The problem with healthy fats

Frankly, it rankles me when people use the term “healthy fats.”  We don’t make a distinction like that when we’re talking about carbohydrates, although there are certainly carbs that are nutritious and carbs that are not.

Consider the Atkins diet.  I like to believe that Dr. Atkins was on the right track, but that he had some of the details wrong.  Clearly, he realized that there was something about carbohydrate in the American diet that was causing a problem.  But he did not understand that there is a big difference between muffins and mangoes, white flour and lentils, table sugar and peaches.  So people who tried the Atkins diet lost lots of weight when they removed virtually ALL the carb from their diets, even green beans, and then regained it when they got tired of the restriction and began to eat breakfast cereal again.  Along with doughnuts, pasta, bread, cookies, cake, and potato chips.

Dr. Atkins also did not understand that there is a big difference between a slice of salmon and a scoop of Crisco.  To him, all fats were the same and they all were good.  We know now that that is not true.

We are still sorting out the differences among the three main families of fats: saturated, monounsaturated, and polyunsaturated.  We know for sure that omega-3 polyunsaturated fatty acids are very good for us, and that the standard American diet is extremely deficient in them.  We know that we can increase our consumption of omega-3s by eating more fish, walnuts, flax seed, and green, leafy vegetables.

We have seen the benefits of the Mediterranean diet, in which olive oil (a monounsaturated fat) is the main fat used for cooking, and from this we understand that olive oil, too, is good for us.  Conversely, we know that trans fats (partially hydrogenated polyunsaturated fats) damage blood vessels, causing heart attacks and strokes.  We know they also increase the risk of diabetes, high blood pressure, and high cholesterol.  So trans fats are definitely NOT good.

But there is still a great deal to figure out.  We know, for example, that cocoa butter is one of the most highly saturated fats on the planet.  But….isn’t dark chocolate supposed to be good?  And aren’t saturated fats supposed to be bad?  So what does this tell me?  That we still have a lot to learn.

Want another curious example?  Most animal fats are actually a mixture of a variety of monounsaturated, polyunsaturated and saturated fats.  Which animal fat contains the most monounsaturated fat, similar to olive oil?  Lard.  Yes, believe it or not, that is true.  So what is most clear to me at this point is that we still, indeed, have a lot to learn.

At the same time, there are some things that I do understand.  The fact is that there are good examples of nutritious foods from each of the three main nutrient groups (fats, carbohydrates, and protein).  If I’m going to make a recommendation that you try one, or if I use one in a recipe or an explanation, I don’t think I need to qualify it with the word “healthy.”   Fat IS healthy.  Protein IS healthy.  Carbohydrates are healthy, too, as long as you get most of them the way our ancestors did, from the garden, with the fiber still intact.  Think fruits, vegetables, legumes, whole grains. These are carbohydrates, through and through.  When I include one in a recipe, I don’t need to say “healthy” apples.  You can assume that I am referring to apples without worms or pesticides.

When I talk about fats and oils, you can assume the same.

Roxanne Sukol is an internal medicine physician who blogs at Your Health is on Your Plate.

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  • Lezlee Maupin White

    I decided to use a glucometer to check to see how my blood sugar reacted to all the whole grains I was eating. Although I was bicycling around 60 to 100 miles a week and walking my dogs for 45 minutes 5 days a week my waist was getting bigger and I was gaining weight. You need to know that my blood sugar was spiking with only 1/2 cup of whole wheat pasta with a little olive oil (insulin is what drives fat into storage). I am not a diabetic but I suspected I was insulin resistant. I cut out all grains, made a huge improvement with inflammatory conditions (hip bursitis and knee pain is gone after 3 months of not eating grains), lost weight, lost 4 inches around my waist. I eat around 75% saturated fats in my diet and my HDL/Trigyercide ratio has improved to safe levels. My HDL went up 30 points. My LDL went to pattern A. I do now believe that Type two diabetes is a carbohydrate intolerance. You know why farmers and ranchers feed their cattle grains? To make them fat for slaughter because they get a better price. This has been know for a long time. How long will it take us?

  • Anonymous

    Interesting points, Dr. S – but here’s the good news about dark chocolate, cocoa butter and heart health. Turns out that the fats in dark chocolate are about 1/3 oleic acid, 1/3 stearic acid and 1/3 palmitic acid. 

    What does this mean?

