Butter is not a good choice for low carber

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In this slide deck I demonstrate the effects of carbohydrate restriction on different lipoproteins such as HDL, LDL, non-HDL-cholesterol and apolipoprotein B (apoB). The effect of butter and saturated fat as such are compared to unsaturated fat and especially to canola oil. Meta-analysis by Mensink et al. 2003 is the primary reference for the analysis.

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Butter is not a good choice for low carber

  1. 1. Changes in apoB, LDL, non-HDL- cholesterol, HDL and LDL particles when carbohydrates are replaced by different fatty acids Scientific evidence Registered dietitian, M.Sc, MBA Reijo Laatikainen www.twitter.com/pronutritionist Page 1
  2. 2. Is butter really healthy for your heart? 2
  3. 3. Why this slide deck? • It’s rather widely accepted that apoB, non-HDL-cholesterol and total cholesterol:HDL –ratio are better predictors of coronary heart disease (CHD) risk than LDL-C alone. The importance of LDL particle number (LDL-P) and high share of small dense LDL is yet to be confirmed in meta-analyses vs apoB etc. • Some proponents of the low carb diet maintain that saturated fat is either beneficial or neutral in regards to these risk factors and that “… saturated fat has nothing to do with heart disease”. Point seem to be that if you reduce carbohydrate intake substantially, all the key risk factors will settle within the optimal range • In some occasions media has declared butter heart healthy • What is actually known about lipoproteins when carbohydrates (“carbs”) are replaced by different fatty acid classes? 3
  4. 4. Source Meta-analysis of 60 randomized studies in weight stable situation by Mensink et al 2003 4
  5. 5. Lipoprotein changes when 1% of daily energy from carbs is replaced by fats 5 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55
  6. 6. Part 1, summary 6
  7. 7. Direction of effects when only 1 E% of carbs is replaced by fatty acids HDL LDL T-Chol: HDL -ratio apoB Non- HDL-C Carbs→ SFA +/- 0 +/- 0 Not calculated in the original paper. I’ve done the math (ie. red text previous slide) Carbs→ MUFA Carbs→ PUFA 7 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 Green arrow= beneficial change in a risk factor, red/striped arrow=negative change, +/-0= not statistically significant change
  8. 8. Part 2, practical example Potatoes (200 kcal) → Butter (200 kcal) or Potatoes (200 kcal) → Canola oil (200 kcal) 8
  9. 9. Effects of replacing potatoes by butter or canola oil in an isocaloric situation 9 ?
  10. 10. -9.3 % -0.7 % 0.4 % 2.8 % 6.8 % -12.0 % -10.0 % -8.0 % -6.0 % -4.0 % -2.0 % 0.0 % 2.0 % 4.0 % 6.0 % 8.0 % Carbohydrate Protein* PUFA MUFA SFA Change in macronutrient intake when 10% of daily energy as carbs (boiled potatoes) is replaced by animal fat (butter) Changes in macronutrient intake when butter replaces potatoes 10 *Protein is considered neutral in the following calculations (no data in Mensink). Therefore actual amount of carbs replaced is 9.3 E%-0.7 E%= 8.6 E%. It follows that the ‘replaceable’ fat intake is also reduced by 0.7 E%, and this reduction is splitted to all 3 fatty acid classes in the following calcutions.
