Cindy Brinn MPH, RD, CDE, BC
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1 Sloughing through the fats: Omega 3 s, Trans Fats and More! Washington Association of Diabetes Educators April 21, 2007 Walla Walla, Washington Cindy Brinn MPH, RD, CDE, BC MPH, RD, CDE, BC- ADM Nutrition Educator, Program Manager St. Joseph Hospital Nutrition & Diabetes Education Clinic Bellingham, WA CBrinn@PeaceHealth.org
2 **
3 ** Fatty acids Insulin Glucose Copyright Sanofi-Aventis used with permission
4 FATS Emerging Evidence: Low-Fat, Low cholesterol, Low Sat Fat Diet Fat chemistry Fats Jobs Trans fats Replacing trans fats with what? Damaged fats heat, oxidation, advanced glycation end products What fats seem reasonable to eat and not eat?
5 Emerging evidence regarding the Low-Fat, Low cholesterol, Low Sat Fat Diet Amount of fat eaten has little effect on CVD risk Dietary cholesterol has little effect of blood cholesterol in most people All saturated fats don t elevate cholesterol Need to look at fats effects on outcomes (CVD & health), not just cholesterol Fats regulate immune function, inflammation & cell membrane integrity Fats are a challenge to study.. many unknowns
6 Normal Artery Heavily Clogged Artery
7 1970 s Diet & CVD Theory (& current thought by many) Dietary Cholesterol/Saturated Fats (all fats) Blood Cholesterol Atherosclerosis MI If a food contains fat or elevates cholesterol it must be a bad food and will clog arteries.
8 Diet and CHD Blood Lipids (Lp(a)) Blood Pressure Thrombotic tendency Diet Insulin resistance Oxidation CHD Homocysteine Endothelial dysfunction Arrhythmia
9 Nurses Health Study: 80,000 women x 20 years No correlation with sat fat or total fat and CVD Oh K. Am J Epidemiol 2005;161:
10 Fats, CHO & CAD progression Angiography in 235 women followed for 3yrs. Quartiles 1st Sat fat% 6.1 2nd 3rd 4th CHO % Change in coronary diameter mm st 2nd 3rd 4th Mozaffarian D. AJCN 2004;80:
11 Fat Chemistry Define saturated fats, monounsaturated fats, polyunsaturated fats transunsaturated fats & sources Describe specific fatty acids & sources
12 Fatty Acid Family
13 Saturated Fats Fatty Acid Family
14 Fatty Acid Family Saturated Fats Unsaturated Fats
15 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products
16 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils
17 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils
18 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils
19 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils
20 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-9 fatty acids
21 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-9 fatty acids Animal beef, lamb, dairy products
22 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
23 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
24 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential n-6 fatty acids essential n-9 fatty acids oleic acid Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
25 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
26 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential Marine n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
27 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential Marine n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados
28 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils n-3 fatty acids essential Marine n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
29 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils Vegetable n-3 fatty acids essential Marine n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
30 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Damaged/Altered Polyunsaturated Monounsaturated Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils Vegetable n-3 fatty acids essential Marine n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Alpha-linolenic acid (ALA) Flaxseed oil, walnuts, canola oil green leafy vegetables Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