    - oleic acid is a healthy monounsaturated fat, also found in olive oil- stearic acid is a saturated fat, but one that research shows has a neutral effect on cholesterol- palmitic acid is also a saturated fat, and is the kind that raises LDL cholesterol and heart disease risk

    Thus only 1/3 of the fat in dark chocolate is bad for you!  More on this at “Is Chocolate Good for Women’s Heart Health”? 

  • Erica Gott

    It is true that there are healthier versions of carbs, just like there are healthier versions of fats. Regardless, I am carbohydrate intolerant (type 2 diabetes), and ANY carbs, whether from whole fruits, starchy vegetables (potatoes, sweet potatoes) OR grains….they all spike my blood sugar. So no, I don’t think carbs in general are healthy for me. 

  • Tami Calhoun

    Then I would have to pass on your recipes as all of your “healthy” carbohydrates would spike my blood sugar.

  • Alexander J. Dolan

    Someone needs to read Gary Taubes’ “Good Calories, Bad Calories”. Trust me, you won’t regret it! :D

  • Beth@WeightMaven

    People use the concept of “healthy” fats as a counterpoint to decades of “fat is bad” pseudo-science thanks to Ancel Keys. It’s a good message to get out to folks: some fats are in fact healthy! Usually it’s the ones found in nature, not the ones Big Food creates in their chemistry labs.

  • Elizabeth Hinely

    You’re article greatly misrepresents the Atkins Diet.  You can eat green beans at every stage of the diet.  Also, trans fats are greatly discouraged and good fats like coconut oil, olive oil, and the like are encouraged.  Also, fiber rich carbs are encouraged and white simple carbs are on the no no list.  Maybe you should read about the Atkins Diet before you reiterate every stereotype about the Atkins Diet in your article.  I’ve lost more than 80 pounds on Atkins and every health marker in my blood work is now ideal.  I’ll stick to my bacon and eggs and leave the breakfast cereal alone, thank you very much.

  • Shelly Valladolid

    You seriously need to actually read the Atkins book, not the website (green beans were accidentally left out on the website – human error – and not yet corrected). 
    This type of ignorance is literally killing people.  Atkins is not just induction.  And, yes, I agree – read Gary Taubes’ books.  Both of them.  
    THEN write an intelligent, informed piece.  

  • Bobby Fernandez

    Great article.  This is the type of nuance the dietary advice from the medical community has lacked for quite sometime.

  • Anonymous

    Saturated fat is innocent! And always was. Whilst everyone has been busy indicting sat fat in numerous health crimes, the food industry has been merrily adding refined vegetable oils to everything. These are the ones we should be watching carefully. These refined oils are principally omega-6 and these are  notoriously pro-inflammatory and implicated in all sorts of chronic disease, including heart disease. Foods cooked in vegetable oils should be avoided in the same way as refined carbs.

  • RIchard Feinman

    What rankles me is that Dr. Sukol knows what Dr. Atkins thought although I doubt she ever spoke to him.  More to the point, as others have pointed out, I doubt that she has read the current Atkins book written by Phinney, Volek and Westman who actually do research in this area.  I know Dr. Sukol and recognize her dedication and seriousness and can only assume she did not notice how high her horse has become. What rankles me is any physician who may have learned whatever they know about biochemistry from somebody like me, is now telling me about the difference between muffins and mangoes and the value of whole grains.  What rankles me is that Dr. Sukol is attacking her friends but is not rankled by the control of the field by USDA, ADA and the NIH, people who mistake their opinion for science. What rankles me is the number of experts who tell instead of ask even though “what is most clear to me at this point is that we still, indeed, have a lot to learn.” So, let me start by suggesting, as clearly indicated in the new Atkins book (p.31) “a fruit is not a vegetable.”

  • Anonymous

    Atkins claimed that if one kept carbohydrate intake low that a diet full of saturated fat and cholesterol rich foods would not raise total and LDL-C levels. Many people including some MDs seem to believe this myth. In fact when kids were placed on a ketogenic diet high in such foods their LDL-C increased about 50% and their apoB increased 57%. Their TGs increased about 60% and their HDL-C dropped by 12%. Unlike the “studies” done on low carb diets that garnered so much media attention despite the fact that compliance was less than terrible there is no doubt compliance with this ketogenic diet was excellent. Given that the diet of these kids before had been typical of most American kids it was hardly “healthy” and full of refined grains and sugars. However, unlike the “studies” done in adults these kids were normal weight and so the impact of diet was not complicated by weight loss. I discussed this study with Dr. Westman years ago and he was baffled and could not explain how a diet so low in carbohydrate could cause such alarming changes in blood lipids if Atkins was correct. However, this study done by Dr Kwiterovich is the only one I am aware of that got excellent compliance with a ketogenic diet over a long period (6 months to 2 years).

