Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test

In this Part IV of the series (Part I; Part II; Part III), I have decided to do go about this in a different way than I’d indicated before. I covered the Paleo Principle in Part II, but more in terms of our having evolved to eat meat and not with a lot of specifics about saturated fat in particular. Accordingly, this is perhaps what Part III would have been had I not got sidetracked on cognitive dissonance.

One of the pioneers of the paleo Diet is Dr. Loren Cordain, PhD. Back in the early 2000s he wrote and published The paleo Diet. It’s a frustrating read because, whereas he got so much right, he just wasn’t correct on the issue of saturated fats in the view of so many, including myself. I’ve blogged about this before. While he was certainly correct about the fat composition of wild animals vs. today’s manufactured ones, many believed he went way overboard in recommending lean meats, avoiding chicken skin, using processed canola oil for god’s sake, etc. And many rightly pointed out that everything we know about hunter-gatherers suggests that they prized fat above all.

What’s now important, however, is that Dr. Cordain recently got wind of something that has caused him to backtrack on saturated fat. His latest paper:

Dietary Fat Quality and Coronary Heart Disease Prevention: A Unified Theory Based on Evolutionary, Historical, Global, and Modern Perspectives

Christopher E. Ramsden, MD; Keturah R. Faurot, PA, MPH; Pedro Carrera-Bastos, BA; Loren Cordain, PhD;
Michel De Lorgeril, MD, PhD; Laurence S. Sperling, MD

The money quote:

The Seven Country Study, a cross-cultural analysis, reported strong positive associations among a population’s average SFA intake, serum total cholesterol concentrations, and 25-year death rates from CHD. However, it is important to note that several groups with very high SFA intakes from coconut fat (up to 40% of energy) and apparently low CHD rates have since been identified. In the Nurses’ Health Study, a large prospective cohort study, a weak but significant positive association between SFA intake and CHD risk was initially seen. With long-term follow-up, this association was no longer significant. Any association between SFAs and CHD appears to be a small fraction of that observed for TFAs [trans-fatty acids]. Other observational studies and dietary trials have been unconvincing or even contradictory. In general, experimental evidence does not support a robust link between SFA intake and CHD risk.

Coconut fat is almost 90% saturated fat. I’ll save the details on those populations for a subsequent post in the series.

And there’s more, from Dr. Cordain’s newly minted blog. Just a couple of days ago he fielded a question about saturated fat.

In summary, high total cholesterol or LDL levels do not increase CVD risk–rather oxidized LDL increases risk of CVD. To produce oxidized LDL requires the factors mentioned above. Hence, consumption of saturated fatty acids is not an issue if we control several other factors such as those mentioned.

Now that’s an enormous step from using the arterycloggingsaturatedfat mantra over and over in his book. So then, Dr. Cordain seems to have realized that fear of saturated fat just didn’t pass the smell test. While he chose to focus in on epidemiology that I’ll address later, here’s four good reasons to believe that saturated fat is not only not harmful but on the contrary, quite healthful.

1. Guess what happens to 100% of excess dietary carbohydrate, i.e., once liver and muscle glycogen (stored carbs) is full up (about 2,000 kcals)? It gets converted to fat. What kind, you ask? I’m glad you asked: palmitic acid. And what’s that, you ask? I’m glad you asked again: saturated fat. The evildoer.

I wanted to confirm this once again so I asked Dr. Stephen Guyenet, PhD (biology):

If it isn’t burned or stored as glycogen, it’s turned into palmitic acid in the liver and exported in VLDLs. It’s called de novo lipogenesis. There’s a caveat though: under average fat:carb ratios not much de novo lipogenesis (DNL) happens. Fructose and alcohol gets turned into palmitic acid pronto, and very high-carb diets promote DNL too. The Kitavans have a bunch of palmitic acid in their lipoproteins even though their dietary intake of palmitic acid is low.

Yes, so even if you aren’t eating carbs to super excess, still, all fructose and alcohol go straight to the liver and converted into saturated fat immediately.

2. What’s the composition of your own body fat which, actually, is in a constant state of turnover?

Lard: 38 percent saturated, 11 percent polyunsaturated, and 45 percent monounsaturated with the rest being trace fats.

Human: 35 percent saturated, 51 percent monounsaturated, and the rest polyunsaturated and trace.

Pretty similar. So if saturated fat intake above 10% of total calories is such a killer, then how come your own body uses it to the tune of 35% of all fat storage?

