1,000-fold per person and margarine consumption increased
12-fold, whereas consumption of butter and lard decreased
by about four-fold each (Blasbalg, T. L., et al., http://dx.doi.
org/10.3945/ajcn.110.006643, 2011). These changes in consumption are depicted in Fig. 1.
Yet at the same time these supposedly “heart-healthy”
changes were taking place, heart disease was on the rise. In
the past decade, deaths from heart disease in the United
States have dropped (Mozaffarian, D., et al., http://dx.doi.
org/10.1161/CIR.0000000000000157, 2015), mainly due to
reduced smoking and improved emergency care, but heart
disease remains the No. 1 killer of people worldwide (World
Health Organization, Fact Sheet No. 317, 2015).
Another major dietary change that has taken place in
the past 50 years is the substitution of fats in the diet with
carbohydrates such as pasta, grains, sugar, fruit, and starchy
vegetables. According to Nina Teicholz, author of The New
York Times bestselling book The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet, in 1960 approximately equal numbers of calories in the American diet came
from fats and carbohydrates (40% each). Then, the low-fat
diet craze hit the nation. People began avoiding foods such
as full-fat dairy, eggs, and red meat and substituted low-fat or
fat-free foods, many of which had added sugar to make them
more palatable. Now, carbohydrates comprise about 50% of
total calories in the US diet, while total fats are down to about
30%. Meanwhile, saturated fat consumption has dropped to
about 11% of total calories (Wright, J.D., and Wang, C.-Y., NCHS
Data Brief, No. 49, 2010).
Ironically, these values are right in line with the US government’s recommendations, yet obesity, heart disease, and
diabetes continue to be problems. “The experts like to claim
that Americans are fat and unhealthy because they don’t follow the guidelines—it’s their own fault,” says Teicholz. “But if
you look at the broad data it’s very clear that, in terms of macronutrients, we have been following the guidelines.”
The reason dietary fats garnered such a bad reputation in
the 1950s is that a high fat intake, particularly saturated fat,
raises the level of total cholesterol in the blood, which is a
risk factor for heart disease. But it wasn’t until the 1980s that
researchers began to appreciate that all forms of cholesterol
are not created equal.
Cholesterol and other fats are transported in the bloodstream by different lipoprotein complexes. Low-density lipoproteins (LDL), or “bad cholesterol,” can contribute to plaques
in the arteries, increasing the risk for cardiovascular disease.
However, high-density lipoproteins (HDL), or “good cholesterol,” have the opposite effect: They transport cholesterol
away from artery walls, reducing the risk of heart disease.
continued on next page
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