Dr. David Katz. (contributed photo)

Dr. David Katz. (contributed photo)

Dr. David Katz, Preventive Medicine: Saturated fat on trial

There is ever more virtual shouting about diet and health these days, much of it self-serving and little of it genuinely informative or helpful. The conflict is prominently, at present, between advocacy for plant-based eating and advocacy for meat and dairy; and between blaming either saturated fat or sugar for all our ills.

Personally, I think everyone loses in this scenario, with the obvious exception of nutritions answer to arms dealers, those creatures who thrive on mayhem and carnage: propagators of perennial doubt and discord about diet; deniers of the weight of evidence and global consensus; promoters of conspiracy theories; agents of foolishness and fanaticism, fads and false promises.

In response, my thoughts have turned to the remedy for such insoluble discord: a trial. I think there is a case to put both saturated fat and sugar on mock trial, and surmise our way to likely verdicts. The trial of sugar is scheduled for this courts next session. Today, saturated fat is on trial for crimes against humanity or, if you prefer, assault and battery of coronary arteries.

This could be a criminal trial, in which case a verdict requires proof beyond a reasonable doubt. Alternatively, it could be a civil trial, in which case the verdict is contingent on the preponderance of evidence, a lower bar to clear. Its a thought experiment; lets run both.

Complete disclosure about saturated fat by both sides in such a trial would reveal interesting things. A lot of facts would be presented, but there would be quite a bit of spin as well. When its all done, lets consider what the jurors know and what they dont.

They know for sure that saturated fat is associated with elevations in LDL cholesterol, and that those in turn are associated with increased heart disease. They know that diets higher in saturated fat sources tend to be associated with more disease and death than diets in which those calories are replaced by unsaturated fats, or whole grains. However, they also know that diets both higher and lower in saturated fat can apparently lead to the same, high rates of heart disease. They know that high saturated fat diets are associated with higher levels of good HDL cholesterol. They also know that not all saturated fatty acids are created equal and that summary judgment against the class may not be unjustified.

Jurors may be left with doubt about exactly what harms are directly attributable to saturated fat. No one, after all, eats saturated fat any more than most people eat sugar, although that is more plausible with sugar, as there are some candies made from nothing else. But thats a fine point. Mostly, people eat foods some of which contain saturated fat, sugar or both.

The foods that contain saturated fat contain other nutrients as well, notably animal protein in the most relevant (but obviously not all) cases. There are arguments that the apparent harms of saturated fat are really the harms of animal protein, and in the proceedings of this case, they have heard them. As they deliberate, they agree that the isolated effects of saturated fat on long-term health outcomes like vitality over a lifetime, and overall life expectancy, are practically unknowable. They are left with a reasonable doubt.

However, they are fully persuaded that diets high in the foods that are high in saturated fat are consistently and decisively disadvantageous to human health. They note in passing that they are comparably so, or more so, to the health of the planet but this particular question was not put on trial. The jury members are unanimous that it should be, before returning to the task of reaching a verdict.

In the criminal suit against saturated fat, a mistrial is declared due to a hung jury. The group could not agree that saturated fat, per se, was implicated in chronic disease and premature death beyond any reasonable doubt. In the civil trial, however, the verdict goes to the plaintiff, because the preponderance of evidence inveighs mightily against saturated fat and the company it keeps in diets. The defendant some medley of bacon, burgers and pepperoni goes bankrupt paying damages.

The jury members of these parallel trials get together right after to mingle over their kombuchas and agree that if the common food sources of saturated fat had been on trial, rather than saturated fat per se, they would have lost both trials. All go home comfortable with their decisions.

However, since everyone eats foods rather than nutrients, the jury members all go home wondering: why werent they asked better questions?

Dr. David L. Katz; http://www.davidkatzmd.com; founder, True Health Initiative

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Dr. David Katz, Preventive Medicine: Saturated fat on trial - New Haven Register