3. And how about all that fiber you are admonished to eat? All those fruits (oops: fructose; palmitic acid), vegetables, legumes & grains? Ever heard of Butyrate? You can also call it butyric acid and it’s a saturated fat. Guess how you get it in your diet? Well, the chief source is butter (get it: BUTyrate). But there’s another source too. Turns out the bacteria in your gut produce it when they go to work on fiber, both soluble and insoluble.

Dr. Guyenet recently posted all about it for those who want the depth.

…In industrialized countries, fiber may contribute 5 to 10 percent of total calorie intake, due to its conversion to short-chain fatty acids like butyrate in the large intestine (free full text). This figure is probably at least twice as high in cultures consuming high-fiber diets. It’s interesting to think that "high-carbohydrate" cultures may be getting easily 15 percent of their calories from short-chain fats. Since that isn’t recorded in dietary surveys, they may appear more dependent on carbohydrate than they actually are. The Kitavans may be getting more than 30 percent of their total calories from fat, despite the fact that their food is only 21 percent fat when it passes their lips. Their calorie intake may be underestimated as well.

4. And last but not least, human breast milk is a whopping 41% saturated fat.

Saturated fatty acids, polyunsaturated fatty acids and monounsaturated fatty acids of human milk constituted 40.7 ± 4.7%, 26.9 ± 4.2% and 30.8 ± 0.6% of the total fatty acids, respectively.


So, given the above and pretending you know nothing of the bad reputation of saturated fat over the last four decades & more, would you not be quite surprised to be told it was unhealthful, a killer? Since it exists in such high concentrations in our own biology, would you not rather assume it to be rather healthful?

Saturated Fat and Coronary Heart Disease, Part V: The “Science”


  1. O Primitivo on December 19, 2009 at 20:15

    Excelent post Richard. Regarding saturated fat, I also enjoyed this recent post from the PALEO DIET group. I think this represents a change of positions, as there is now much evidence that saturated fats are innocent.

  2. epistemocrat on December 19, 2009 at 15:48

    Hi Richard,

    Those are four solid conjectures to fund self-experimentation with hyperlipidity and fructose/alcohol detox.

    It’s worked well, so far, for me.



  3. Ryon Day on December 19, 2009 at 15:59


    Interestingly enough, if you talk with Robb Wolf, who worked with Cordain, he says that Cordain himself was unhappy with what the publishers/editors did with The Paleo Diet in terms of some of the content regarding saturated fat.

    One can imagine the book’s editors imagining the uproar from the public and the establishment over arterycloggingsaturatedfat being part of the diet and heading that off at the pass. The fact that the book is merely mostly correct and was yet completely revolutionary is still pretty staggering to me!


    • Richard Nikoley on December 19, 2009 at 16:11

      I’m certainly happy to be able to let him off the hook now. Saves time too, as those trying pale and not up on the latest can easily be shown the latest.

  4. Jack Christopher on December 19, 2009 at 17:02

    On mammal bodyfat comp.
    Here’s an analysis on dietary fat type and bodyfat changes in rabbits :

    “Adipose tissue takes up many different fatty acids from the diet. The degree to which these fatty acids are absorbed varies, however. Specifically, a diet high in saturated fat raises saturated fat in rabbit adipose tissue only modestly, whereas a diet high in polyunsaturates increases PUFA levels in adipose tissue dramatically.”

    I wonder how the avg. bodyfat comp of people today differ from a healthy grok?

    • Richard Nikoley on December 19, 2009 at 17:24

      Yea, but when you look at the percentages of SFA and MUFA, PUFA is always by far the least, by a factor of 3ish. I don’t think a few % in any directions is going to make a profound effect, though, the balance of 3:6 within the PUFA is important as pretty well established.

  5. Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test … | cholesteroltests on December 19, 2009 at 17:44

    […] Continued here: Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test … […]

  6. Bryce on December 19, 2009 at 18:54

    Excellent as usual Richard. This is a nice condensation of several of your past posts. I wonder if the doctor you dedicated to this line of posts to has had any response to the completely overwhelming evidence vindicating saturated fat?

    Hope everyone has a chance to tribe with family and friends in the coming weeks. Merry Christmas all.


    • Richard Nikoley on December 20, 2009 at 09:33

      I haven’t attempted to let him know about it,but there’s always Google, I suppose. Perhaps when I’m done I’ll find some way to make sure he’s at least aware of it.

  7. Todd Hargrove on December 19, 2009 at 20:47


    Great post, I rarely comment but read them all.

    Interesting news – evidence that cereal grains were used 100k years ago?

    • Richard Nikoley on December 20, 2009 at 09:37

      I’ll probably blog something about that next week. In the meantime, until they start unearthing a whole lot more of these finds in a lot more places and for a lot more populations I doubt it was anything but a necessity for survival at the time.

