What A Degree In Dietetics DIDN’T Teach Me About Saturated Fat

Saturated fat good or bad

nazreth

What does bloodletting, scurvy, and our understanding of saturated fat have in common?

Before I share the answer with you, allow me to say that while we live in an era of unparalleled educational opportunities, there are some things that are still undervalued, and often unappreciated.

Skepticism, curiosity, and the ability to think and research for oneself, are not always met with enthusiasm.

Even when there’s concrete evidence to support the view of the minority, popular opinion is not something that likes to go away without a fight.

Take, for example, the advice, “Eat less saturated fat.”

That has been the message from health professionals, like me, for years now.

But, while we have dutifully reduced the percentage of calories we take in from saturated fat over those years, what can’t be ignored is that we continue to have worryingly high rates of obesity, heart disease, and diabetes.

Is it just that people don’t heed the advice, or is there more to it than that?

Learning From History

In 1593, Admiral Sir Richard Hawkins, recorded that orange and lemon juice should be drank as a means of preventing scurvy. In 1614, John Woodall, Surgeon General of the East India Company, published a handbook for apprentice surgeons aboard the company’s ships, which gave similar advice.

And yet, for another 200 years, men aboard ships continued to die due to scurvy, resulting in an estimated 2 million deaths between 1500-1800.

Its eradication from the Royal Navy didn’t come until the 1790′s, when finally, the chairman of the Navy’s Sick and Hurt Board, put the long-ignored prescription of fresh lemons to use during the Napoleonic Wars.

A similar story is seen in the history of bloodletting. A practice which went on for 2,000 years as a cure-all for sickness and disease.

In 1628, William Harvey disproved its widely believed ‘benefits’, and yet, over 200 years later it was still being recommended at the Royal College of Physicians.

Can a similar story be seen in the history of saturated fat? Possibly.

What is beyond doubt, however, is that we’ve become so conditioned to think saturated fat isn’t good for us, that the mere suggestion this may be bad advice makes most people think you’re a quack.

To understand the current popular opinion surrounding saturated fat, it’s important to go back a few years to an important publication by Ancel Keys.

Stick with me. This gets interesting.

How Did The Diet-Heart Hypothesis Originate?

The first scientific indictment of saturated fat came in 1953.

In that year, physiologist, Ancel Keys, published a highly influential paper, “Atherosclerosis, a Problem in Newer Public Health.”

He concluded that while the total death rate in America was declining, the number of deaths due to heart disease were steadily climbing.

He blamed a diet high in fat for these heart disease deaths. This belief is what became known as the diet-heart hypothesis.

And, it wasn’t well received by his peers at the time.

One of the main problems with Keys method was, that although data was available for 22 countries, he only used 6 countries (later 7) in his comparison.

As a result, his research showed an increase in heart disease cases, which corresponded with an increased fat intake.

However, when the 22 countries are included, the data looks more like this:

The second graph shows such a weak correlation, that Keys’ hypothesis is totally demolished.

Statistician, Russell Smith, had this to say about Keys’ research:

“The word “landmark” has often been used… to describe Ancel Keys’ Seven Countries study, commonly cited as proof that the American diet is atherogenic… the dietary assessment methodology was highly inconsistent across cohorts and thoroughly suspect. In addition, careful examination of the death rates and associations between diet and death rates reveal a massive set of inconsistencies and contradictions…

It is almost inconceivable that the Seven Countries study was performed with such scientific abandon. It is also dumbfounding how the NHLBI/AHA alliance ignored such sloppiness in their many “rave reviews” of the study…

In summary, the diet-CHD relationship reported for the Seven Countries study cannot be taken seriously by the objective and critical scientist.”

(Source: Diet, Blood Cholesterol and Coronary Heart Disease: A Critical Review of the Literature, Volume 2, November 1981, pages 4-49)

You may be asking yourself why Keys would leave out such incredibly important data?

The phrase “cherry picking” comes to mind.

The fact that Keys did not consider other factors, such as smoking, sugar intake, and exercise frequency, make his conclusions merely a shot in the dark as to a possible cause.

This study has, unfortunately, been cited for decades as “fact.”

Brief History Of The Diet-Heart Hypothesis

In the 1950s, Keys and others promoted a low fat diet, which they labeled the Mediterranean diet.

