A fat load of good: why it's time to bring full fat back
Start your day with toast, hold the butter but add margarine if you like. Have it with an egg-white omelette because the yolk is bad and a strong coffee with a splash of fat-free milk and maybe a calorie-free sweetener.
Splenda perhaps – apparently, according to Splenda, "people with diabetes can enjoy up to 4 packets of SPLENDA® No Calorie Sweetener or up to 8 teaspoons of SPLENDA® No Calorie Sweetener, Granulated, because it is considered a 'free food'."
Ten or 15 years ago, this messed-up meal might have been considered a healthy breakfast.
In recent years however, we have learnt that fat is nothing to be afraid of; fat, unlike the message sounded out since the 1950s, does not make us fat. Fake food like margarine and calorie-free sweeteners on the other hand ... well, that's another story.
Another food myth that has been busted is that full-fat dairy and other animal fats – including bacon and egg yolks – lead to heart disease.
In fact, new research has found that those who consume full-fat dairy tend to weigh less and have a reduced risk of diabetes.
Research published in the American Journal of Nutrition analysed the data of 18,438 women in the Women's Health Study, and found that those who consumed the most high-fat dairy products were about 10 per cent less likely to be overweight.
A separate meta-analysis of more than 3000 people over 15 years found that consumers of full-fat dairy had a 46 per cent lower risk of diabetes.
"There is no prospective human evidence that people who eat low-fat dairy do better than people who eat whole-fat dairy," lead researcher Dr Darian Mozaffarian, of Tufts University, told Time.
It makes sense that the fat from full-fat dairy is more satiating, so people are less likely to overeat and the fat is not being swapped for sugar or carbohydrates, but why the association with diabetes?
"They did find that saturated fatty acids in dairy are strongly associated with reducing risk (of diabetes)," explains cardiologist and adviser to the UK's National Obesity Forum, Dr Aseem Malhotra, who was not involved in the study. "When you remove fat you remove the fatty acids."
In a separate paper tellingly titled Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983, researchers concluded that recommendations to reduce fat intake to lessen the risk of heart disease were misguided.
"The present review concludes that dietary advice not merely needs review; it should not have been introduced," concluded the researchers from the University of West Scotland.
It is an issue close to Malhotra's heart.
"The science is quite clear," says Malhotra. "There are two major factors why the low-fat message is perpetuating itself – that fat will increase the risk of heart disease and that fat makes you fat.
"The latest data on saturated fat – over several decades – has revealed that it doesn't increase heart disease and, if it comes from dairy, it is protective against diabetes and heart disease."
He adds fat has the lowest impact on insulin resistance and says that insulin resistance is the greater risk factor in cardiovascular disease. "Good fats – extra virgin olive oil, nuts, butter, coconut oil – are anti-inflammatory and reduce the risk of a heart attack," Malhotra says.
So why is it that the Australian Dietary Guidelines and many doctors and dietitians still advise consuming reduced fat dairy?
"We're unwilling to admit that we were wrong, but science evolves," Malhotra says. "I started off giving that advice [low-fat]. For me, knowing what I know, it would be unethical to give that advice now.
"There is an urgent need to overhaul the dietary guidelines – the guidelines lag behind the science."
As they stand, he says they're a "direct cause" of the obesity epidemic.
Dr Joanna McMillan says we "have to be careful" not to attack the guidelines with every new study.
"Is the dairy making the difference or is it what they're eating instead?" she asks. "What about if you have a diet with plenty of fat from extra virgin olive oil, nuts, seeds, oily fish, avocado and so on, but choose to have skim milk to reduce the kilojoules from your several coffees? Or just because you like it (as I do!)?"
There is also the fact that not all fat is equal of course. "At the end of the day saturated fat from a piece of cheese is not the same as saturated fat from a party pie," McMillan says, adding: "The message overall is to stop buying low fat when it is replaced by refined carbs (not just sugar) – in fact eat more real food that is not manipulated by manufacturing to meet some nutrient criteria."
Indeed Yale's Dr David Katz has argued that the low-fat advice, based largely on the controversial findings from a 1950s study by scientist Ancel Keys and echoed by Preventive Medicine Research Institute founder Dr Dean Ornish, has been warped by the food industry.
"When [Ancel Keys] advised that we should eat less fat, the advice meant eat more spinach," Katz tells Jeff Wilser in his new book The Good News About What's Bad For You. "The food industry said, we can't make a lot of money selling spinach, but we can invent Snackwell Low-Fat Cookies."
"I wouldn't disagree with that," says Malhotra, who eats up to 15 eggs a week and has bacon a couple of times a week. "If you're avoiding fat and eating more vegetables, there's not a problem with that."
His problem is whether fat is being replaced by sugar or refined carbohydrates, and that people still fear fat. McMillan agrees this needs to change.
"I think we will see a revisal of the dairy guidelines in future Australian Dietary Guidelines and that would be a welcome move," she says.
"Eating fat is as likely to make you fat as eating greens is to make you green," Malhotra says. "It's time to bring fat back."
How much fat is OK?
"Force yourself to eat anything in excess and you will probably do harm," Malhotra says. "Eat until you're full. Try to avoid snacking and eat real food."