      But I haven’t looked into it very deeply, yet. Here’s what I posted on the paleo-libertarian list:

      “Why, with all the massive evidence showing we sourced animals above all is it a problem when one small population, probably faced with hunger resorted to the labor intensity of gathering seeds?

      I think that’s a strike in favor of evolution, not against our primary sources of nutrition. I’d happily eat grains too, if I was hungry and couldn’t kill & slaughter enough animals to feed me and mine.

      But I’ll bet they were still n the lookout. That’s why in addition to bakeries, nowadays, we’ve also got Ruth’s Chris. Yum.”

  8. Alex Thorn on December 20, 2009 at 02:33

    I have the PDF of one of the research papers to which Loren Cordain contributed. It has several tables detailing the fatty acid composition of wild game compared to both grain-fed and pasture-fed cattle. Most of the wild game have a saturated fatty acid content very similar to domesticated cattle and, in the case of white-tailed deer and elk, a significantly higher proportion. In most cases the domesticated cattle had higher ‘heart-healthy’ monounsaturated fats compared to wild game. The only fat that was more abundant in wild game than in the domesticated cattle was polyunsaturated fat – which, to my mind, is not particularly a health boon! Admittedly the wild game had less fat overall even though there was often as high or higher percentages of saturates but that point is addressed in the next paragraph.

    Another thing that annoys me is that when referring to analyses of game animal fat content it is a) restricted to intramuscular fat (marbling) and b) or samples are trimmed of any visible fat before the analysis was done. In the one instance I have seen, it was stipulated that, in the comparison between wild boar and domesticated pig, the wild boar meat had not been trimmed and, lo and behold, they had virtually identical fatty acid profiles. They also only ever seem to refer to muscle meat and imply that any visible fat would have been removed rather than prized and eaten preferentially to the lean, unmarbled meat.

    • Richard Nikoley on December 20, 2009 at 09:45

      Good analysis, Alex.

      Yea, my reasons for going grassfed primarily are the n-6 issue. Because I eat out quite a lot — and even specifying that my eggs be cooked in butter, etc — I know I probably still get more n-6 than desirable, so grassfed is the way to go.

      I’ll tell you what, though, if you get a sous vide and do porkchops, no way you’re trimming any fat. Most delicious fat I have ever tasted, and I’m talking the less expensive, thin, bon-in chops. I did the thick boneless ones the other day and even sous- vide were significantly dryer that the bon-in chops. On the other hand, the outer strip of fat was delicious, like bacon fat just before crispy.

  9. Monica Hughes on December 20, 2009 at 03:29

    Interesting. I’ve been reading through the Paleo Diet blog and there is a lot of great advice there. But then I unfortunately found this:


    • Richard Nikoley on December 20, 2009 at 09:46


      • Dave, RN on December 21, 2009 at 10:51

        If you want some REALLY good fat, go to your grass-fed meat butcher and get some bones. Have them cut into 1 to 3″ lengths. The marrow is mostly fat… GOOD fat. Cook’em in the oven for 20-25 minutes. It’s the stuff our ancestors craved!

  10. Nicole on December 20, 2009 at 05:22

    Just a little point: Cordain does not write that blog himself. Someone named Patrick Baker wrote the entry you quote above.

    • Monica Hughes on December 20, 2009 at 09:23

      I guess that’s the danger of letting your grad students write a blog with your name attached. :)

    • Richard Nikoley on December 20, 2009 at 09:47

      Thanks for clarifying that, Nicole. Probably should have mentioned that in my entry but i wasn’t completely sure.

  11. Ned Kock on December 20, 2009 at 08:39

    Some self-experimentation can be very enlightening regarding this connection between saturated fat, cholesterol, and heart disease.

    Here is what happens with me:

    If my intake of refined carbs and sugars is very low, and saturated fat high, my LDL cholesterol will go DOWN (but will still be a bit higher than if carbs AND sat. fat are low), my HDL cholesterol will go UP (big time), and my trigs will go DOWN.

    If my intake of refined carbs and sugars is high, and saturated fat high, my LDL cholesterol will go UP, my HDL cholesterol will go UP (but not nearly as much as on a low carb. diet), and my trigs will go DOWN (but, again, not as much as on a low carb. diet).

    If my intake of refined carbs and sugars is very low, and saturated fat is also low, my LDL cholesterol will go DOWN (a lot), my HDL cholesterol will go DOW, and my trigs will go DOWN. (This ends up being a starvation diet, because it is hard to get enough protein and still keep carbs AND fat intake low.)

