Last week one of my blog posts highlighted a piece I had written for the Times on the relative merits of butter and margarine from a health perspective. I was limited to 1,300 words, and in the space allowed attempted to summarise all the most important prevailing nutritional themes here. I came out heavily in favour of butter.
I know this can be a controversial view, and it’s inevitable that some professionals will not agree with it. Several years ago, for instance, I ‘bumped into’ someone on the internet who was in my year at medical school. Whilst polite, she seemed aghast at my views on butter and margarine. I (also politely) asked her to get together all of the evidence she could find that supports the idea that margarine is healthier than butter and send it my way. She emailed me back to say she couldn’t find any.
Not all people are open enough to take on new information and move on in their thinking. For example, dietician Reijo Laatikainen took me to task over my failure to report evidence which he felt invalidated my case.
In my piece, I had mentioned a huge meta-analysis that failed to find any benefits from reducing saturated fat in the diet and/or replacing it with something supposedly healthier [1]. Reijo was keen to point out to me the claim by the authors that they found an 18 per cent reduction in risk of ‘cardiovascular events’.
I pointed out to Reijo, though, that some of the studies used in the analysis involved changes other than those to do with fat. When the analysis was confined to studies in which fat intake was the only change, absolutely no benefits were found at all.
I’ve asked Reijo to comment on this and whether he feels his original assertion was correct. He has steadfastly refused to comment.
Reijo was also keen to point out a study included in the meta-analysis, the so-called The Los Angeles Veterans Administration Diet Study (LA Veterans study). This study tested the effects of a diet in which vegetable oils replaced animal fat in the diet (details below). I recalled this study when Reijo raised it, but could not remember the detail. One detail I did recall, though, was that while the experimental diet improved some ‘cardiovascular’ outcomes,overall risk of death was not improved.
My exchanges with Reijo around this study caused me to go back to read the original study [2], was well as a later report on the study [3] with some critical detail not included in the original study report. This report [3] was specifically cited by Reijo.
I’m going to describe the study and its findings now. Just bear in mind that this is the study that Reijo is pinning his hopes on as the saviour of the ‘butter is bad, margarine is healthy’ paradigm.
The study involved 846 middle-aged and elderly men (54-88 years) living in a veterans institution in the US. Each man was allocated to eat one of two diets:
1. a diet low in animal fat but enriched with polyunsaturated vegetable oils (corn oil, safflower oil, soya bean oil, and cottonseed oil)
2. a normal diet
The food was supplied in the centre’s canteen under-double blind conditions (neither the men nor the researchers knew which diet each participant was eating). This is good, but what was not so good is that, once assigned to the diet, men were considered as part of the study however long they lived at the centre subsequently. What this means is that it was possible for men who only ate the prescribed diet for a relatively short period of time (even a few days or weeks) to be included in the data analysis, and that these results would have equal weight of those obtained from people who had been in the study for several years.
But another major failing of the study was that the diets of the men were not strictly controlled at all. Dining room records reveal that, overall, only about half the meals the men ate were at the centre and therefore controlled. We have no idea what they ate the rest of the time (good, bad or indifferent).
Each participant was allotted his diet on a random basis. This is done to ensure that the two groups being compared are equivalent in terms of characteristics such as age and general health. While the two groups were well matched in many areas, one critical area that the men were not was cigarette smoking.
For example, 45 men in the ‘healthy diet’ group smoked more than a packet of cigarettes a day, compared to 70 in the control group. Also, there were 99 non-smokers in the ‘healthy diet’ group, but only 86 in the control. The generally higher levels of smoking in the intervention group would bias the results in favour of this group of course.
The ‘primary outcome’ (pre-determined main measured outcomes) for this study was the number of cases of ‘sudden death’ and heart attacks. The differences between the groups were not significant. In other words, the researchers failed to find any benefit in terms of the main outcome they measured.
In situations such as this, it is not uncommon for researchers to start ‘shifting the goalposts’, and dicing and splicing the data in a way that increases the chances of finding a positive result. The outcome that Reijo has been keen to draw our attention to relates to ‘cardiovascular fatalities’. This is a ‘composite’ outcome of a wide range of things including death from sudden death, heart attack, stroke, amputation and rupture of the aorta (the main artery in the body).
Lumping all these things together did produce a statistically significant result. However, as I mentioned earlier, the LA Veterans study failed to find any reduction in overall risk of death.