31 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils Oxidized/Hydrolyzed heat, oxygen, light, deodorized fats, rancid fats Damaged/Altered Vegetable n-3 fatty acids essential Marine Polyunsaturated n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil Monounsaturated n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Alpha-linolenic acid (ALA) Flaxseed oil, walnuts, canola oil green leafy vegetables Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
32 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils Oxidized/Hydrolyzed heat, oxygen, light, deodorized fats, rancid fats Altered interesterification, genetics, hydrogenation Damaged/Altered Vegetable n-3 fatty acids essential Marine Polyunsaturated n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil Monounsaturated n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Alpha-linolenic acid (ALA) Flaxseed oil, walnuts, canola oil green leafy vegetables Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
33 Fatty Acid Family Saturated Fats Unsaturated Fats Animal butter fat from meat dairy products Vegetable palm, palm kernel, coconut, chocolate hydrogenated oils Trans-unsaturated partially hydrogenated oils, deodorized fats, highly heated fats, ruminant fats Oxidized/Hydrolyzed heat, oxygen, light, deodorized fats, rancid fats Altered interesterification, genetics, hydrogenation Damaged/Altered Vegetable n-3 fatty acids essential Marine Polyunsaturated n-6 fatty acids essential Mainly vegetable oils soybean, sunflower, peanut, canola, safflower, corn oils Eicosapentataenoic Acid (EPA) Fish, shellfish, fish oil Monounsaturated n-9 fatty acids Animal beef, lamb, dairy products Vegetable olives & olive oil, canola & peanut oil, nuts & avocados Alpha-linolenic acid (ALA) Flaxseed oil, walnuts, canola oil green leafy vegetables Docosahexanoci Acid (DHA) Fish, shellfish, fish oils
34 Triglyceride=glycerol + 3 fatty acids Mahan, LK. Food, Nutrition & Diet Tx, 2004
35 C18:0 Stearic Acid--chocolate Saturated Fatty Acid
36 Saturated Fatty Acids 10:0 to 22:0 10:0 Coconut 12:0 Animal 14:0 Palm oil 16:0 Chocolate 18:0 20:0 22:0 Enig M. Know your Fats 2000
37 Monounsaturated Fatty Acids 18:1n-9 Olive oil
38 Monounsaturated Fatty Acids 18:1n-9 Olive oil
39 Polyunsaturat d Fatty Aci : C18:2n6 Corn oil
40 ** 1 atu Olive oil 18:1n-9 essential 18:2n-6 corn oil essential 2 18:3n-3 flax oil 3 20:5n-3 essential fish oil 4 22:6n-3 essential fish oil
41 Enig M. Know your Fats 2000 Unsaturated Fatty Acids Olive oil Corn oil Corn oil Fish Oil Cornl Flax oil Fish Oil
42 Trans fatty acids: Partially hydrogenated fat unnatural Olive oil Chocolate C18:1n-9 C18:1n-9 C18:0
43 Fatty Acids (FA) Subtle, important differences Length of Fatty Acid Saturation with hydrogen saturated, monounsaturated, polyunsaturated Position of double bonds omega 3 fatty acids, omega 6 fatty acids, omega 9 fatty acids (also( gamma and beta b fatty ty acids)
44 Fatty Acids (%) Fat/Oil Saturated Mono Poly n6 n3 Capric C10:0 Lauric C12:0 Myristic C14:0 Palm C16:0 Stearic C18:0 Oleic C18:1 Linoleic C18:2 ALA C18:3 EPA/ DHA Beef Butterfat Cod liver Walnut Flaxseed Corn oil Cocoa Coconut Canola oil
45 Fats Jobs inflammation FAT
46 Common Factor: Inflammation Heart Disease=inflamed blood vessels Cancer=starts as inflamed tissue Alzheimer's=inflamed brain Osteoporosis= = inflamed bones Arthritis=inflamed joints Irritable bowel syndrome=inflamed bowels Asthma=inflamed lungs
47 Fats & Inflammation PUFA MUFA Sat Fat Trans Fat n-6 n-3 Inflammation F. Hu, JAmCol Nutr 20(1):5-19
48 Current n-3 Intake Recommended Intakes Nat'l Acad. Science Other adult Rec.*/** Current est. intake Linoleic acid Corn oil, i etc. 18:2n6 Alpha Linolenic Acidc d Flax, l walnutsw 18:3n g/d 17g/d g/d 1.6g/d EPA +DHA Fish oil 22:5n3 n3; ; 22:6n3 NA 7-15g/d 1.7-2g/d mg/d 14g/d 1.7g/d <170mg/d Kris-Etherton P. AmJCardiol 2006;98:3i-18i *Wijendran V. AnnRevNutr 2004;24: **Wimopoulos A. Prostg. Leuk Esse FA 2000;63:119-21
49 n-6 polyunsaturated fatty acids promote inflammation n-3 polyunsaturated fatty acids prevent inflammation Omega-6 6 PUFAs Linoleic acid (LA) (corn, r sunflower, s n, canola, c a soy) s Gamma-l linolenic n leni acid Arachidonic acid (meat) Pro-Inflammatory Prostaglandin's Enzymes Omega-3 3 PUFAs Alpha-linolenic linolenic acid (ALA) (flax, walnut, canola, soy (only o l 2-5% 2 converted) o Eicosapentaenoic acid (EPA) ( fish f oil) ) Docosahexaenoic oi acid (DHA) ) (fish oil) Anti-Inflammatory Prostaglandin's Wang C. AJCN 2006;84:5-17