    As for those of you who have been confused by the improved blood lipids when your patients adopt an Atkins-style diet that is easy to explain if you think about what they were eating before and after eliminating all those “bad carbs”. Let’s see if anyone out there can explain it or the results of Dr. Kwiterovich and what they really mean for those whjo believe a diet high in saturated fat and cholesterol does not promote atherosclerosis.

    • RIchard Feinman

      My recollection is that that study was done in a specific population, (kids with epilepsy ?) but, in any case, this is an isolated exception. Lowering TG and raising HDL is reliably shown in almost every study comparing low fat and low carbohydrate diets.  Compliance is always at least as good on low carbohydrate diets, usually better, than on any other.  

      But nobody says you have to do it.  It has always been offered as the alternative.  The complaint is that it is not offered to patients to try.  In fact, DR. Kwiterovich and Dr. Eckel and Dr. Ornish have the answer.  There is no obesity epidemic.  There is no diabetes epidemic.  There are some bad patients who won’t follow good advice but there is no problem in nutrition.  Right? So, as Dr. Eckel says, we don’t even need to study low-carb diets.  We have the answer.  

  • RIchard Feinman

    I may have gotten carried away a little bit since Dr. Sukol’s blog is clear on not insisting that one size first all, and, her original point that the term “healthy” is not a good idea, seems correct.  “Healthy” is not generally used by researchers in carbohydrate restriction but rather by the lipophobes, as Michael Pollan calls them.  The recent Harvard School of Public Health uses the term all the time. My own blogpost on their foodplate suggested that if we knew what healthy was we wouldn’t have an obesity epidemic.  The HSPH was taking questions on their new proposal. Although they left a full hour for all of the country to ask questions, they neglected to test the AV equipment so it didn’t go well. In my post, though, I suggested this question:  “Dr. Rimm, I think the American public expects a scientific document.  Don’t you think continued use of the words “healthy,” “packed with nutrients,” makes the Plate more of  an informercial for your point of view?” so, in the end, Dr. Sukol and I are probably on the same page.

  • Michele Lee Bordelon

    As an “retired” exercise physiologist, I’m so tired of people labeling food as “good” or “bad”. We’ve turned food into proteins, carbs and fats vs. wonderful vegetables, fruits, grains, delicious gifts from the ocean and the land. Our attitude about food and what we do with it has to be considered in the conversation.   Eating right for one’s body is not a fight although most of us make it such. It is a choreographed dance.  I’m not just throwing out these words.  This is my own personal experience and as a result of making the mental shift from making food the enemy to embracing it fully and reallly appreciating all the food sources available to us, I’ve seen amazing results. Reading Michael Pollan’s book, “In Defense of Food” was a major eye opener for me and I highly recommend it to everyone.  

  • Anonymous

    Richard – you are correct about the Kwiterovich study being on kids with epilepsy. Of course, all the data I’ve seen show that the blood lipids of kids and adults respond proportionately the same to dietary changes. Nor is there any evidence kids with epilepsy respong differently than other kids. Of course, since cheating on the ketogenic diets for these kids usually meant a big almost instantaneous increase in epileptic siezures compliance was excellent. Also since the diet was prescribed to control epilepsy and not weight loss there was no weight loss.
    You are also correct about compliance being equally bad or worse on the high-carboydrate diets as the Atkins diet in studies which failed to find much difference in blood lipids with the Atkins or Ornish diet. The lack of compliance coupled with the loss of weight confounded the results of those studies. When people restrict calories and are losing weight body fat stores are released into the blood in direct proportion to the calorie deficit. The more weight being lost the greater the impact of this fat on serum cholesterol level and the less import the diet itself has on blood lipids. The liver does not treat saturated fat coming from adipocytes any different than it does fat being absorbed from the gut. Since human fat is high in saturated fatty acids (and has some trans fatty acids too) when it is mobilized it can surpress LDL-receptor production by the liver just as saturated and trans fatty acids arriving from the gut. 