In 1957 the American Heart Association proposed that modifying dietary fat intake would reduce the incidence of coronary heart disease.

In 1961, William Kannel published the landmark paper, “Factors of Risk in the Development of Coronary Heart Disease.” In the following years the term “risk factor” became commonplace.

Also in 1961, the American Heart Association published a report on preventing coronary heart disease, which pointed to reducing certain dietary fats to lower the level of risk.

The report was cautious, however, stating:

It must be emphasized that there is as yet no final proof that heart attacks or strokes will be prevented by such measures.

In fact, they made these recommendations for those who were at risk of cardiovascular disease, either by heredity, or because of a prior heart attack or stroke.

At this time, they were not recommending a low fat diet for all.

According to Daniel Levy, current director of the Framingham Heart Study, the sense of urgency concerning dietary fat and heart disease did not come until 1977.

That year, the U.S. Senate’s Select Committee on Nutrition and Human Needs, put the diet-heart hypothesis on the national agenda when it published, “Dietary Goals in the United States.”

This report stated:

Too much fat, too much sugar or salt, can be and are directly linked to heart disease, cancer, obesity and stroke.

In 1983, a turning point in the obesity/heart disease studies came with the publication of an article based on the Framingham studies. This article cited obesity as an independent risk factor for heart disease.

This was significant because it lent further support to the low fat approach to diet.

Many scientists believed a low fat diet may not only prevent heart disease, but it could also promote weight loss, and as a result, reduce the incidence of obesity.

By 1984, the scientific consensus was that a diet low in fat was appropriate for high-risk patients, but also as a preventive measure for everyone, except infants.

Still Only A Hypothesis

The strange thing in all of this is that the diet-heart hypothesis remained exactly that, a hypothesis.

No studies proved conclusively that saturated fat led to heart disease.

Yet, this notion became ingrained in public health policy, and was widely promoted by health professionals, as if already a proven, indisputable fact.

From 1984 through the 1990s, dietary fat was increasingly blamed for heart disease, as well as for the increasing obesity levels.

Then, when the National Institutes of Health Consensus Development Conference issued, “Lowering Blood Cholesterol to Prevent Heart Disease,” in 1984, it was endorsed by the American Medical Association, and the National Heart, Lung, and Blood Institute.

And, while some scientists and physicians remained skeptical, the argument in favor of the low fat diet for all was the “gold standard” advice, as a result of this report.

 The Food Industry

By the 1980s food manufacturers had noticed the profit making opportunities to be had through the low fat diet approach.

They began replacing fat with sugar, which lead to “Snackwell’s phenomenon.” Basically, low fat foods having just as many calories as the former high fat versions.

The result was that people ate more of the low fat food than they otherwise would of the normal cookies, because they believed them to be healthier.

So, in the 1980s and 1990s these low fat, high sugar products began to fill grocery store shelves, in response to consumer demand.

In 1988, in an effort to raise funds and promote better health, the American Heart Association introduced its program to label foods with their “heart healthy” seal of approval.

Food companies were then able to pay for the rights to label their foods with this seal of approval.

Many of these products were packaged foods like breakfast cereals.

One of the main problems was that fresh foods were not labeled, which to some, may have given the impression that these highly processed foods were more heart healthy than fresh foods.

Did all of this mean that as long as a food was low in fat, it could be eaten to appetite?

If so, it’s clear why a diet filled with low fat foods may ironically be promoting obesity, despite its heart healthy seal of approval from the American Heart Association.

Has The Low Fat Diet Been Successful?

Interestingly, from 1950 to 1998 mortality rates from heart disease decreased 53 percent.

However, in 1998, physicians Daniel Levy and Thomas Thom noted a “puzzling paradox.”

While mortality from heart disease had decreased dramatically from 1950 to 1998, the incidence of heart disease remained about the same.

In addition to this, a study covering the years 1987 to 1994 suggested that the reduced mortality rate was the result of medical and/or surgical intervention, and secondary rather than primary prevention.

Unfortunately, these figures do little to clarify the role of the low fat diet in relation to heart health.

(Thanks to Ann Berge and her extensitve report, “How the Ideology of Low Fat Conquered America,” for an overview of the history of saturated fat.)

Saturated Fat: Good Or Bad?

A number of very large, expensive studies have looked at the relationship between heart disease and saturated fat.

