Over the last month, the #1 question I have received has been, “Does eating meat and fat help in heart disease prevention and treatment? Dr. Esselstyn, PCRM, and Dr. McDougall advocate no meat, fish or dairy, and no oil. Your advice differs. What should I do when recommendations conflict?”
That is a very good question and one I get asked regularly from the public and from doctors and dentists. The benefits of the ultra-low-fat diets recommended by Dr. Esselstyn, PCRM, and Dr. McDougall come from adding extra fiber from vegetables, fruits, and beans, plus spices & herbs, and cutting out bad inflammatory fats—I completely agree with these specific recommendations, as adding these fiber-rich, plant-based foods is the foundation of my food recommendations.
Following a vegetarian diet, or a pesce-vegetarian diet can be a very healthy lifestyle, but my point is that you don’t have to be vegetarian to be healthy.
However, cutting out Smart Fats, such as avocado, extra virgin olive oil, nuts, and wild salmon is not supported by sound scientific studies, and I would say purely from a health perspective, as I will expand upon shortly, that it is actually a bad recommendation.
I also recommend avoiding bad inflammatory fats, such as hydrogenated fats (trans fats), and animal fats that come from feedlots which are loaded with pesticides and hormones (likely 90% of animal protein sold in the US and Canada). So if you do eat animal protein, from a health perspective, it should be free-range, pasture-raised, or wild. I encourage you to eat it in moderate portions, and that most of the food on your plate should come from colorful plant foods. For more details on this, please review the book that I co-wrote with Jonny Bowden, Smart Fat.
I interviewed Dr. Dean Ornish, MD on this topic last year. He was one of the original founders of the ultra-low-fat, vegetarian diet recommendations. During our conversation, we both agreed that recent studies have shown that adding olive oil, nuts, and fish oil help to reverse heart disease, and that along with these healthy fats, you must also consume an abundance of colorful vegetables, fruits, beans, and spices. That was an amazing interview as I have always held Dr. Ornish in high regard and have followed his work since the 1990s.
Adding more of these “Smart Fats” lowers tissue inflammation, and multiple studies have shown that they will reduce your risk for heart disease and memory loss. The PREDIMED study (Estruch et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet; NEJM 2013; 368:1279-90.) published in the prestigious New England Journal of Medicine compared a low-fat diet with the Mediterranean diet and those who consumed more olive oil and nuts had fewer cardiovascular events.
Your brain, in particular, needs Smart Fats to improve cognitive function and prevent depression–after all, did you know your brain is more than 60% fat by weight? Compared to a Mediterranean diet that was shown to improve cognitive function and prevent memory loss, following a low-fat diet actually increased the rate of dementia and memory loss.
The good news is, there is no health evidence that you have to cut out clean animal protein (as in wild, grass-fed, and organically raised). The most recent studies published (such as Chowdhury et al. Ann Intern Med 2014;160:398-406; Praagman J et al. Am J Clin Nutr 2016;103:356-65; and Wang et al. JAMA 2016;176:1134-45.) showed that eating moderate saturated (animal) fat does not increase the risk for heart disease. Clean sources of animal fats appear neither beneficial nor harmful.
Please don’t get the wrong impression here. I am not saying you should eat “more” red meat and fatty dairy products, and if you do not eat them, then you do not need to start. I am trying to say that if you do so in moderation with organic and pasture raised products, it appears to be more neutral than anything.
The most harmful food group remains sugar and flour, as well as the toxic fats noted above. We should do more to avoid high glycemic load foods (glycemic load refers to foods that increase your blood sugar levels) and toxic fats.
Another finding that is crystal clear is that consuming processed meats (deli meats, hot dogs, and bacon) that are produced from animals raised in feedlots and sprinkled with toxins like nitrosamines, are deadly. These processed meats increase your risk for cancer, heart disease, and memory loss—so please avoid them altogether.
One last point: If you wish to follow a vegetarian diet, then I totally support that and think it can be super healthy, just be sure to meet your nutrient needs, including your requirements for smart fats. (See my blog post on key nutrients needed when following a vegetarian diet).
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
clear all doubts about fat intake. thanks so much
Very helpful….thanks
Three years ago, after being diagnosed with Atrial Fib, I started taking my diet more seriously. Don’t remember how it happened, but I was really lucky to stumble across a copy of Dr Masley book : 30-Day Heart Tune-up. Ever since, I have followed his eating recommendations. Dr Masley is really good about his constant reminders and reinforcements of what to eat and what to avoid. Seems we all need this!