    Ultimately if one is weight stable on a diet high in saturated fat and cholesterol such as Atkins one will have a much higher total and LDL-C level than if one is weight stable on a diet high in whole grains, fruits, vegetables, nonfat dairy, and a modest amount of omega-e rich seafood. That one can be weight stable and indeed thin on a high carbohydrate diet was demonstrated by the Japanese back in the 1950s, 1960s, and 1970s. They had low TC and LDL-C levels and little atherosclerosis despite plenty of smoking and hypertension  – the latter caused largely by excessive salt intake.

    • RIchard Feinman

      Again, it’s only one choice.  If you do well on nonfat dairy and whole grains, you should. Lots of people do well on low fat diets.  If you want to tell me that it is a preferred diet for everybody and that low-carbohydrate diets are not, as I teach, the “default diet” (the one to try first) for diabetes and metabolic syndrome, then you would have to make a better case than the one you did.

  • Heidi At Tucson Orthopaedic

    I’m pretty sure that Atkins did differentiate carbohydrates.  I recall charts he put together based on the glycemic index of carbs, and also discussion about why complex carbohydrates were valuable for the diet.  Please clarify when you say “he did not understand that there is a big difference between muffins and mangoes, white flour and lentils, table sugar and peaches”

  • David Voran, MD

    What’s very interesting is the responses to the primary post above are as interesting and eye-opening as the post itself. Wouldn’t it be nice if there was a way for the primary post to be displayed to the reader and have the responses fill the right handed column currently filled by advertisements, trends, spotlights and other items pushed to us by the blog architecture?  That way the reader could be getting a better picture before replying, forwarding or sharing.
    What surprised me in reading the responses was that T. Colin Campbell’s book “The China Study” wasn’t mentioned at all.  Or is the overall apparent negative impact of animal protein on many of the lifestyle diseases with which people are filling our clinics too much to contemplate?  Would be interested in the thoughts of not only Dr. Sukol but those who posted replies here.

    • RIchard Feinman

      My thoughts are that if you start out suggesting that your point of view is too much for me to contemplate, that you don’t really want my thoughts.

  • Anonymous

    David – While Colin Campbell’s China Study book is an interesting read his vegan ideology seems to have twisted much of it to make a case that the data themselves do not make and that is that eating any animal products is unhealthy. There is no doubt consumed in moderation nonfat dairy reduces the risk of at least colorectal CA.  It is also more than clear that people who eat more omega-3 rich seafood are less likely to suffer a fatal MI. Such foods also appear to protect against macular degeneration and at least some forms of cancer. Vegan diets are typically deficient in long-chain omega-3s, vitamin D and vitamin B-12. It is also abundantly clear that human beings are not naturally vegans. People in rural China, Japan back in the 1950s & 1960s, New Guinea Highlanders (eg, the Azaro), Tarahumara Indians in Mexico to name but a few populations who suffer little atherosclerosis all consumed limited amounts of animal foods. None were vegans so using data from populations that were not vegans to argue for veganism seems a bit anti-science to me.

    I find it fascinating that those like Willett at Harvard who promote “healthy fats” and argue that refined carbohydrates are bad ignore the fact that these refined oils are every bit as devoid of nutrients as the refined carbs and even more calorie dense. Diets full of calorie dense foods with little or no nutrients (refined fats & oils and refined sugars & grains) are what promote obesity and type 2 diabetes in America and elsewhere. Trying to argue that adding more refined fat or refined carbs to the diet is preferable is like trying to argue the Democrats or Republicans are more interested in middle class Americans than the “special interests” of the few who donate so generously to their campaigns. Am I wrong?

  • RIchard Feinman

    Useful here might be my study of the low carber forums (ALCF), an online support group which currently has more than 130,000 members. Available without subscription at  We found that 55 %

    identified themselves as following the Atkins diet and another 19 % as following “My own variation of Atkins.” The main conclusions from that study were that  “the average diet that 
    emerges from the ALCF is a carbohydrate restricted diet 
    that is high in non-starchy vegetables, low in fruit and only slightly higher in meat compared to respondents’ baseline” Most respondents were happy with the diet and many had lost 30 lbs and kept it off for more than 1 yr (criterion of the National Weight Registry). This is in distinction to Dr. Sukol’s statement that “people who tried the Atkins diet lost lots of weight when they removed virtually ALL the carb from their diets, even green beans, and then regained it when they got tired of the restriction and began to eat breakfast cereal again” unless she has some other evidence.

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