Cochrane Collaboration

In 2000, a respected international group of scientists, called the Cochrane Collaboration, conducted a meta-analysis of the scientific literature on cholesterol-lowering diets.

They included 27 trials, with more than 18,000 participants.

And, although the authors concluded that reducing dietary fat may help reduce heart disease, their published data actually showed no significant effect of a low fat diet on overall mortality, cardiovascular mortality, or cardiovascular events.

Women’s Health Initiative

In 2006, the Women’s Health Initiative (reportedly costing American taxpayers $725 million) found that a diet low in total fat and saturated fat did not significantly impact heart disease risk.

This study followed slightly over 48,800 postmenopausal women for 8 years.

Meta-Analysis

A meta-analysis published in 2010, pooled data from 21 studies, and included almost 348,000 adults.

The researchers found no difference in the risks of heart disease and stroke between those with the lowest and highest intakes of saturated fat.

Reduce Refined Carbs

One of the main problems I have with encouraging a low fat diet, is that you have to replace the fat with something, and that usually means replacing it with carbohydrates, mainly of the refined variety.

study in 2010, noted that there are few studies to support the notion of replacing saturated fat with carbohydrate.

They concluded the emphasis should be on the limitation of refined carbohydrate intakes, and a reduction in excess weight.

A recent 2011 study, found that dietary intake of saturated fats is associated with a modest increase in serum total cholesterol, but not with cardiovascular disease.

These researchers noted, however, that replacing saturated fats with carbohydrates, particularly those with a high glycemic index, is associated with an increased risk for cardiovascular disease.

Interesting. So removing fat and adding sugar increases the risk of cardiovascular disease?

Can anyone say ‘low fat yogurts’?

But, let’s not just pick on yogurt. Pretty much everything with bold low fat labels, is packed with sugar instead.

Read what Steve Parker, M.D. has to say on saturated fats good or bad.

LDL Subfractions

If you’re not familiar with the term LDL Subfractions, don’t worry. I intend to write about this in a more complete way in the future. However, let me give you a relevant synopsis to add weight to the discussion around saturated fat.

Dr. Krauss, professor of nutritional sciences at the University of California, Berkeley, has been studying the effect of diet and blood lipids (low and high density lipoprotein, commonly referred to as LDL and HDL, and fatty acids) on cardiovascular disease for years.

In 1980, Krauss and his colleagues discovered LDL cholesterol comes in a series of different sizes, known as subfractions. Some LDL subfractions are large and fluffy. Others are small and dense. And, it is this distinction that is important.

While all LDL cholesterol is bad, the small, dense LDL subfractions are really bad, since they greatly increase the risk of developing clogged arteries.

Interestingly, Dr. Krauss found that when people replaced carbohydrates in their diet with fat, whether saturated or unsaturated, the number of small, dense LDL particles decreased.

Trans Fats

So, does all of this mean you can eat as much fat as you want?

No, certainly not.

It’s clear there is some association between fat and heart disease. Unfortunately, most studies don’t differentiate between saturated fat and trans fat. I believe this is a big mistake.

Trans fat is known to increase LDL cholesterol levels (as we noted above, LDL cholesterol is bad), while also lowering HDL (good) cholesterol levels.

This is bad news, and the opposite of what we need for good health.

So, if there is one thing you should definitely be avoiding, it’s artificially hydrogenated oils. The trans fats from partially hydrogenated oils are more harmful than naturally occurring oils.

The main culprits to be aware of are margarine, shortening, and partially hydrogenated oils. You will find these in most processed junk foods, and deep fried foods.

At the end of the day, the best way to avoid trans fats is to make sure you are choosing a whole, natural, and minimally processed diet, as much as you possibly can.

The Way Forward

I have struggled with this issue for some time. And, this article is merely a drop in the ocean of all that could be said.

I am well aware that this is information most health professionals won’t be telling you, and until you’ve been through four years of university training in Human Nutrition and Dietetics, you won’t understand how difficult it is to teach something that’s contrary to what you have been taught.

However, something I’ve discovered in recent years is that no one cares how much you know, until they know how much you care.

What good is a degree, if you’re not willing to continually research for the truth, and present that truth no matter how much it goes against the grain?

If the health of our nation is to improve, we need open minded scientists and health professionals who speak truth, and don’t simply regurgitate what they are told to say.

It’s important that we are real with ourselves, and others.

