In integrative medicine, a nutritious diet is highly encouraged to foster a resilient body that can resist disease and chronic illness. Addressing the root cause of an illness considers aspects of diet, sleep, exercise, and other lifestyle factors. Because information about diet is frequently a part of the integrative medicine healthcare appointment, questions about dietary fat come up. Quick answers are difficult because people have unique body chemistries and because fats have a complicated story!
Did you know that eating specific fats can significantly benefit overall health, and even contribute to superb brain health? Yet dietary fat has been vilified for decades, and news about fats has been contradictory over the years. Unfortunately, the confusion has led many people to be unsure about whether it is okay to consume fats and what characteristics make a fat "good" or "bad." This article examines a few healthy fats and explains what makes them beneficial for most people.
Why We Need Healthy Fats
It must be stressed that the human body requires fats to function properly! In the past, all fats were lumped into one category, and as a group, they were suspected of driving many negative health outcomes. However, removing all fat from the diet can have devastating effects. Harvard researcher Vasanti Malik recently stressed the need for consistently eating dietary fat. He said,
"Fat helps give your body energy, protects your organs, supports cell growth, keeps cholesterol and blood pressure under control, and helps your body absorb vital nutrients. When you focus too much on cutting out all fat, you can actually deprive your body of what it needs most” (1).
Fats help maintain many aspects of human health in various ways, including:
Dissolving and absorbing fat-soluble vitamins A, D, E, and K, allowing these important vitamins to be circulated throughout the body (2):
Vitamin A: nourishes skin and hair, boosts immunity, aids vision
Vitamin D: activates the immune system, builds strong bones, and helps create and metabolize chemical messengers in the brain (affecting temperament, thought, and memorization)
Vitamin E: fights free radical damage (aging), aids and nourishes skin
Vitamin K: fortifies bone, stabilizes blood pressure, adjusts ability of blood to clot
Insulating nerve conduction, forming cell membranes (3)
Countering inflammation in the body (4)
Decreasing heart disease risk (5)
Over time, research has shown that it's not the presence of fat in the diet that is problematic; it's the type of fat that makes the difference. Healthy fats help carry out vital functions in the body and increase health, while unhealthy fats perform their functions poorly and sabotage health.
What is a "Healthy" Fat?
Below is a simplified way of looking at what separates a "bad" fat from a "good" one. However, it's a more complex reality because healthy fats can become unhealthy through rancidity or heat.
Characteristics of Healthy Dietary Fats:
Resistant to high heat; not easily denatured or oxidized (interact with free radicals and become changed) by high heat
When incorporated into a cell wall as fatty acids, they contribute to the strength and resilience of the cell (6)
Do not tend to accumulate on artery walls or contribute to the accumulation of plaques through inflammation (7)
Characteristics of Unhealthy Dietary Fats:
Break down easily when heat is applied, interacting with free radicals which create oxidized fats that (8):
Damage the endothelial lining of arteries
Contribute to fat accumulation in inflamed artery walls
Is There Such a Thing as "Too Much Fat?"
Yes, too much fat can be consumed; however, part of the picture is exercise level. Are calories in the diet being utilized (burned up) by frequent movement or exercise? Calories can be considered as fuel for the body to move, think, and grow. Fat is an excellent fuel, having nine calories per gram versus four calories per gram of the other macronutrients (proteins and carbohydrates). Fat is more "calorie dense" than the other macronutrients, providing more than double the fuel than the others.
A good ratio of macronutrients provides the perfect amount of fuel for your body without a lot left over. After many complex processes, leftover fuel can be stored as body fat, whether from dietary fat, protein, or carbohydrates. The desirable state is to burn about as many calories as are eaten. The point is that gram-for-gram, you get more calories from fat, so it's easier to over-consume.
Working out the ideal ratio of fats, proteins, and carbohydrates that is right for your body can take some trial and error. Some people do great with a fat-heavy diet mixed with intermittent fasting. In contrast, others look and feel better with roughly equal amounts of fats, proteins, and carbohydrates eaten throughout the day. Working with a knowledgeable practitioner can shorten the process of finding your perfect macronutrient balance and eating pattern.
Any Healthy Fat Can Become an Unhealthy Fat
It is interesting to note that a healthy fat can become harmful. Anything that changes a fat's molecular structure can reduce its health benefits or cause toxic byproducts (including damaging molecules called free radicals). Healthy fats stay intact under heat stress, resist being damaged by oxygen, and do not produce secondary products that can harm health. Heat, rancidity, and manipulation can transform healthy fats into harmful fats.
