HOW TO PREVENT CANCERS

by ABC Health & Wellbeing

If you have been following the recent debate over the relationship between saturated fat, cholesterol and heart disease, you might be wondering what makes a healthy diet.

For decades, doctors have told us saturated fat raises cholesterol which leads to heart disease. For almost as long, some sections of the community – including some medical professionals – have argued that cholesterol is not the villain it's made out to be when it comes to your heart.

The debate reached fever pitch recently after the publication of an editorial in the British Medical Journal, which stated the advice to reduce cholesterol has in fact increased our risk of heart disease.

This was followed by a program on ABC TV's Catalyst examining whether the role of cholesterol in heart disease is one of 'the biggest myths in medical history'.

A second Catalyst program suggested evidence shows the majority of people taking medications to lower cholesterol – known as statins – will receive no benefit; a claim that has drawn strong criticism from many in the medical community, who say this is a dangerous message and fear people could die if they stop taking necessary medication.

So does this mean we ignore the recommendations of doctors, health organisations and the Australian Dietary Guidelines and eat as much saturated fat as we want, so long as we avoid sugar and refined carbohydrates?

Dr Rosemary Stanton is a nutritionist and author who was on the working committee for the latest version of the guidelines. She says we should all be following the guidelines, and there is extensive evidence doing this is likely to benefit your heart – and other aspects of your health. We asked her what the guidelines recommend in terms of saturated fat.

When it comes to making sense of claims and recommendations about diet – or any health related issue – Stanton says you should try and check genuine research papers, rather than just believe what is published on blogs or other health websites.

She also recommends trying to see if the person writing the article has any conflicts of interest. It pays to be sceptical of those trying to sell you modified products, symbols on food packaging, or 'shonky' supplements and powders. (As Stanton says was the case with three of the four US 'experts' on Catalyst.)

The 2013 Australian Dietary Guidelines are based on a massive review of evidence – more than 55,000 papers were consulted on targeted questions.

In addition, there was extensive modelling of various meal patterns to ensure all nutrients are provided in the recommended foods.

Also the guidelines were checked by a committee of experts, and peer reviewed by internationally recognised experts. Research with consumers also determined they were understandable.

The 2013 Australian Dietary Guidelines encourage us to focus on the foods we eat rather than specific nutrients that might be in them.

Saturated fats come in a wide range of foods, many of these are unhealthy processed foods but they are also present in some foods that can be valuable to include in our diet.

Rather than focusing only on the fat content, aim to eat a range of foods from five food groups. These include:

vegetables;fruit;grains (predominantly wholegrains);lean meat or poultry, fish or other seafood, legumes, tofu, nuts and seeds;milk, cheese or yoghurt, or plant alternatives (such as soy or rice beverages).

To address diet-related health problems, including heart disease, diabetes and cancer, you should limit foods containing saturated fat, such as biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savoury snacks. Many of these foods are also high in sugar or salt – and the guidelines have always recommended limiting both.

The specific advice on fats also suggests replacing those foods high in saturated fat (butter, cream, cooking margarine, coconut and palm oils) with either liquid oils or spreads made from polyunsaturated and monounsaturated fats (without trans fats), as well as nut butters and pastes, avocado, or nuts and seeds.

While there's no absolute requirement for saturated fat, it would be virtually impossible to choose an adequate diet with no saturated fat – and this has never been recommended.

Only a diet of fruits and vegetables (with no avocado) would be totally free of saturated fat and it would be unlikely to meet nutrient needs. But it is important to pay attention to the types of foods you eat that contain saturated fat and don't consume too much of these.

Foods contain a mixture of fatty acids, usually grouped as saturated, monounsaturated and polyunsaturated (further divided into omega 6 and omega 3s). For simplicity, we tend to describe a food on the basis of its major fatty acid. For example:

olive oil is called 'monounsaturated' but has 75 per cent monounsaturated, 16 per cent saturated and 9 per cent polyunsaturated fatty acids.eggs are 50 per cent monounsaturated, 33 per cent saturated and 17 per cent is polyunsaturated.fish doesn't have much fat (even when it's called 'oily'), but fresh salmon has 32 per cent saturated, 34 per cent monounsaturated and 34 per cent polyunsaturated fat, while flathead has 40 per cent saturated, 25 per cent monounsaturated and 35 per cent polyunsaturated fat.

The dietary guidelines recommend foods, not just nutrients, as this will take into account the overall contribution a particular food will make.

For instance all the following foods contain some saturated fats, but can still play a vital role in a healthy diet.

milk is important for its protein, calcium, vitamins (especially B2 and B12);meat is a good source of protein, iron, zinc and B vitamins (especially B3 and B12);nuts are excellent sources of protein (and high in the amino acid arginine that has benefits for heart health), minerals (especially calcium in almonds, iron in pine nuts, selenium in Brazil nuts, potassium in pistachios, manganese in cashews) and vitamins (especially vitamin E);extra virgin olive oil has a number of compounds (not fats) that have beneficial effects on blood pressure, blood clotting and inflammatory reactions.

By contrast, foods such as fried chips or crisps, most savoury snacks, crackers, pastries and cakes, many desserts and fats, such as dripping, offer little of nutritional value along with their saturated fat. It makes sense to limit saturated fat by reducing these foods rather than fussing over the small amount of saturated fat in an egg.

The benefits of meat or milk remain when the fat is trimmed or skimmed off and this has the advantage of saving kilojoules – important in a population where the majority of people are overweight or obese.

In considering food choices, Stanton recommends:

Choose appropriate portion sizes to avoid gaining weight. The issue of excess body fat can't ignore exercise which has benefits in decreasing sedentary time, improving fitness and blood flow, and helping to align appetite with energy needs. Being more active also accommodates eating a little more without gaining weight.Avoid the 'all or nothing' approach. It is the quantity of anything that is important. Most extreme diets that forbid foods are not sustainable. There is nothing wrong with enjoying a good feast every now and then – just not several times a week!Vary choices. Whether it's vegetables, fruit, nuts, grains or any other food, there is safety and greater chance of adequacy in variety.Note all the messages of the dietary guidelines. They have always included advice to reduce sugar as well as saturated fat, salt and alcohol so reduced-fat foods where sugar or refined starches have replaced fat have never been recommended in official guidelines.Stop eating so much junk! Rather than fussing over whether you should go low carb or low or high fat, go for quality fresh foods instead of the mundane junk foods and drinks that currently contribute 36 per cent of the average Australian adult's diet and over 40 per cent of a child's. Go for quality foods instead.Published 04/11/2013