What about you — do your beliefs stand up to the available research on this topic of saturated fats? Please share any interesting studies you know of on this topic with me, too.

Note: If you enjoyed this article, sharing it (on Facebook, etc) is a great way to say ‘thank you’.

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About Melanie
Melanie is a Registered Dietitian who started Dietriffic in March 2007. Her aim is to make good health attainable and sustainable, without guilt and torture, making her approach popular with those who desire a level-headed approach to good health. Have you got your copy of her free book yet?


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{ 28 comments… read them below or add one }

Elaine Egan May 16, 2012 at 11:50 am

Hi
I really enjoyed reading this article and I am definitely going to sign up for your news letter. For years everyone has been told to follow a “low fat” diet. Yet obesity rates are spiralling upwards at an alarming rate. A much more sensible approach would be to cut as much processed food from our diets inc bread pasta etc and instead load up on fruit and veg, what we are designed to eat!

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Melanie May 16, 2012 at 12:23 pm

Hi Elaine,
Thanks for your comment, I’m glad you enjoyed the article :-)

I agree with you wholeheartdly, overly processed foods are a major culprit.

I enjoyed taking a look at your website, too, you have some interesting content.

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Steve Parker, M.D. May 16, 2012 at 12:18 pm

Hi, Melanie.
My first book (2007) was dedicated to the memory of Ancel Keys. Then in 2009 I went through an evolutionary process such as yours. It’s a little scary to give up the dogma you learned in training. Most dietitians and physicians out of training will not do the independent literature review that leads to the new paradigm. They want it passed down to them from the leadership.
I think many of your ideas above will be considered mainstream within the next decade.

-Steve

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Melanie May 16, 2012 at 12:30 pm

Hi Steve,
Thanks so much for your encouragement. It’s so true what you say, I think many health care professionals feel they don’t have the time to research independently, and it is scary to go against the grain, but I wonder what a degree is worth if you can’t think independently about a topic? We aren’t puppets on a string!

I hope you’re right about these ideas becoming mainstream. Time for another book on your part perhaps :-) Or maybe you have already written that??

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julia June 3, 2012 at 10:06 am

Great article Melanie, but 200 million people died of scurvy in 200 years?

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Melanie June 4, 2012 at 9:17 pm

Hi Julia,
Thanks for pointing that out. I think I got confused with the 200 years, it should read 2 million. Appreciate your input :)

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TheFatNurse June 3, 2012 at 10:20 am

It can be hard to even bring up the idea of saturated fat not being evil. Here is the reaction from my peers: http://wp.me/p2mRdq-55

And from my friends: http://wp.me/p2mRdq-6O

It’s a sad and lonely fight…but luckily my bacon keeps my spirits up!

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Melanie July 7, 2012 at 1:12 pm

lol yes, I know what you mean!! Thankfully others are talking about it now, though :)

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Sascha August 10, 2012 at 9:56 pm

This is an interesting article, especially considering I am a medical student learning all about cholesterol and saturated fat being the bad guys. I have not read the original research articles but I do have some questions. First I wonder why your title is about saturated fat but the topic of the article is much more about low fat and especially about replacing unprocessed higher fat (consisting of a larger proportion of saturated fat naturally occuring in these foods) for highly processed foods where fat is replaced for sugar. Stating that fat must be replaced with something when limiting the amount of fat. But isn’t that just marketin of food companies trying to sell cheap products and making it appear to be healthy? When consuming too much calories and as a result of that are obese you have a higher risk of heart disease. When reducing (not eliminating) the amount of fat and especially an excess in saturated fat – since this is a type of fat we don’t neccesarily need like we need omega 3 and omega 6 fatty acids – we could reduce the amount of calories we take in without compromising the nutritional value of our food. Just like we need to reduce the ‘added sugar’ calories so we reduce the carbohydrate calories without compromising on fiber and phytochemicals and vitamins and minerals. So not taking in ice cream and whipped cream and cookies with lots of fat and sugar is in my eyes reducing your risk of heart disease, since it reduces your caloric intake without compromising nutritional value. And if you would replace saturated fat, you surely wouldn’t want to do it with added sugar but with omega 3 fats (not omega 6 because although we do need omega 6, most people do tend to consume to much omega 6). And that is not by replacing the butter in a cookie by vegetable oil (or making it low fat and adding even more sugar), but by replacing the cookie for a couple of walnuts for example. I can’t help but still believe that would make it a heart healthier choice. I also wonder what the clinical relevance is of these major studies is because it is very difficult to investigate just one component of food and look at the result that it has on our health. Especially when a large part of the investigated population isn’t following nutritional guidelines by eating too much junk food and not nearly enough fruits and vegetables. Like popping a beta-carotene pill increases the risk of cancer while eating whole foods rich in beta-carotene decreases those risks, that must be some sort of indication that it is a little more complex than we can fully understand right now. Or is my view completely flawed?