Now, the fact that cardiovascular deaths were reduced butoverall risk of death was not points to the possibility of an increased risk of death from non-cardiovascular causes. In this study, the ‘healthy’ diet appeared to increase the risk of cancer.
I put this to Reijobut he dismissed it. I suggest one needs to take the rough with the smooth. Is it good science to take a study and laud findings you like, and just wave away those you don’t? Not usually.
And on this point, remember that the LA Veterans study was included in the meta-analysis that found that this was the only study to find benefits in terms of cardiovascular mortality. No other suitable study found this, and overall there was no benefit [1].
And a few other home truths are that the meta-analysis also found that in studies were fat had been reduced or modified in a ‘healthy’ way, there was no benefit in terms of risk in any of these things: heart attack, stroke, diabetes, cancer. And life was not extended by a single day, either.
Here’s a summary of the evidence Reijo has put up to question my conclusions regarding butter and margarine:
- A ‘positive’ finding from a meta-analysis (Cochrane review) of fat reduction/modification trials that does not stand up to scrutiny (a fact he won’t comment on)
- The cardiovascular benefit of a study (LA Veterans) which also found an increased risk of cancer (and no reduced risk of death)
- That the original intended measured outcome of the study was not found to be improved, and that benefits were only found once the authors started to ‘massage the data’
- That this study was ‘double-blind’, but in no way ‘controlled’ in that the men were free to eat what they liked about half the time
- That in this study, results could be included from men who participated in the study for a short time only
- That higher smoking rates in the control group biased the results in favour of the ‘healthy diet’
- That this is the only study listed in the Cochrane review that found benefits in terms of cardiovascular deaths (none of several others found benefit here)
- That overall, fat reduction/modification has not been found to reduce risk of cardiovascular death
- That overall, fat reduction/modification has not been found to reduce the risk of heart disease or stroke, and has not been found to extend life either
Reijo can ignore these facts but he can’t change them.
I don’t know Reijo and perhaps he’s a very well-meaning chap. Even if this is true, I think he’s suffering from a terrible case of bias. My sense is, for whatever reason, he is stuck in an old paradigm where saturated fat is ‘artery clogging’ and highly refined and heavily processed vegetable oils (margarine) somehow have (miraculous) health-giving properties.
Even in the face of overwhelming evidence to the contrary he appears to cling to this paradigm for grim life. Let’s hope it won’t be the death of him.
References:
1. Hooper L, et al. (2012) Reduced or modified dietary fat for preventing cardiovascular disease. The Cochrane Library.
2. Dayton S, et al. Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications. Lancet. 1968;2(7577):1060-2.
3. Dayton S, et al. Los Angeles Veterans Administration Diet Study. Nutrition Reviews 1969;27(11):311-316.
Is there actually any sort of research report which documents exactly how saturated fat clogs the arteries once ingested? The Australian Heart Foundation keeps repeating over again like a broken record that fat will clog the arteries, inflammation has nothing to do with heart disease, margarine is healthy and we should eat heaps of sugar. They keep saying they have all the “high quality research from the top scientists and academics”which backs their claims. Do you know if they even exist? I have never read one.
I asked them to tell the public what the physiological process is for the clogging of the arteries with saturated fat on their Facebook page, but they deleted my comment!
The spokeswoman for the Heart Foundation is obese, so I’m not sure the healthy heart diet they promote actually works (?)
Thanks, Lisa
I believe I read (amongst all the dietary info I have studied recently) that the LA Veterans trial made a point of using fresh vegetable oil daily, to avoid problems associated with high-temperature damage spoiling the results. How many fast-food outlets go this far? Saturated fat, however, is apparently indestructible…
I may respond to your allegations more precisely later.
Meanwhile, I need to say this claim does not depict my view on dietary fats: ” My sense is, for whatever reason, he is stuck in an old paradigm where saturated fat is ‘artery clogging’ and highly refined and heavily processed vegetable oils (margarine) somehow have (miraculous) health-giving properties.”
I don’t think margarines or refined oils are miraculous, but I do think they are somewhat better than butter at the population level in terms of cardiovascular health. I do think cold-pressed oils are healthier than refined ones. I think dietary fats are just one part of healthy diet and their role per se has been too much underlined in the past.
In a way this exchange between me and John has been very odd incidence because here in Finland some “gurus” and health care professionals consider me too favourable towards saturated fat. So, there I am, stuck at the middle.