  11. 11. Changes in macronutrient intake when canola oil replaces potatoes 11 -9.3 % -0.7 % 2.8 % 6.4 % 0.7 % -12.0 % -10.0 % -8.0 % -6.0 % -4.0 % -2.0 % 0.0 % 2.0 % 4.0 % 6.0 % 8.0 % Carbohydrate Protein PUFA MUFA SFA Change in macronutrient intake when 10% of daily energy as carbs (boiled potatoes) is replaced by canola oil
  12. 12. Change in LDL 12 0.1808 -0.0883 -0.15 -0.1 -0.05 0 0.05 0.1 0.15 0.2 Carbs replaced by butter Carbs replaced by canola oil Change in LDL (mmol/L) mmol/L (For mg/DL multiply by 38.67) Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  13. 13. Change in HDL 13 0.087 0.0694 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1 Carbs replaced by butter Carbs replaced by canola oil Change in HDL (mmol/L) mmol/L (For mg/DL multiply by 38.67) Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  14. 14. Change in total cholesterol:HDL –ratio 14 -0.0545 -0.2403 -0.3 -0.25 -0.2 -0.15 -0.1 -0.05 0 Carbs replaced by butter Carbs replaced by canola oil Change in TOT CHOL:HDL -ratio Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  15. 15. Change in non-HDL-cholesterol 15 0.1272 -0.1426 -0.2 -0.15 -0.1 -0.05 0 0.05 0.1 0.15 Carbs replaced by butter Carbs replaced by canola oil Change in non-HDL-Cholesterol (mmol/L) mmol/L (For mg/DL multiply by 38.67) Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  16. 16. Change in apoB 16 2.88 -48 -60 -50 -40 -30 -20 -10 0 10 Carbs replaced by butter Carbs replaced by canola oil Change in apoB (mg/L) mg/L Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  17. 17. Part 2 17 125 grams (25 E%) of carbs → SFA or 125 grams (25 E%) of carbs → MUFA or 125 grams (25 E%) of carbs → PUFA
  18. 18. The following calculations are theoretical because edible fats are mixtures of different fatty acids. However, calculations demonstrate the direction of the change with given fatty acids. 18
  19. 19. 19 25 E% of carbs all replaced by SFA 25 E% of carbs all replaced by MUFA 25 E% of carbs all replaced by PUFA 3 scenarios in weight stable situation 1 2 3 ? ? ?
  20. 20. Change in HDL 20 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1) 0.25 0.20 0.15 0.00 0.05 0.10 0.15 0.20 0.25 0.30 by SFA by MUFA by PUFA Change in HDL (mmol/l) when 25 % of energy from carbs is replaced by different fatty acid classes mmol/L (For mg/DL multiply by 38.67)
  21. 21. Change in apoB 21 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1) 65.00 -120.00 -192.50 -250.00 -200.00 -150.00 -100.00 -50.00 0.00 50.00 100.00 by SFA by MUFA by PUFA Change in Apo-B (mg/L) when 25 % of energy from carbs is replaced by different fatty acid classesmg/L
  22. 22. Change in non-HDL-cholesterol 22 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1) 0.65 -0.35 -0.68-0.80 -0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.80 by SFA by MUFA by PUFA Change in Non-HDL (mol/L) when 25% of energy from carbs is replaced by different fatty acid classes mmol/L (For mg/DL multiply by 38.67)
  23. 23. Change in total cholesterol:HDL -ratio 23 0.075 -0.65 -0.80-0.900 -0.800 -0.700 -0.600 -0.500 -0.400 -0.300 -0.200 -0.100 0.000 0.100 0.200 by SFA by MUFA by PUFA Change in Tot Cholesterol:HDL -ratio when 25% of energy from carbs is replaced by different fatty acid classes Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
  24. 24. Change in LDL-C 24 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta- analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1) 0.80 -0.23 -0.48-0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.80 1.00 by SFA by MUFA by PUFA Change in LDL (mmol/L) when 25% of energy from carbs is replaced by different fatty acid classes mmol/L (For mg/DL multiply by 38.67)
  25. 25. Changes in LDL-particle size, LDL pattern B or number (LDL-P) 25 No data available in Mensink’s meta-analysis or in any other currently available meta-analysis