50 n-6 polyunsaturated fatty acids promote inflammation n-3 polyunsaturated fatty acids prevent inflammation Omega-6 6 PUFAs Linoleic acid (LA) (corn, sunflower, canola, soy) Gamma-linolenic acid Arachidonic acid (meat) Pro-Inflammatory Prostaglandin's n-6 PUFA s Trans-fatty acids Inhibit Enzymes Enzymes Omega-3 3 PUFAs Alpha-linolenic linolenic acid (ALA) (flax, walnut, canola, soy (only 2-5% 2 converted) Eicosapentaenoic acid (EPA) ( fish oil) Docosahexaenoic acid (DHA) (fish oil) Anti-Inflammatory Prostaglandin's Wang C. AJCN 2006;84:5-17
51 Hibbeln J. AJCN2006;83:1483s
52 EPA & DHA n-3 from fatty fish
53 Secondary Prevention of MI with Fish Oil 30% all cause and coronary mortality w/2 servings fatty fish/week 45% sudden death & 20% all-cause mortality w/850 mg. EPA + DHA Gruppo Italiano. Lancet 1999, 354:447-55
54 N-3 PUFA s from Fish Oil: Benefits Ventricular arrhythmias Thrombosis Inflammation Triglycerides BP Improves endothelial function Rate of growth of atherosclerotic plaque Risk of renal cancer Depression Risk of Alzheimer's disease Lipids Dec;35(12): Nutrition Journal 2005, 4:6
55 Fatty Fish/Fish Oil AHA Recommendations No CHD: Eat 2 servings fatty fish/week With CHD: Fatty fish daily or fish oil supplement daily (1000mg EPA + DHA /day)=3 capsules For TG: 2-4 grams fish oil/day Per 3 oz. serving EPA+DHA (mg) Herring 1807 Salmon 1800 Mackerel 1571 Halibut 1001 Trout 981 Tuna 585 Cod 134
56 Avoid Contaminated Fish (PCB s & Mercury) Best choices: wild salmon, cod, sardines, distilled toxin free fish oil supplements), small tuna or halibut Big fish contain more toxins reslist.php? product id=140 Consumerlabs.com
57 Cell Membrane Cell Structure Trans Fats Replacement of Trans fats with what?
58 Cell Membranes ** Fatty acids
59 Membranes & Fatty Acids (FA) FA s provide the backbone of EVERY cell membrane MOST of the important metabolic chemistry of LIFE occurs in the cell membrane Membrane FA influence membrane function Saturated Fat and MUFA in membranes is constant (body can synthesize) n-3 and n-6 in membranes depends on diet intake (body cannot synthesize) Hulbert AJ. Biol Rev 2005;80:
60 Phospholipid (key part of membranes) Phosphate grp 18:0 18:2 n-6 Chocolate or meat Corn oil
61 Changed Phospholipid w/2 stearic fatty acids or a trans fatty acid Chocolate or meat 18.0 or trans 18:1 Partially hydrogenated fat
62 Membranes & Metabolic Syndrome Insulin resistance related to phospholipid fatty acid s PUFA insulin resistance Trans fats and saturated insulin resistance Membrane FA s may alter membrane proteins related to insulin action Insulin sensitizers (bezafibrate) increase unsaturation of membrane lipids Borkman M. NEJM 1993;328: Vessby B. Diabetol 1994;37:
63 Epidemiological Studies Large studies Nurses Health & Health Professionals Study 2% increase in trans intake=40% increase of DM risk Odegaard A. Nut Rev 2006;64(8):
64 Trans Fats: Actions Increase systemic inflammation Inhibit conversion of ALA to DHA Make membranes more rigid because their structure is straight Interfere with intercellular communication LDL cholesterol oxidation Insulin resistance Mozaffarian D. AJCN 2004;80: Lovejoy J. Diabetes Care 2002;25:1283-8
65 Tarrago-Trani M. JADA 2006;106: Replacing Partially Hydrogenated Fats.....with what? Fully hydrogenated fats Inter-esterified fats Genetically modified oil seeds Tropical oils Partially hydrogenated with low Trans Fats
66 Polyunsaturated Fatty Acid Molecule
67 Fully Hydrogenated Fatty Acid
68 Inter-esterification removes an sn2 PUFA and replaces it with a saturated fatty acid making the fat more stable Fatty Acid Fatty Acid sn2 position Glycerol chain sn1 position Fatty Acid sn3 position
69 Inter-esterification removes an sn2 PUFA and replaces it with a saturated fatty acid making the fat more stable Fatty Acid Fatty Acid sn2 position Glycerol chain sn1 position Fatty Acid sn3 position
70 Sundram K. Nutr & Metab 2007;4:3 Inter-esterified Fat Study 3 test diets--4wks Palm Oil (16:0) Partially hydrogenated soybean oil (trans fat) Inter-esterified fat w/ stearic acid in sn2 position