Those who may have become interested in my views can check some slide decks on fats I have produced to Slideshare.
or try luck with google translator with this piece in Finnish (my conclusions on fat).
http://www.pronutritionist.net/yhteenveto-ravinnon-rasvoista/
Dear John,
you are sick, denialist fuck, making a cheap buck by putting up nonsense for people who do not know better.
You are on par with Anti-darwinian creationist community (intelligent design). In fact, as a cholesterol/diet-heart denialist you have very much in common with the above mentioned religious whackjobs.
Okay,
I am not expecting you to publish that. Sorry for the vulgar language. I am sure you are a nice person and a good doctor. When it comes to lifestyle, we are on a different page, though 🙂
Have a good weekend,
Best,
R
Well done Dr B for publishing both Richard Mjödstånka’s comments!
Maybe Richard can put up some serious research conclusions to back up his comments…?
Or can we assume that apart from margarines’ known negative health effects, we can add Asperger Syndrome as well?!
Look folks, why do either? I do not find that either of them really enhances the taste of cooked meat or vegetables more than say, olive oil. If the taste is not an issue (at least for me), what is the reason for using them?
Is it because that’s the way you grew up and are used to having to use a butter-like substance on your food? Olive oil will crisp chicken skin just as well as butter.
Just a thought. Try doing without either. If you don’t like olive oil, use a different, more healthy substitute of your choice.
😉
Reijo
“I may respond to your allegations more precisely later.”
If you do, can I suggest you use proper research that you report accurately?
I don’t think margarines or refined oils are miraculous, but I do think they are somewhat better than butter at the population level in terms of cardiovascular health.
You can ‘think’ what you like. It’s the evidence that matters, I think, To date, all you’ve able to do is cherry pick a poor study from a wider context that does not support your stance. So far, so bad.
The nights must draw in early in Finland. Poor Richard Mjödstånka. There must just be too many chemicals in his margarine.
I am just warming some pre made soup for my lunch. Which would be best for me (or least bad)? Should I warm it up and eat it or boil it to within an inch of its life, add some chemicals I made earlier, boil it for a bit longer, add some more things to colour it, then more to flavour it? Then put stuff in so I can keep it in the fridge and eat it next year. Oh, also add some more chemicals to make it taste ok. Then eat it.
Irrespective of the intricacies of industry sponsored trials and publication bias it does not seem too difficult to decide which of these options may be best. Even if you live in a country where the lights are about to go out for a few months!
Hmm . . . Finland . . . isn’t that where the where the wood chip industry found a profitable use for their industrial sludge cellulose by adding it to margarine and calling it Benecol. Any possible connections here?
Last week, me and my partner, just in passing, were wondering if you ever post/receive any anti-Briffa comments, as it seems to us all the comments we read are highly (thankfully) supportive of you, and I do know all comments get moderated before posting. And I myself have posted on how much I enjoy reading the comments and experiences of your readers. I was quite shocked to read Richard Mjödstånka’s foul mouthed post, and hats off to you for going ahead and posting it (and at the same time answering our question between ourselves). Shame on you Richard Mjödstånka for stooping that low. Now Dr. B., could you please do a post exonerating beef dripping too 🙂 ??
Liz
I base my advice on what I think the evidence shows and/or my clinical experience. This is what ‘evidence-based’ healthcare is supposed to be about. I think most people recognise that I offer a quite-balanced and holistic view, and I think this is why I get surprisingly little dissent.
However, occasionally, someone will decide to ‘have a pop’. Often, if I’m honest, this is a dietician like Reijo who (in my view) is misinterpreting or misrepresenting the evidence (or simply doesn’t have a good grasp of it). I used to get my fair share of ‘hate mail’ (again, usually from dieticians), but that’s stopped of late, it seems.
I do not do what I do to be popular. My commitment is to providing the best information and advice I can. If someone gets upset in the process, it does not deter me. There are plenty of other writers and bloggers like me, too. I actually think that truth is finally winning out.
What’s (potentially) wrong with beef dripping?
“In a way this exchange between me and John has been very odd incidence because here in Finland some “gurus” and health care professionals consider me too favourable towards saturated fat. So, there I am, stuck at the middle.”
I am from Sweden, a neighbouring country to Finland and know for a fact that the experts in Finland is very very much against saturated fats. I myself is eating low carb diet and on different forums we have many people from Finland and Norway participating in our discussions. They also give their opinions about the dietary advices they get in their respective countries.
