Confused about fats & sugars? The answer is not black & white.

Guest Post Sally Marchini, Dietitian

The reason for my blog today is to try to help settle some of the confusion that has been stirred up recently in the media about fats and sugars to reassure our readers about their food choices to help avoid cardiovascular disease (CVD).

It is an important topic for us because diabetes has a very strong link with Cardiovascular Disease or CVD.  CVD is recognised as the major cause of death for people with diabetes, and in 2012 it was estimated that about 65% of all CVD deaths in Australia were in people with diabetes or pre-diabetes.  Hence, the focus of diet and lifestyle to avoid it in our population.  Click on the link to read more from the 2012 Baker IDI report on Diabetes: The Silent Pandemic and it’s effect on Australia.

This recent media frenzy (as far as I can work out) stemmed from an ‘opinion’ piece in the British Medical Journal about saturated fat.  It was also discussed in the ABC’s Catalyst programme last week.  Additionally, American, Dr David L. Katz, has written a blog about the controversy which I think addresses the various issues rather well in a balanced way.

Before we start though, I’d like to remind you about the recent (February 2013) launch of the Australian Dietary Guidelines that provides up-to-date advice about the amounts and kinds of foods we need to eat for health and wellbeing, and this is an excellent guide for us to follow. Before being published they underwent a three year review and development process and involved analysis of more than 55,000 research publications by extremely well qualified individuals and groups.  For the Australian population they take into account nutrient requirements, cultural acceptability, Australian consumption patterns AND evidence for optimal health and wellbeing.

My own view as an Accredited Practising Dietitian is that fats and sugars, the macronutrients in question in this blog, are extremely complex. There are many types of fats, many types within those types of fats, and so forth, all with various qualities.  The same goes for sugars. They are not ‘good’ or ‘bad’, and it is important to learn as much as possible about the varieties in order to empower us to make our own dietary decisions.   This is difficult to do in one blog without oversimplifying matters, so I’ll keep it general.

In his blog this week, Dr David L Katz explains this aspect of saturated fats:

“Saturated fat is not one food component; it’s a category. Just as polyunsaturated fats include the anti-inflammatory omega-3s, and the pro-inflammatory omega-6s (and even that is over simplified), so does the saturated fat class contain a diversity of members. One of them, stearic acid, found in dark chocolate among other places, is now clearly established to be innocuous. Another, lauric acid, predominant in coconut oil among other places, may prove to be as well. But still others, such as palmitic acid and myristic acid, appear to be substantially guilty as charged, contributing to inflammation and atherosclerosis. The body of relevant evidence is expansive.

What this means is that even if there are harms attached to some saturated fats, summary judgment against the whole clan was never valid. The combination of parsing and over-simplification invites the devils in the details to run amok. That clearly happened here.

Some saturated fat simply isn’t harmful. Some is.

Later in his blog, David continues, and I have bolded the words I’d like you to remember:

“If we focus only on cutting saturated fat, we can find new ways to eat badly. We have, over the years, done exactly that. Of note, we can do the same when cutting carbs, or gluten, or fructose, or sugar, or meat, or grains, or salt, or wheat, too. Diet never was, and never will be, a single ingredient enterprise. The whole recipe matters.

There is no need to obsess about cutting saturated fat. But I advise against any particular effort to add saturated fat to your diet. In fact, don’t waste much time focusing on saturated fat per se. Rather, focus on eating well, as the Okinawans have long done with a very low-fat plant-based diet, or as the Mediterraneans have long done with a much higher-fat, but still mostly plant-based diet. If we choose wholesome foods, we will wind up with better diets and better health. Incidentally, our saturated fat intake will not be more than moderate.”

And if you want to talk about sugar which was implicated in the Catalyst programme for causing CVD, again this has been far too over-simplified.  In simple terms anyway we know that all carbohydrates break down to glucose (a type of sugar – a monosaccharide – that is our body’s preferred fuel source)  and we know that carbs with a low glycemic index that are nutritionally rich are an important food source in our diets for many reasons.  We also know that high-glycemic index and nutritionally poor carbohydrates can have a detrimental effect on the fat levels/types in our bodies, perhaps even as bad as ‘bad’ fats themselves. Just learn to choose nutrient-dense carb sources whenever possible.

As an Accredited Practising Dietitian I recommend sticking with the balanced diet that is provided to us in the very well researched and explained Australian Dietary Guidelines.

Sally is owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.



  1. Mel on October 28, 2013 at 8:44 am

    HI Sally,

    Seeing the “healthy plate” reminded me of discussing this when I was doing my MTeach and we were thinking about how to teach this to primary school children. All of us were confused by this plate. Is the plate a visual representation of the ideal plate or more of a pie chart of sources of kilojoules? If your plate looked like that it seems that you’d tend towards too much carbohydrate and hence too much energy intake-doubling up on grains and starchy vegetables like corn and potatoes seems a bit troubling but maybe that’s my carbohydrate focused diabetic brain.

  2. Sally on October 28, 2013 at 9:38 am

    Hi Mel
    Thanks for your question.
    This picture is more of a pie chart than a plate, in terms of where your energy for the 5 food groups should come from.
    Your plate should be about one quarter carbohydrate foods, one quarter lean protein foods, and half being non-starchy vegetables.
    Were you able to watch the webinar that I presented on healthy eating with diabetes? That went into greater detail about types of carbohydrates that are best for our diabetes control.
    Let me know if you would like me to do a blog on the topic of carbohydrates in future.
    Hoping that answers your question. Warm regards, Sally 🙂

  3. Mel on October 28, 2013 at 10:29 am

    Thanks Sally, I’ve read extensively about carbs and the studies on diabetes and diet, and diet in general and that’s why I find that guide to healthy eating a totally misleading health message-it is being taught and understood as plate and not a pie chart. Even if you see it as a pie chart there is no indication that it’s talking about kilojoule sources and not relative food quantities.

    Students of teaching at USyd have/are been(ing) taught that that visual represents what your plate should look like and many primary school children in NSW at least are being taught that in the classroom-and not just from Usyd grads, it’s very much the way most people see it. You actually need to bring a good knowledge of food to that chart in order to not be misled by it IMO.

    Sorry for the tangent, it wasn’t the point of your post but I really see that chart as a major public health failure in an area where Australia needs to do better.

  4. Youtube on December 2, 2014 at 7:18 pm

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    The answer is not black & white. – Diabetes Counselling Online
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