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Melanie August 16, 2012 at 1:31 pm

Hi Sascha,
I am not sure I follow your comments. My title is about saturated fat because the advice to eat a low fat diet originated from the idea that saturated fats are not heart healthy. The article is about investigating this theory, how it is flawed, and ultimately how that advice has affected what many now believe to be “gospel,” that too much saturated fat leads to heart disease.

Of course, if people are eating lots of highly processed foods, their disease risk will be much higher. I agree with you that we should be eating healthy whole foods, like nuts rather than cookies.

I also agree that investigating one component of the diet doesn’t always give a clear indication of what will happen when you mix that item with others in the diet. But, what’s the alternative? We need to use some kind of research to back up our recommendations.

This is one reason I referenced so many studies in my article, I wanted to give a comprehensive overview, that people could look up and research for themselves. I think that’s the key with research, don’t just take what one study says as the truth, you need to compare what other researchers are saying and test that against your own hypothesis.

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Nick December 9, 2012 at 4:08 pm

Sascha, your assuming as do current guidelines that reducing fats reduces overall calories in an ad libitum diet because fat is calorie dense. This is a hypothesis and is not well evidenced. In contrast the meta-analysis have show low fat ad libitum diets that have worked are confounded by high protein intakes, i.e fat was replaced by protein and not CHOs as the guidelines recommend. In fact, ad libitum diets high in fat and or protein perform better than those high in CHOs at habitually reducing overall calories. This with the lack of evidence against fat intake and CVD as this article shows questions why we recommend low fat for health. I am currently being taught post graduate Dietetics, this is my take on the research I have read not what I have been taught

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Nicola August 14, 2012 at 5:00 am

Hi Melanie,
It’s definently an interesting topic. I spent today at work reading lots of literature about CVD and saturated fat. From what I’ve read, saturated fats should be kept low in our diets, but we need to make sure they’re replaced by polyunsaturated fats, NOT refined carbohydrates. Replacing saturated fats with polyunsaturated fats clearly shows a lower risk of CVD. Interestingly, studies are showing that low fat dairy is likely to lower the risk of CVD . I think i’m all researched out today!!

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Melanie August 16, 2012 at 11:19 am

That’s fantastic, Nicola. I wish more health professionals would spend a little time on these topics themselves. If you come to the conclusion that saturated fat is indeed bad, at least you know you’ve discovered it for yourself.

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adam August 28, 2012 at 6:02 pm

Hi,

Im actually in my 2nd year of Dietetics in a UK institution and I actually follow a diet which is exactly the opposite of what i am taught! (i eat high fat and protein diet, filled with saturated fat and mono, rather than poly…but all natural stuff (Paleo))

I hope by the time I graduate the truth about nutrition will be out there, rather than stuff thats promoted by the corporate companies who sponsor the dietetics industries.

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Melanie September 19, 2012 at 1:54 pm

Hi Adam,
That is so interesting. When I was a uni I have to say I didn’t think too much about what I ate, which I find really shocking now. I didn’t even realize just how much corporate companies influence what we are suppose to tell people as dietitians. Now, I am fully aware of it, lol Are you subscribed to Dietetics Today? It is full of ads from big companies like Kelloggs pushing their products. Makes me sick, I will admit!

I hope you are right about things changing soon. Best wishes with your studies. Where are you based?

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Nick December 9, 2012 at 8:19 pm

As somebody training as a dietitian in first year of a post graduate its refreshing to here there is dietitians out there that expert opinions are not fully supportive of the current recommendation. I actually became critical at the start of this course when I looked into the research behind the guidelines, often interpreted to support the conscious opinion of the authors rather than a direct reflection of evidence. Low fat recommendations are to reduce the risk of CVD and to lower overall energy intake, both not very well evidenced. In reality it about sustainability, CHO are cheap to grow, store and transport and are cheap for the consumer.