Being stuck in the middle I do fully understand so please be considerate and to the facts.
Bravo John! It so great to have someone who is conventionally trained have a view that is on par with mine. I too get dismayed at dieticians who for some reason favour foods that are detrimental to health. Cold pressed oils like Reijo mentioned do have very good properties but they are very different to butter and both offer nutritional benefits to the human body. One should not be replaced in favour of another. I use cold pressed oils and butter (and plenty of it!).
I went to a meeting last week where a dietician and nutritionist were the headline speakers. I was dismayed that the dietician literally slagged of two of the most nutritious foods on the planet in favour of milk and salt!
When asked why this was she stated that high doses of (the natural food sources) have been shown to have a high risk of cancer. To say I was horrified is an understatement.
Ok, this wasn’t about oil and butter but it just goes to show how far removed from reality these people are. What the heck are they studying?
If I followed their advice, I’d be fat, ill and perhaps have diabetes. Thankfully I eat plenty of fat!
Put that in your arteries and smoke it Reijo!
Having been taught that margarine was invented in 1922 to fatten turkeys ,it occurs to me that the turkeys were really clued up as they hated it and it was then coloured and flavoured so that humans would eat it.
I am aware that 80 years later things must have changed a mite in the producing of the same yuck. I read that margarine does not go off, so how old is the pot in the house you are using? I like to know food has an ultimate day for eating, like most foods it has a smell and an appearance that shows it’s not for devouring.
The notion that heart problems did not start until after 1920’s makes me wonder if that’s the symbol that margarine is not for human digestion, if the turkeys refused it, surely we should too? Well in our house we don’t eat it either.
I really can’t see how that study of US veterans could possibly have been double-blind. I thought double blind meant that neither the “Doctor” not the “patient” knows which regime is being consumed
Surely the men who were eating the food would have been able to tell whether it was made with animal fat or vegetable. I’m sure I would. So doesn’t that invalidate it ?.
Marg and veg oils – what do we know?
We know that rates of diabetes, obesity, CVD and stroke are soaring, the latter affecting younger and younger age groups in the last few decades during which fat phobia has become entrenched in the public imagination.
We know that margarine is a chemical concoction including transfats, emusifiers, preservatives, hexane and perhaps other damaged fats or industrial solvents.
Our vast consumption of highly processed vegetable oils and hydrogenated fats not only distort the ratio of fats in the diet which promotes chronic inflammation (the precursor to many major degenerative diseases) but are also not chemically stable enough to resist high temperatures without oxidising. Chemically, saturated fats are safer in this respect.
Bottom line: transfats, damaged fats, hydrogenated fats – no thanks. A long shelf life is good for the retail industry but what about my shelf life?
Butter, preferably from grass fed cows is a joy, flavoursome and rich in nutrients such as CLA – but here’s the skinny on fats – butter is nutrient dense, therefore highly calorific, so must be eaten in moderation, especially if excess body fat is an issue. Sadly, excess white adipose tissue is not inert but independently and metabolically active.
Bottom line – your marg and veg guzzling friends are possibly healthier by virtue of normal body weight than podgy pals who are carrying their very own inflammation factory around with them 24/7. So bring on the butter – but in moderation only.
The key figure in this issue is Dr Johanna Budwig, the renowned German microbiologist, who in her day was a world authority on the impact of fats on the body. Her view was that hydrogenated fats like margarine and most commercially-produced non-cold-pressed oils have the effect of interfering with the healthy function of the body at a cellular level in that they impair the cells’ ability to communicate with adjoining cells and with their ability to absorb nutrients and allow the entry of insulin, hence being a major cause over time of type-2 diabetes and cancer. Cooking in oils at a high temperature also hydrogenates them, so should be avoided (ie deep frying)
Margarine is a major culprit in this process and should therefore be avoided. She was sued in court by powerful commercial interests such as margarine manufacturers three times and won on every occasion on the basis of her research, which was carried out at a molecular level of examination. What’s more, she was nominated for the Nobel Prize six times, but her therapeutic approach, which involved the amalgamation of flax oil and cottage cheese was so unorthodox there was little chance of success.
Butter does not cause these problems and eaten in moderation is very healthy.
The case of Dr Budwig reminds us that it’s not just the power of drug companies we sometimes have to fear, but the power of commerce and advertising which has with great success changed a whole generation’s diet by means of relentless promulgation of unhealthy foods.
