(in progress)
Is Saturated Fat Bad For You?
Ketogenic diet therapy doesn't have to include any saturated fat; many people eat a vegan keto diet or one that is vegetarian without dairy, or some other specialized form of keto. It's possible to make a keto diet that is compliant with almost any other restriction, such as vegan, vegetarian, Mediterranean, carnivore, and others.
Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews
Absolute risk is much more informative than relative risk- relative risk sounds more catchy but doesn't actually tell you as much. When thinking about what a study means for you, whether its conclusion means you need to make changes, depends on the quality of evidence and not just the presence or absence of evidence. This paper found that the evidence supporting a risk from consuming saturated fat was low or critically low quality. When looking at the results of reducing or replacing saturated fat in terms of cancer mortality, the authors found that the evidence showed a range of 8 fewer deaths to 3 additional deaths per 1,000 people, and the certainty of evidence (quality) was low to very low. So no clear-cut link between saturated fat consumption and risk of death from cancer. When considering the impact of saturated fat in the diet and cardiac deaths, they found a rate of two deaths per 1,000 people with low to moderate certainty. This does not support the strength of the message we get through doctors and public health to avoid saturated fat.
There are other factors to consider when seeing if the results of a study means anything for you individually. To illustrate this point, consider one study that was included in this meta-analysis (with moderate quality evidence) that found 24 fewer deaths per 1,000 people from all-cause mortality in a treatment group that reduced saturated fat intake. We need to look at the details to see what the implications are. Most people being studied are eating the standard American diet, high in ultra-processed foods, and get their saturated fat from sandwiches, desserts and sweet snacks like cookies, cakes, ice cream, pastries; and rice and grain-based dishes like pasta and pizza, and milk and yogurt which is usually sweetened and flavored. These foods are all high in sugars and simple starches. Natural foods, including plain meats, cheeses, butter, etc are lower on the list. The question then is how do you eat- if you eat lots of junk food, fast food, and processed food, then this study might apply to you. If you already eat a diet primarily of whole foods and low processed foods then these results probably have no relevance for you.
"Nutrition science is full of low quality evidence that applies to a general population eating a low quality diet". As a patient, we all deserve to have care providers who treat us as individuals.
A short history of saturated fat: the making and unmaking of a scientific consensus
Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based?