  26. 26. Conclusion • Replacing carbohydrates by PUFA/MUFA compared to SFA induces more beneficial changes in the key CHD risk factors, ie. apoB, non- HDL-cholesterol and total cholesterol:HDL ratio, in addition to LDL-C. • All fatty acids in place of carbohydrates increase HDL cholesterol • When carbohydrates are replaced by SFA, apoB and total cholesterol:HDL ratio seem to change little or not at all. This may partly explain why replacing saturated fat by carbohydrates has not been associated with improved CHD outcomes in prospective cohorts (Jakobsen et al. 2009) • Favouring food items rich in MUFA and PUFA instead of SFA is likely to be beneficial to cardiovascular health when “going low carb” 26
  27. 27. Healthy switch 27
  28. 28. Unhealthy switch 28
  29. 29. Disclaimer This analysis focuses on lipoprotein changes only in weight stable situation. Other diet related factors (such as protein quality, fiber, vitamins, minerals, phytochemicals, healthy weight etc.) may also play a critical role in preserving cardiovascular health 29
  30. 30. What about morbidity and mortality trials and prospective cohorts? Visit my other slide deck on butter http://www.slideshare.net/pronutritionist/margi ne-or-butter 30
  31. 31. What about LDL-particle size or LDL-P? Visit my upcoming slide deck (due before September 2014) 31
  32. 32. Wellcome aboard! http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionist.net Reijo Laatikainen, RD, MBA Images bought and licensed from BigStockPhoto. Snapshots from papers and sites referred to. Page 32
  33. 33. Back up slides Calculations behind the substitutions
  34. 34. Change in LDL when canola oil replaces potatoes 34 0.016 -0.0549 -0.0494 -0.0883 -0.1 -0.08 -0.06 -0.04 -0.02 0 0.02 0.04 POtatoes replaced by SFA (0.5 E%) Carbs replaced by MUFA (6.1 E%) Carbs replaced by PUFA (2.6 E%) Net change (sum) Change in LDL cholesterol (mmol/L)
  35. 35. Change in HDL when canola oil replaces potatoes 35 0.005 0.0488 0.0156 0.0694 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 Carbs replaced by SFA (0.5 E%) Carbs replaced by MUFA (6.1 E%) Carbs replaced by PUFA (2.6 E%) Net change (sum) Change in HDL cholesterol (mmol/L)
  36. 36. Change in total cholesterol:HDL –ratio when canola oil replaces potatoes 36 0.0015 -0.1586 -0.0832 -0.2403 -0.3 -0.25 -0.2 -0.15 -0.1 -0.05 0 0.05 Carbs replaced by SFA (0.5 E%) Carbs replaced by MUFA (6.1 E%) Carbs replaced by PUFA (2.6 E%) Net change (sum) Change in Tot Chol:HDL -ratio
  37. 37. Change in non-HDL-cholesterol when canola oil replaces potatoes 37 0.013 -0.0854 -0.0702 -0.1426 -0.16 -0.14 -0.12 -0.1 -0.08 -0.06 -0.04 -0.02 0 0.02 0.04 Carbs replaced by SFA (0.5 E%) Carbs replaced by MUFA (6.1 E%) Carbs replaced by PUFA (2.6 E%) Net change (sum) Change in non-HDL-Cholesterol
  38. 38. Change in apoB when canola oil replaces potatoes 38 1.3 -29.28 -20.02 -48.00 -60 -50 -40 -30 -20 -10 0 10 Carbs replaced by SFA (0.5 E%) Carbs replaced by MUFA (6.1 E%) Carbs replaced by PUFA (2.6 E%) Net change (sum) Change in Apo B (mg/L)
  39. 39. Change in LDL when butter replaces potatoes 39 0.208 -0,0234 -0,0038 0.1808 -0.05 0 0.05 0.1 0.15 0.2 0.25 Carbs replaced by SFA (6.5 E%) Carbs replaced by MUFA (2.6 E%) Carbs replaced by PUFA (0.2 E%) Net change (sum) Change in LDL cholesterol (mmol/L)
  40. 40. Change in HDL when butter replaces potatoes 40 0.065 0.0208 0.0012 0.087 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1 Carbs replaced by SFA (6.5 E%) Carbs replaced by MUFA (2.6 E%) Carbs replaced by PUFA (0.2 E%) Net change (sum) Change in HDL cholesterol (mmol/L)
  41. 41. Change in total cholesterol:HDL –ratio when butter replaces potatoes 41 0.0195 -0.0676 -0.0064 -0.0545 -0.08 -0.07 -0.06 -0.05 -0.04 -0.03 -0.02 -0.01 0 0.01 0.02 0.03 Carbs replaced by SFA (6.5 E%) Carbs replaced by MUFA (2.6 E%) Carbs replaced by PUFA (0.2 E%) Net change (sum) Change in Tot Chol:HDL -ratio
  42. 42. Change in non-HDL-cholesterol when butter replaces potatoes 42 0.169 -0.0364 .-0,0054 0.1272 -0.05 0 0.05 0.1 0.15 0.2 Carbs replaced by SFA (6.5 E%) Carbs replaced by MUFA (2.6 E%) Carbs replaced by PUFA (0.2 E%) Net change (sum) Change in non-HDL-Cholesterol
  43. 43. Change in apoB when butter replaces potatoes 43 16.9 -12.48 -1.54 2.88 -15 -10 -5 0 5 10 15 20 Carbs replaced by SFA (6.5 E%) Carbs replaced by MUFA (2.6 E%) Carbs replaced by PUFA (0.2 E%) Net change (sum) Change in Apo B (mg/L)

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