Complementary Alternative Cardiovascular Medicine

Chapter 6 / Oils, Fats, and CVD 75
recommendations that acknowledge the health benefits of unsaturated
fat. In addition, the Dietary Guidelines 2000 recommend a diet low in
saturated fat and cholesterol and moderate in total fat (3).
The new guidelines represent a shift in philosophy about total fat
content in the diet. Previous guidance highlighted the importance of
reducing total fat. The message that evolved was: “consume a low fatdiet.”
As a result, this often was taken to an extreme, with the effect that
fat was the focal point of the diet in a way that ignored calories and
micronutrients. However, an abundance of recent research has shown
many health benefits of unsaturated fats, which, in part, was the impetus
for revising the low-fat diet message. As a result, a contemporary diet
message was developed that advocates a diet moderate in total fat but
low in saturated fat, trans fat, and cholesterol. This diet message underscores
the important functions of fat in the diet and the health benefits of
unsaturated fats.
This chapter reviews the scientific evidence that supports the current
dietary recommendations for fat and fatty acids. These recommendations
are guided by a philosophy of reducing certain nutrients that have
adverse effects on risk factors for cardiovascular disease (CVD) (e.g.,
saturated fat, trans fat, and cholesterol) and replacing these with healthful
nutrients, including healthy fats, as well as carbohydrates. The chapter
discusses the evidence in support of replacing unhealthy fats with
healthy fats, notably unsaturated fatty acids, to reduce CVD risk. In
addition, important food sources of different fatty acids in the diet are
presented to facilitate diet planning.
SATURATED FATTY ACIDS
The Seven Countries Study (4) was a landmark epidemiologic investigation
that reported a significant association between serum cholesterol
and increased risk of coronary disease and between diet and serum
cholesterol levels. With respect to diet, saturated fat intake (as a percentage
of calories) was significantly correlated with serum cholesterol levels;
80% of the variability resulted from differences in dietary saturated
fat intake among the populations. Moreover, saturated fat intake was
also correlated with 5-yr incidence of CHD.
The epidemiologic evidence prompted carefully controlled clinical
studies to be conducted to evaluate the effects of fat classes and individual
fatty acids on plasma lipids and lipoproteins.
The results from many of the well-controlled clinical studies were
used to develop blood cholesterol predictive equations for estimating the
changes in total cholesterol in response to changes in type of fat and