    Many people I talk to seem to respond in the same way. Of course, some many not, as everybody has a slightly different genetic makeup and body composition from the other person. In any case, all it takes is several 3-month periods with blood tests at the end of each period.

    Since HDL is a much better predictor of heart disease than LDL, the one that seems to be the least heart disease generating diet of the three is the low carb., high saturated fat diet.

    I am not saying anything about paleo here, but I am pretty sure that refined carbs and sugars are what make most westernized diets decidedly non-paleo.

    Ned Kock

  12. Todd Hargrove on December 20, 2009 at 11:36


    Good response on the cereal grains issue. Don at Primal Wisdom has a good new blog about it as well.

  13. Paleo Pete on December 21, 2009 at 05:24

    Hey Richard, what do you make of this study I stumbled on this morning?

    • Richard Nikoley on December 21, 2009 at 09:04

      It’s crap. The begin with a premise that certain cholesterol levels are “bad” a priori.

      • Paleo Pete on December 21, 2009 at 10:20

        well, this is the only part that really caught my attention:

        And they checked blood vessel functioning by measuring blood vessel dilation in the arm.

        They found that “as you increase the amount of saturated fat [in the diet], blood vessel dilation is reduced,” Miller said. Healthy vessel dilation is important to proper blood flow.

        “The diet that performed the worst [on the blood vessel test] was the Atkins diet,” Miller said. “It contains more saturated fat.”

      • Paleo Pete on December 21, 2009 at 13:44

        That eades article was awesome.

      • Alex Thorn on December 21, 2009 at 11:46

        That article was dated April 1st – April Fool anyone?!

        The last time that ‘trick’ was tried (with the same results) it transpired, on closer examination of the data, that those subjects given the high fat test meal had a lower blood vessel dilation reading at baseline while those given the low-fat test meal had a higher blood vessel dilation at baseline. The upshot being that the impairment was greater for the low-fat subjects than for the high-fat subjects because they had more to lose in the first place!

        You guys should really check out the full text with data – it’s a hoot!

        The Atkins group had a greater increase in HDL and a greater decrease in triglycerides than those at the other end of the dietary fat scale on the Ornish diet who decreased their HDL and increased their triglycerides (by a whopping 4.4x the difference in the Atkins group) from baseline!

        They also measured apoA-I (antiatherogenic) and apoB (proatherogenic).

        In the above study they found that the ratio between apoA-I/apoB was a better indicator of risk of CHD than any other combination of lipid factors. The higher the ratio, the lower was the risk. The Atkins group only had a marginally lower ratio than the Ornish group, 1.98 versus 2.00 respectively, while the South Beach group faired best with a ratio of 2.29 after the intervention. Again the Ornish group only pipped the Atkins group because their apoA-I was already higher at baseline but the Atkins group increased apoA-I by 3 mg/dL while the Ornish group decreased theirs by almost 6x that at 17.8 mg/dL after the intervention. The only negative for the Atkins group was that they also increased their levels of apoB while the South Beach and Ornish groups decreased theirs – but not enough to cancel out the ratio benefit from the increase in apoA-I.

      • Richard Nikoley on December 21, 2009 at 14:37

        Thanks for all that digging and analysis, Alex.

      • Alex Thorn on December 22, 2009 at 04:40

        You’re welcome. It always annoys me that people quote the conclusions of a study and never look at the data or methodology. Often the two are poles apart. One thing that occurred to me after I wrote that was in what order were the diets given? There were three 4-week diet interventions (randomised cross-over design) with a 4-week washout period between each intervention. Subjects embarking on the Atkins diet arm of the study may have just finished the Ornish arm and had their baseline levels negatively affected as a result.

      • Dave, RN on December 21, 2009 at 10:53

        That doesn’t make sense. Since “going paleo” two years ago, My blood pressure has dropped from 135/95 ish to 108/66 ish.
        you can read all you want, but personal results speak for themselves.

      • Richard Nikoley on December 21, 2009 at 10:56

        Me too, Dave. I was 150-160 / 95-105 every time I checked and now I’m normal.

  14. Aaron on December 21, 2009 at 12:29

    Is there any evidence to support for/against the fact that cooked yolks may be problematic because of oxidized cholesterol? Cooked eggs are infinitely more tasty than raw eggs, and I don’t think anyone has really studied the question much. I’m pretty sure even Ravnskov didn’t have a direct answer.

    • Alex Thorn on December 21, 2009 at 13:55

      My personal opinion is that it is a bit of storm in a teacup. I’ve not come across any persuasive evidence that eating oxidised cholesterol is anywhere near as bad as the oxidation of the cholesterol already in your body. Since food has to be oxidised during digestion it seems a moot point:

      “For example, the digestion of food is an oxidation process. Food molecules react with oxygen in the body to form carbon dioxide and water.”

