicator of high inflammation, or damaged tissue. It also has been shown that more than 85% of our cholesterol is produced by our liver (as opposed to 15% from food), making reducing our diet fat quite useless in reducing cholesterol. Our concern should be more about why the tissue is damaged in the first place rather than lowering the cholesterol (which no doubt frees up clogs in our arteries, but leaves them damaged anyway). One of the unambiguous factors that have correlated with tissue damage is high blood sugar. The other one (although opinions differ on this one) is a diet deficient in fat soluble vitamins and high in vegetable oils.

What am I trying to say? Just that blindly obeying the dictats of modern medicine, that are based on a few years of possibly highly skewed research, has led us to a more unhealthy lifestyle very far from our roots. Tamil Brahmins reducing fat in their diet is the most extreme diet measure I have heard of. We know that people have lived long and healthy a certain way in a certain place. It is easiest to return even partially to that life, than to follow a largely unknown path, especially one that has proven over the years to be quite useless. Pass the ghee and the coconut oil, please. And make them organic and extra-virgin, while you are at it.