The mystery is why mainstream medical advice appears to reflect the same ideas which have no foundation in bio-chemistry or micro-biology. All medics must have had the same training in the subject as those who occasionally raise their heads above the parapet to tell the truth.
I’ve never accepted the idea that an industrial processed fat could be healthier than something you could produce yourself from some cream. Also the quantities you would naturally eat seem relatively small to have such a big effect.
What is depressing, as the family shopper, is that just as the fat villain is about to be unmasked the supermarkets seem about to give up on normal yoghurt in favour of zero fat.
Re Pete Grist.
Yes, yes. Tell me, someone, what is the POINT of fat free Greek yogurt. Surely it was always meant to contain its fat. I live in dread of my local store withdrawing the proper and properly sating full fat variety with miserable zero fat. Bang would go one of my favourite breakfasts – full fat Greek yogurt, a tiny drizzle of (preferably Greek) honey a handful of raspberries and a generous fistful of walnuts. That’s what I call healthy.
It’s been a long time since I’ve read fat research and LA Veterans study, but…
The rate of smoking was actually not much lower in the experimental group.
The amount of chain smokers was lower indeed, but the amount of low-level smokers was also higher in the experimental group:
2+ packs/day: 13 control group / 7 experimental group
1-2 packs/day: 57 control group / 38 experimental group
½-1 packs/day 129 control group / 173 experimental group
0-½ packs/day: 62 control group / 46 experimental group
Occasionally: 18 control group / 19 experimental group
Didn’t smoke at all: 86 control group / 99 experimental group
No data: 57 control group / 38 experimental group
So I don’t know whether the differences in smoking is so an important factor here.
On the other hand, one pro-butter argument here is the fact that the control group’s diet had too low vitamin E content. Chris Masterjohn has written:
“The diet rich in animal fats, moreover, was deficient in vitamin E. Animal experiments suggest that we should obtain 0.6 milligrams of vitamin E for every gram of PUFA we consume. The vegetable oil diet came close to this requirement, supplying a ratio of over 0.5, but the animal fat diet fell miserably short of it, supplying a ratio of less than 0.2.”
“Animal fats are not intrinsically deficient in vitamin E, however. The average store-bought butter, for example, easily meets the vitamin E requirement, and a high-quality pastured butter can provide more than double this requirement. […] It is thus unclear why the animal fat diet was so deficient in the vitamin[…]”
Source: http://www.westonaprice.org/know-your-fats/good-fats-bad-fats-separating-fact-from-fiction
——
BTW John… I have one quite a big request to you. Please read this article (written by me) and say what you think about it: http://180degreehealth.com/2013/08/thyroid-hormones-heart-disease/
The article is a very long one but I think you might find the data very interesting.
It’s really easy to make your own Greek yoghurt and you can be more certain about the source of the milk and use raw if you want. You can use low or fat free for the starter if you can’t find any whole milk yoghurt. Add some cream after you’ve made it to make it even better.
In my previous comment, I forgot to mention that the experimental group also gained some weight compared to the control group. 🙂
Dennisvjames – you’re right of course, there is no reason to slather everything you eat with any kind of added oil at all.
But the problem is people are being encouraged to go to insane lengths to eliminate any amount of saturated fat from their diet, removing it from perfectly healthy natural foods or avoiding others entirely. Meat is a great example of this; people are put off eating very economical and nutritious cuts because they are fatty, rather than enjoying the fat that comes in the natural proportion to protein. I know so many people who will only eat lean (dry) chicken breast or steak, for “health reasons”. Liver on the other hand is hardly eaten by anyone, despite being packed with health-giving nutrients like vitamin K, A, B12, folic acid, phosphorus and so on. And yet people avoid it because of the cholesterol.
Some people in the low carb community I think take it too far; what is the evolutionary rationale behind chugging pints of double cream, eating sticks of butter and so on? But eating natural foods with a healthy amount of saturated fat and a full complement of micronutrients should be the advice, rather than trying to eliminate a perfectly benign source of energy which is frequently accompanied by lots of good stuff.
Tom
All well said and well put, I think, especially this part:
eating natural foods with a healthy amount of saturated fat and a full complement of micronutrients should be the advice, rather than trying to eliminate a perfectly benign source of energy which is frequently accompanied by lots of good stuff.