      Read more: Oxidation-Reduction Reaction – examples, body, used, water, process, life, plants, chemical, form, energy, gas, animals, carbon, oxygen, substance, plant, Redox and electron exchanges

      It should be born in mind that in order for anything to oxidise it has to be in close contact with oxygen and the process is enhanced by heat. With that in mind, an unbroken egg yolk is enclosed in a membrane that will help keep oxygen out while cooking if it is not broken – as in frying, boiling, poaching, etc. Omelettes and scrambling involve the membrane being broken, so oxygen is more likely to come into contact with the cholesterol and lipids during cooking.

      However, as already said, I don’t think eggs cooked in any manner are unhealthy. Egg yolks are fine raw but whites are better off cooked, due to presence of the anti-nutrient avidin, and also because the protein is more digestible/bioavailable in cooked egg whites.

  15. Aaron on December 21, 2009 at 15:41

    Alex, it’s logical that food digestion is an oxidation process. That seems ok for fats,carbs and proteins, though I’m not convinced that we should be eating cooked cholesterol (even though I do). I’d like studies showing me evidence that we aren’t incorporating oxidized food cholesterol into our membranes.

    • Alex Thorn on December 22, 2009 at 04:29

      I don’t know if it is possible to provide evidence that something is NOT occurring – seems like a logical fallacy to me!

      Having failed to convincingly implicate dietary fat and cholesterol in heart disease it seems like the shills for conventional wisdom are changing tack and trying to scare everyone afresh with ‘cooked, oxidised cholesterol’. Personally I’m not buying it. Man has been eating cooked sources of cholesterol since the discovery of fire – if it was that much of a health risk we would have become extinct long ago – since we haven’t it is either not a significant health risk or we evolved and adapted to it.

  16. Aaron on December 22, 2009 at 15:55

    Alex– what you said is complete hogwash — just because we’ve been eating cooked cholesterol doesn’t mean it is necessarily healthy for us. I don’t believe we ever had large supplies of eggs to eat. This is similar to the fact that ancient man probably gorged on fruit when it was available, that doesn’t mean fruit is automatically healthy for us.

    We know that un-oxidized cholesterol is completely healthy — I’m just trying to be careful with cooked eggs. I’m asking for data– not personal opinions.

    Man didn’t usually didn’t live long enough back then to prove if things like eating oxidized cholesterol might be a negative.

    I’m like you — I don’t think it’s a big problem — just seeing if there is any data out there to prove either way.

    • Alex Thorn on December 23, 2009 at 02:43

      You sound a bit like a dietary hypochondriac (no offence)! If it worries you that much type in ‘dietary COPs and health’ into the Google Scholar search engine – I’m sure you will find a wealth of propaganda (sorry, scientific data0 that will, no doubt, have you contemplating a vegan lifestyle!

  17. Aaron on December 23, 2009 at 11:45

    Hell no to vegan lifestyle! I eat a lot of grass fed beef with veggies/fruit. I throw some sweet potatoes/potatoes/rice in the mix for variety.

    Just wanted to throw the oxidized egg cholesterol stuff out there. There’s a lot of smart people coming through this blog, just wanted to see if anyone had some data.

  18. Jim Purdy on December 23, 2009 at 19:55

    “Ever heard of Butyrate? You can also call it butyric acid and it’s a saturated fat. Guess how you get it in your diet? Well, the chief source is butter (get it: BUTyrate).”

    Thanks to this and similar blogs, I’ve changed from cooking with canola and olive oils. Now I drizzle melted unsalted butter over almost everything I eat.

    • Richard Nikoley on December 24, 2009 at 07:46

      While I still use olive oil for salads, I don’t eat tons of salads. Rather, I like my veggies cooked in lots of butter. The French has it right all along.

  19. bucklesnarf on December 27, 2009 at 07:40

    Dr. Esselstyn knows what he is talking about. A very brilliant man.

    • Richard Nikoley on December 27, 2009 at 09:31

      OK, second comment like that. Do you actually have anything to say or are you just going to go around Dr. Esselstyning us to death?

  20. […] Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test […]

  21. […] Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test […]

  22. […] Saturated Fat and Coronary Heart Disease, Part IV: The Smell Test […]

  23. cardiology emr on June 21, 2010 at 18:23

    Coronary heart disease refers to the failure of the coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. Coronary heart disease is most commonly equated with Coronary artery disease although coronary heart disease can be due to other causes, such as coronary vasospasm.


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