Thank-you Dr M.
Felicity Rask
Hi Felicity,
Thanks for your kind comments.
Steven Masley, MD
I have been increasing my fat intake by using olive oil for drizzling over veggies and avacado oil for cooking. However, I have had two gall bladder attacks since then. I have never had a gallbladder problem until a couple of months ago. Is this yet another contradiction? How can I best avoid another attack. The doctor in emergency told me to cut out fats!!
Hi Darlene,
The liver produces bile to help you digest fat, and your gallbladder stores and squirts the bile into your intestine when you eat fat. If you have gallstones and they happen to block your bile duct while your gallbladder is contracting, this can be very painful, and rarely lead to serious complications. Eating a big dose of fat at a single time makes this problem worse. It is better to spread your fat intake out over the day and to avoid eating large portions. I’ve had patients with gallstones who never needed surgery and were able to go decades without gallstone attacks, by keeping their fat intake modest. Other patients have needed surgery to fix their gallbladder stones as they kept having recurrent attacks, even while following a low fat diet. Talk to your own physician about your options.
Steven Masley, MD
I agree
Very informative, thank you
I think moderation of animal product intake is essential.
Dairy products with their IGF1 growth hormone and sugars can contribute to metabolic syndrome and autoimmunity. Too much protein can be turned into sugar and if not used as energy stored as fat.
Hi Heidi,
I agree with your concerns, although the only dairy products I think have more benefit than harm are yogurt and kefir, as they are loaded with probiotic microbes. And even with the benefits of protein, probiotics, and calcium, I still suggest that if people are sensitive to dairy that they avoid even these sources as well.
Most of our plate should be plant based, colorful, and with a low glycemic load.
Steven Masley, MD
Dr. Masley’s comments are consistent with his books. His books provide excellent reason and rationale for his opinions. I have found his writing to be respectful and open to other ideas. I have suggested his books to family, friends, and patients. I have seen excellent results when people take the time to read, think slowly, and make decisions based on their long term health.
This was helpful. The contradictory information out there is overwhelming. When you can’t even decide what to eat due to all the conflicting advise, it’s very stressful. One day I decide to double my intake of lovely leafy green vegetables, then after locating exciting new recipes, I read that greens are bad for my hypothyroidism. Enough to make you want to just give up on trying to eat healthfully. But at least I can put the animal protein issue to rest. Or can I? Joel Fuhrman quotes all kinds of studies warning of bad side effects.
Hi Mary,
Be careful what you read and who you trust. The amount of contradicting information is overwhelming. Please rest assured that you can eat green leafy vegetables and that they are good for your thyroid. But if you push it to the extreme, caution, as if you start juicing cabbage and drinking in large quantities, then you might over do it and impact your thyroid, but you can safely eat a couple servings of green leafy vegetables daily and not have to worry—except, spinach and kale are on the dirty dozen list, so do look for organic options.
Keep in mind, many medical providers will compare studies of people who eat animal protein with those who don’t and show studies saying those eating animal protein have more cancer and heart disease. But keep in mind that they are usually comparing people who eat nitrosamine-toxic deli meats, hot dogs with white bread and white buns, and who avoid eating vegetables. These studies do not address people who choose to eat mostly plant based food, and have a modest portion of wild seafood, or organically raised poultry or eggs. They are comparing organic apples with toxic bacon, and it isn’t a fair comparison. To risk repeating myself, be careful what you choose to read and look for a voice that you can trust.
To Your Health!
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
I do not foresee the fat controversy will ever ends. Olive oil, avocado oil nut, oils, and Omega 3 oil are now frequently touted as good fat while there is no scientific evidence to support that. Moderate amount of saturated oil is OK according to the agreement between Dr Masley and Dr Ornish. I am thinking how many lives were saved by Dr Ornish’s pristine diet along with exercise, stress control, good sleep and other factors that he recommended.
We were told saturated fats will raise blood cholesterol while according to Framingham it is the low cholesterol that causes early death, stroke, infectious disease, depression, suicide and more. Cholesterol is so fundamental to our physiologic function that our life depend on it. Millions of Americans are lowering their cholesterol by dangerous drugs and diet for half century, but CVD and cardiovascular death are on the rise. The cholesterol theory has been the greatest fraud in the medical history of mankind.
