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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