Heat - Heat and oxygen interact with fat in a process called oxidation. This chemical reaction damages the fat and creates free radicals, which are molecules that destabilize nearby molecules by "stealing" oxygen molecules. Free radicals can damage DNA and the macronutrients (fats, carbohydrates, and proteins) (9). Additionally, toxic byproducts are created during fat oxidation, such as a type of lipid peroxide that is damaging to artery walls. When using high heat to cook, these byproducts can be quickly created.
Rancidity - When fat begins to break down due to light, oxygen, or heat, we say it is going rancid. Rancidity is a chemical change similar to heat damage from cooking. However, less intense ambient heat causes a slower decay.
Artificial manipulation of the molecule (trans fats) - Fats can be made "shelf-stable," meaning they can be manipulated to resist rancidity. All carbon molecules in fat can be artificially made to bond with hydrogen, "saturating" its molecular structure. This saturation makes the molecule more stable and solid at room temperature; however, the human body has great difficulty handling this artificial fat. Trans fats cause inflammation in the body. Unfortunately, inflammation has been identified as the underlying process for many chronic illnesses. Indeed, inflammation caused by trans fats has been implicated in cancer, coronary artery disease, and other adverse health outcomes (10).
Temecula Center for Integrative Medicine (TCIM) recommends buying high-quality resilient oils that are packaged to prevent light and heat and avoiding trans fats altogether. Unfortunately, fast food restaurants generally use low-quality oils and fry foods in high heat, damaging the fats and contributing to body-wide inflammation. Making a commitment to make more food at home and avoiding fried foods from restaurants can go a long way towards fostering health.
Now that we've identified mechanisms that cause healthy fats to become unhealthy let's cover some of the oils that avoid these pitfalls.
HEALTHY FAT #1: EXTRA-VIRGIN OLIVE OIL (EVOO)
According to some researchers, extra virgin olive oil (EVOO) is the most stable fat under heat stress and produces less harmful byproducts than other oils (11). Olive oil is composed of mostly monounsaturated fat. Its lack of hydrogen molecules for each carbon makes olive oil liquid at room temperature.
If olives are pressed without applying heat or chemicals, the oil is called extra virgin olive oil. Since no heat is used to get the oil out of the olives, the fat is less likely to be damaged. Lacking both chemical manipulation and heat damage, EVOO decreases the creation of free radicals and increases the possibility of health benefits from the olives. However, you must be sure to use EVOO at room temperature or low heat when baking or sautéing and buy EVOO in cans or dark glass that prevents light damage.
When people think of EVOO, they often think of the Mediterranean diet. Researchers were able to correlate positive health outcomes (less cardiovascular disease, less chronic illness) with items frequently eaten in the Mediterranean, which included the fats found in fish and olive oil (12).
The Harvard Health Publishing site shows an excellent example of implementing a Mediterranean diet. A modified Mediterranean diet (with lower amounts of processed carbohydrates such as pasta) may be necessary for those with blood sugar issues, so please work with a nutrition counselor for personalized recommendations.
What makes EVOO healthy:
Produces few toxic byproducts when heated (2)
Oleic acids in olive oil stabilize the bilayer structure of the cell membrane (13)
Oleanolic acid in olive oil protects against inflammation (13)
EVOO Pros:
EVOO is proven to improve long-term health. A twelve-year study of women adhering to a Mediterranean diet proved the diet helped lower the risk for a lengthy list of health issues: cardiovascular issues including heart attack and strokes, many forms of cancer, adult-onset diabetes, fatty liver disease, and many others (12).
EVOO Cons:
While EVOO consumption is excellent for health, getting a good quality EVOO and avoiding high heat is essential. Some olive oils are diluted with unhealthy oils (14).
HEALTHY FAT #2: COCONUT OIL
Coconut and its products have a long anecdotal history of contributing to health, dating back 4,000 years to the Indian health practices of Ayurvedic medicine (15). Only recently have some producers adulterated coconut flakes and meat by adding sugars or unhealthy oils. In its natural state, coconut provides a satiating inner flesh and "water" filled with nutrients and enzymes. The flesh can be minimally processed (and often fermented) to form a shelf-stable oil brimming with medium-chain fatty acids that form antimicrobial acids when broken down. However, if you plan to cook with it, use specially formulated high-heat versions for high-temperature cooking, such as frying.
What Makes Coconut Oil Healthy:
Produces few toxic byproducts when heated (2)
Shown to increase HDL (the "good" cholesterol) (16)
Has a positive effect on blood sugar by increasing insulin sensitivity (16)
Coconut Oil Pros:
Coconut oil is an immune system booster and an infection-fighting topical ointment! High in acids that are antifungal, antiviral, and antibacterial, consuming a small amount of unheated, unfiltered organic coconut oil as a regular part of the diet is beneficial to the immune system (15). Studies show coconut oil can stimulate the immune system to create anti-inflammatory agents (15). Coconut oil can also be applied topically to provide a barrier that kills microorganisms even as it moistens the skin, a boon to those with psoriasis.
