Dear DOCTOR Owen:

I have an elevated cholesterol level and am unclear about how much fat to eat. I have read that 30% of the diet as fat is optimal. I have also read that 20% is ideal. And, I’ve read that most of the fat should be unsaturated. What are the latest recommendations?

Fat Confused

Dear “Confused”:

You are not alone. The percent fat recommended in diets has changed over the last two decades, and the correct data reveal a direct relationship between the amount of saturated fat in the diet and a person’s age and degree of atherosclerosis (hardening of the arteries).

The average American diet has hovered around 40% fat since the 1970s. The same percentages are seen in countries with high-fat intake—Finland, Denmark, and Norway. Those countries also have the highest rates of heart attacks and strokes in the world, and at earlier ages.

The American Heart Association (AHA) publishes and revises recommendations periodically as new data emerge. The AHA recommended 30% fat originally, then lowered that recommendation to 20% for those at high risk—that is, strong family history, high cholesterol level, a prior heart attack, or stroke. Some professional organizations have recommended this amount for all Americans because cholesterol kills a vast majority of us.

Several recent studies suggest that the amount of fat in our diets has been decreasing in spite of the fact that our society is getting progressively fatter. Most of these studies have been on self-reporting documents. Dieters and non-dieters alike have been known to under-report their calorie and fat intake. (Overweight subjects, as opposed to lean subjects, are found to under-report more.) A recent study at Glostrup University Hospital in Denmark, reported on in the International Journal of Obesity, Vol. 24, 435–442, demonstrated that people under-report more now than in the past. The study, which was designed to assess under-reporting, revealed that there is more awareness now about fat intake than in years past. The researchers found no decrease in actual intake of fat compared to years past—just more under-reporting.

I guess this means that people feel embarrassed and guilty about eating fat. The “fat police” have done a good job! The real question now is: “How in the world will people calculate fat percentages in their food without going crazy?” This information is not taught in the schools or on TV nor is it published in the newspaper. And, it gets short shrift in most magazines. The public is left to trust accurate labels from food manufacturers.

Labels list the calories as percentage of fat, as mandated by the Food and Drug Administration (FDA). This is in an attempt by food companies to help people comply with AHA and Centers for Disease Control (CDC) recommendations. The only problem is that fast food menus are very inaccurate. While the labeling on store-bought items is closer to reality, food companies are allowed a 20% error (and none of them have ever been fined for mislabeling).

Of course, percent fat does not address type of fat. The AHA recommends that half the fat consumed be unsaturated. Unsaturated fat is liquid at room temperature and when cooled. Heating unsaturated fat (as in frying) saturates it with hydrogen, and it loses its benefit. People might as well fry with lard because it is less expensive and tastes better.

None of these fat facts address obesity. Obesity is related to calories—period. If you take in more calories than you need to run your organs, do your work, or even exercise, you will gain weight. As with the Glostrup University study, most people simply do not know about calories, do not use calories, and do not care about calories. This comes as no surprise because the recommendations change and there is no public education to help people calculate. (We’ll do this in later columns in this book.)

Over the past years, I have simplified the low-fat diet recommendations for the average patient for routine consumption: If it is greasy to the touch—make other choices. If it floats—make other choices. If it is heavy, but not from water—again, consider other choices.