Dr Sadaty,
Thank you for your comment. However, there is substantial published evidence that eating nuts, fish rich in omega-3 fats, and olive oil will decrease cardiovascular outcomes and improve brain function, so your statement that there is no scientific evidence to support these foods is just plain not true, and suggests that you should read more nutrition related journals. Please look over the 500 scientific references listed in my last books, The Better Brain Solution, The 30-Day Heart Tune-Up, and Smart Fat.
I do agree that we have over-emphasized lowering cholesterol, and sometimes cause harm by doing so.
All the best,
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
Thank you for this article as I enjoy my healthy coconut oil, olive oil, etc. I am 80 years old and my weight has remained stable for many years with the consumption of healthy fats.
What about coconut fat? How do you advise on cholesterol tracking? Mine is 218.
Consuming coconut oil:
• Boosts metabolism (calorie burning) in people who exercise daily.
• Provides a terrific fuel source (medium chain triglycerides) for prolonged exercise sessions and for athletes.
• Has anti-microbial properties, helping to fight infections.
• For people with mild cognitive dysfunction, it appears beneficial for memory, and for people with neurological disease, the MCT portion of coconut oil helps injured brain cells function.
Despite these benefits, there is still controversy with coconut oil because eating more coconut products increases total cholesterol levels. When you look at specific impact on your lipid profile it raises LDL and total cholesterol levels, but it also increases LDL and HDL particle size (considered good) and healthy HDL cholesterol levels (also good), so the overall impact on cholesterol isn’t bad, and for some people perhaps mildly beneficial. The problem is we do not have any clinical outcome studies that show eating coconut is either neutral or beneficial, and at least one clinical study using coconut products showed that it decreased artery function, so I have some major hesitation in recommending coconut oil to people with established heart disease.
My bottom line recommendation is if you are in good health, or if you have neurological issues, then it’s likely smart to eat more coconut fats. However, if you have established heart disease or you are being treated by your doctor for abnormal cholesterol problems, I’d recommend that you consult with your doctor and avoid coconut fats and enjoy the many other heart-friendly smart such as avocado, macadamia nut, or almond oil, or extra virgin olive oil instead.
Also, don’t be fooled about the myth regarding cooking with coconut oil at high heat. In reality, coconut oil has a low smoke point, only 350 degrees (F). So only use coconut oil at low or medium-low cooking heat, not higher.
Steven Masley, MD
Thanks for addressing this issue. I have always been in a dilemma with Dr. Esselstyn
statement he claims is scientifically proven that any oil is inflammatory to the lining of the artery and should be avoided. For those like me who already have Atherosclerosi i was an ex-smoker, He wants to keep the bruised or inflamed plaque area in the artery “capped” so it will not breck off and instantly 100% block and create a heart attack. So sounds to me if he says it is scientifically proven to avoid oils because oils create inflammation of the artery wall and to eat a mostly plant based diet with the power greens boiled for nitric acid protection of the artery walls it is still a dilemma for me what to do with your response with this critical issue? Would you still say it ok to eat the smart fats in moderation? Thankyou.aimar
Hi Aimar,
Yes, for my patients with established heart disease, yes I tell them it is ok to eat smart fats, but I am much more cautious on having them avoid bad fats and sugar. And any saturated fat from animal protein needs to be modest.
We have shown with our patients that our average patients shrinks their plaque every year, including people with established heart disease, and that we have hundreds of patients that have shrunk their arterial plaque by at least 10%, their arteries are 10 years younger, their artery plaque lesions (the capped plaque) shrink as well, and we have presented this data at medical meetings and published it in medical journals.
For people with heart disease, compared to a low fat diet, adding olive oil or adding nuts has been shown to reduce their risk for a heart attack or stroke.
Dr Esselstyn and I agree that most of your plate should be plant based, not processed, and you absolutely should eat more vegetables, fruits, and beans. However, we differ in that I allow my patients to add smart fats to their eating plan daily, and I also think that smart fats are essential to your brain as well.
The best source for producing nitric acid would be beets, so eat them often, and include other nitric oxide producing foods as well, such as spinach, arugula, and other greens.
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
I appreciate all of your knowledge. I I have been passing your articles out to family and friend. God bless you and keep up the good health.
Thanks Berta! I appreciate all you do.
Steven Masley, MD