Coconut Oil Cons:
There are some genetic types (such as ApoE 4 or those with familial hypercholesterolemia) whose cholesterol tests may show an exaggerated response to saturated fats in the diet. By observing diet and cholesterol scores, some people may learn they need to minimize coconut oil and all saturated fats, including meat and dairy.
HEALTHY FAT #3: OMEGA 3 FATTY ACIDS
Omega 3 fatty acids are polyunsaturated fats, meaning that multiple carbons in the molecular structure do not have an attached hydrogen. This molecular structure of Omega 3s is easily damaged by heat, so to preserve health benefits, they are best when processed without significant heat. Certain types of fish naturally contain high amounts of Omega 3s and are often used to formulate nutritional supplements. Exposure to air and heat rapidly oxidizes Omega 3s, so supplements are typically encapsulated with a gel cap to prevent exposure. They are best when cold-processed and protected from air and heat.
Two important molecule types of Omega 3 fatty acids are DHA and EPA. While DHA is highest in fish, a vegan source can be derived from algae. Achieving higher doses of EPA aids the health benefits from Omega 3s, which is powerful enough to reduce cardiovascular events such as heart attack (17). Consistent high doses (over 1g each) of DHA and EPA help the body thin the blood a little, making it less likely to adhere to artery walls or clog kidneys. Numerous other benefits are attributed to Omega 3s, such as reduced blood pressure scores, platelet clumping, and inflammation (17).
What Makes Omega 3 Fatty Acids Healthy (17):
Anti-inflammatory
Improves artery endothelial linings
Thins blood slightly
Stabilizes heartbeat
Reduces high blood pressure
Omega 3 Pros:
Omega 3s have positive cognitive benefits such as anxiety reduction and increased focus, attention, and memory. For this reason, Omega 3s are popular with parents of children with ADD/ADHD and with those experiencing mild cognitive decline.
Omega 3 Cons:
Omega 3 fatty acids are delicate and break down quickly with light and heat. Never cook in fish oil. When cooking fish high in Omega 3s, such as salmon, it's essential to preserve the fats by minimizing the cooking time and temperature. Unfortunately, many Omega 3 supplements may become harmful because they were overheated during processing or shipping.
Omega 3 supplements should come from a reputable supplier who does not use excessive heat or chemicals. Some supplement companies do testing on their products, so they cost a little more, but you can be sure you're getting Omega 3s that promote health rather than increase risks.
HEALTHY FAT #4: PHOSPHATIDYL CHOLINE (PC)
Phosphatidylcholine (PC) is a specific type of fat molecule called a phospholipid that helps form the double-layer cell membrane of most human cells. This molecule's role in human health is vast since its presence in the cell wall is a significant way a cell is held together, resists invaders, and remains rigid yet flexible. PC can be broken down into its components, releasing multifunctional choline to be used in the liver and brain. Eggs contain small amounts of naturally occurring PC.
Lecithin is primarily composed of PC (18), and many use the names interchangeably. Because lecithin is oily, it is frequently used as an emulsifier in foods, which helps blend two or more substances into a cohesive, creamy substance. Lecithin is usually derived from soy or sunflower and comes in a moist powder, liquid, or encapsulated form for protection.
What Makes PC Healthy:
Dietary PC is incorporated into the cell walls of human cells
Plays roles in fat metabolism and detoxification in the liver
Vital for the formation of communication chemicals in the brain
PC Bonus Points:
Besides its crucial role in the cell wall, the choline in PC is a precursor for acetylcholine, an important chemical messenger in the brain (neurotransmitter). Acetylcholine figures largely in cognitive processes related to learning and memory, and many people report improved mental clarity when taking PC supplements.
PC Caveats:
PC is not an oil that can be used in cooking. While PC is not easily damaged by oxidation, it can break down under high heat. Some people are sensitive to soy-derived lecithin and may respond better to sunflower-based supplements and lecithin.
Dietary Fats Will Either Benefit or Harm You - Consume Them Wisely!
Dietary fat can be a powerful ally in brain health and weight loss, especially if appropriately combined with adequate exercise. However, damaged fats contribute significantly to inflammation, clogged arteries, and subsequent cardiac events. In contrast, fats such as coconut oil, extra virgin olive oil, Omega 3s, and phosphatidylcholine are health-promoting and, in some cases, essential to good health.
As integrative and functional medicine practitioners, we can partner with you to reduce your risks for cardiovascular disease, obesity, and many other chronic illnesses. Beginning your health journey with a full cholesterol blood panel or an Executive Physical is a great way to proactively increase your health and vitality. Just don't be surprised if we encourage you to eat some healthy fats!
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
951-383-4333
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