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Melanie December 14, 2012 at 3:57 pm

Hi Nick, I feel refreshed to know there are others out there in training who query what they are being taught :) It is a good practice, and it will stand you in good stead as you finish your degree and start out on your own. Thanks for your comments.

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Brooke Fredrickson, RD, CSG, LRD December 11, 2012 at 4:07 pm

Melanie – I’m not alone! Yay! I am also a registered dietitian who was taught that saturated fat is bad. After reading “Good Calories, Bad Calories” by Gary Taubes, I began doing my own research. I’ve never felt more betrayed by my profession! It’s exciting to know that there are other dietitians out there with some common sense. Humans have survived on naturally occuring saturated fats for thousands of years, and yet now refined processed oils are supposed to be better for us? Look at the health of our world over the past 100 years… since the low fat craze and rise in processed foods (and nutrition advice from the government), our health has plumeted. Thanks so much for standing up for the truth!

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Melanie December 14, 2012 at 4:01 pm

Hi Brooke, thanks so much for your comments, it is very encouraging to hear from! Something I always try to ask when I’m thinking about a recommendation or hear a new piece of advice is, “who benefits?” For the most part you will find it is often the mega companies or big pharma, which makes me query if I can actually trust whatever the advice is. Great to hear from you. Are you practicing in a hospital or on your own?

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Brooke Fredrickson, RD, CSG, LRD December 17, 2012 at 3:16 pm

I am the food service director at a small hospital, but I also do a lot of health promotion in my town. I write newspaper articles about things such as this! Controversial, but true. I try to discuss these things with other RDs, but they are so ingrained with “saturated fat and cholesterol are bad” that they can’t see what the research actually proves (or doesn’t prove)! It doesn’t help that the USDA, American Heart Association, and other organizations continue to rule saturated fat as bad. Until they admit they are wrong, the public will continue to believe what they say :(

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Melanie February 7, 2013 at 10:20 pm

Hi Brooke, It is very difficult to persuade other health professionals, I find they need to go away and imerse themselves in the research for a long time, and even then it can take a while before they can admit they’ve been wrong or misinformed. It really is such a conundrum, I really wonder when things will change. Thanks for getting in touch.

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Lyrr Descy February 16, 2013 at 4:28 pm

Hello Melanie,

I’ve been doing my own research after getting the usual “you need to lower your total LDL” after my recent physical. My doctor either didn’t know about differentiating small particle from large particle LDL, or was sold on the idea that LDL is always inherently bad. Curiously, my HDL ratios are either good or ideal, but that didn’t give my doctors pause (I saw two). Go figure …

So: About midway through the above article you write: “While all LDL cholesterol is bad, the small, dense LDL subfractions are really bad, since they greatly increase the risk of developing clogged arteries.” And you add “(as we noted above, LDL cholesterol is bad).”

But your article doesn’t point to any evidence that ALL LDL is bad. In fact, there’s a hypothesis that large particle LDL (fluffy and buoyant) may actually be protective, or is at least benign. Moreover, the association of cholesterol to heart disease is being questioned entirely. And there appears to be a correlation between low LDL and colon cancer. (A useful analogy I’ve seen is a balloon bumping against a window, versus pellets from a BB gun.)

Could you please explain your assertion that all LDL is inherently bad, with small particle just being worse? This sounds to me like the old discredited thinking. Very simplistic. And frankly, if it appears that elevated LDL (large particle) levels may protect against colon cancer, then I’ll take my risks with heart disease.

I think, too, that polyunsaturated fats (especially from seeds) may not be the answer to the fat conundrum. Canola oil especially is a bastardization of toxic rapeseed oil. Monounsaturated fats like olive oil are preferred, and minimally processed coconut, palm, and animal fats should be studied further. Any thoughts?

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Jonathan March 23, 2013 at 6:07 pm
Becca March 21, 2013 at 10:51 am

Hi, I stumbled upon this article, and am glad that people are starting to realise that saturated fats are not all bad. Very interesting, very well-researched article; I shall be sharing this on Facebook. :)

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Jonathan March 23, 2013 at 6:06 pm

Another good article. For those who would like to read more interesting related info I linked on another article.

http://www.dietriffic.com/2013/03/21/full-fat-dairy/

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