What puzzles me is why when we knew in 1965 the effect of CORN OIL IN TREATMENT OF ISCHAEMIC HEART DISEASE.why we still have this argument more than 55 years later?
I can’t understand why the UK Heart Foundation chooses to recommend corn oil as a healthy alternative to natural saturated fat from grass raised animals.
It still seems LA Veterans study was at least somewhat believable, although the popular assertion that it was effective because of ALA-rich oils may not be (were ALA amounts mentioned in the paper?). The fresh oil argument is interesting as well, because there was another trial that replaced animal fat with soybean oil for up to 7 years, the 1968 Medical Research Council trial, which found no difference in total mortality or CHD mortality. Soy bean oil has been a regular in other positive studies and it has a lot of ALA.
Obviously the oil/fat quality differed enormously during the big bad 60/70’s studies in addition to many other dietary and lifestyle (smoking) factors. One should be really careful of making strong assertions about those studies and be wary of anyone trying to do so (since they are just about the only RCT:s ever conducted). In my view, Reijo did just point out that making strong assertions on pointing out of benefits of butter are not backed up either.
Tom,
There are no randomized (fat swap or
multiple factor) intervention studies either that show that keeping saturated fat intake is in any form beneficial either. Simply keeping one attached to the delicious theory of “natural” one ruminant species’ processed milk product is not at all among the strongest bets for better health.
Perhaps, just perhaps after taking care of ALA/fatty fish consumption to boost all omega 3s, eating fresh greenies, berries and nuts and seeds regularly with good stress management, sleep and balanced exercise and energy balance does guarantee that adding some saturated fat does not change things a bit. I would actually guess it doesn’t.
But getting lots of LDL raising animal fat based foods (of which butter is one) does not seem a good idea if one is older than 65, a male and doesn’t care much for anything else healthy (in aforementioned sense). Lots of people probably have done exactly that, reading apologetical SaFa articles with a passing glance and upped their butter consumption while thinking there is no risk involved after all.
But alas, no study yet has shown that! And there are other lines of study that agree healthy suspicion should be the safest bet on behalf of saturated fats, especially butter. Not a giant killer once thought, but not proven harmless and definitely not proven beneficial.
In terms of speaking of paleo diet concept, I urge people the expand their minds a bit. Studied present African ruminant species contain similar fatty acid ratios and percentage of fat (lowish) as the wild animals in other continents, which points out to somewhat similar contents and amounts during the upper Palaeolithic as well.
Different animals’ meats have different health effects. For example, bison meat is far more bening when compared to regular cattle:
http://content.lib.utah.edu/utils/getfile/collection/etd2/id/1061/filename/1505.pdf
In similar vein, also butter can be better or worse. Costa Rican ruminants have more Vitamins D, K2 and CLA content, as well as maybe some unknown factors considering the environment and the race of the cattle itself.
How about cheese, which has not as strong LDL raising effect as butter and can contain a mydiad of other stuff like K2-MK4, of which consumption has been associated with 50% reduction in heart attacks?
Obviously people can make better choices, depending on resources and knowledge, even within similarly obtained foods. Keeping the discussion on the level of fat swap (and those generally bad 50 years old RCT-studies) is not the only way to keep on looking it. Let’s open our minds a little.
Neonomide: “It still seems LA Veterans study was at least somewhat believable”
What was so believable about it?
Neonomide: “In my view, Reijo did just point out that making strong assertions on pointing out of benefits of butter are not backed up either.”
No, Reijo stated that he thinks that margarines or refined oils are “somewhat better than butter”. He was unable to back up his assertions and hasn’t responded yet. He even ignored every one of my posts.
Neonomide: “But alas, no study yet has shown that! And there are other lines of study that agree healthy suspicion should be the safest bet on behalf of saturated fats, especially butter. Not a giant killer once thought, but not proven harmless and definitely not proven beneficial.”
Saturated fat does not have to prove itself harmless, inductively that’s assumed. The burden is on you to prove that saturated fat is harmful. In fact, given the numerous clinical trials (whether replacing or reducing saturated fat) and observational studies throughout the decades which are consistent with each other, we can say that saturated fat has indeed proven itself to be harmless.
Neonomide: “Keeping the discussion on the level of fat swap (and those generally bad 50 years old RCT-studies) is not the only way to keep on looking it.”
Actually many of those old studies were well conducted and measured meaningful outcomes. Are you going to do like Reijo and rely on short term data on surrogate markers the significance of which is unknown?