71 HDL & LDL Changes FBG HDL LDL Trans 9% 8% 7% Inter-esterified 22% 9% 4% Sundram K. Nutr & Metab 2007;4:3
72 Food Labeling Laws Inter-esterified fats only need to be identified if >20% How to identify?
73 Fatty Acid Composition of Traditional & Genetically Engineered Oils n-6 n-3 Tarrago-Trani M. JADA 2006;106:
74 Tropical Oils Traditionally discouraged Tropical oils may LDL and HDL cholesterol Tropical oils provide other protective micronutrients Coconut oil very heat stable, antimicrobial benefits Pedersen J. AsiaPacJClinNutr 2005;14(4): Ebong P. PlantFoods HumNutr 1999;53(3):209-22
75 How else can we damage fats? Refine Oxidize Heat
76 Refining
77 Enriched (refined) Wheat Flour
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79 Refined Sunflower Seed Oil
80 Refining grain/nut/seed oils Mechanical, chemical & heat processes Create a colorless, flavorless oil Destroy/remove micronutrients Minerals--Ca, Mg, Fe, Cu Fat soluble vitamins-- vitamin E, ß-carotene Essential n-3 fatty acids >450º trans fats form >350ºC fatty acids are oxidized (esp. PUFA s)
81 Clinical Conditions association with Oxidized Polyunsaturated Fats Gastrointestinal Eye Skin Heart * Hepatitis * Cataracts * Dermatitis *MI Teeth * Periodontitis Oxidized Fats Reactive Oxygen Species "Free Radicals" Central Nervous System Multiorgan Vessels failure Brain * Atherosclerosis * Cancer * Stroke Joints * Arthritis Lung * Asthma Akoh C. H 2006 Handbook of Functional Lipids p.327 Dobarganes C. CurrOpinClinNutrMetabCare 2003;6:157-63
82 ROS Reactive oxygen species Free Radicals Oxidation Oxidative Stress Anti-oxidants Oxidized Cholesterol Oxidized Fatty Acids Lipid Peroxides
83 Polyunsaturated Fatty Acids Double bonds are unstable H atoms are easily picked off by free radicals Quickly decompose (rancid) in foods When heated very easily oxidized
84 Polyunsaturated Fats: The problem of oxidation! Polyunsaturated fats are recommended because they lower serum cholesterol However, polyunsaturated fats oxidize easily & free radicals are formed esp. when heated Do we need to rethink the recommendation of polyunsaturated fatty acids?? Diniz Y. Nutri 2004;20: Dobarganes C. CurrOpinClinNutrMetabCare 2003;6:157-63
85 Hypertension is related to the degradation of dietary frying oils AJCN 2003:78: subjects Collected & analyzed kitchen cooking oil (olive & sunflower & mixed) samples for oxidation products Serum Phospholipid fatty acids & BP were measured Soriguer F. AmJClinNutr2003;78:
86 Study Results 6.2% of olive oil was oxidized vs. 16.2% of sunflower oil Odds ratio of: BP Insulin resistance Olive oil: oxidized fatty acids.92 Sunflower oil: oxidized fatty acids Soriguer F. AmJClinNutr2003;78: Soriguer F. Eu J Endo2004;150(1):33-39
87 Inherent Stability to oxidation of Frying Fats/Oils (350ºF) Refined Oil Inherent Stability Coconut 0.24 Palm kernel 0.27 Tallow 0.86 Palm 1.3 Less stable Olive 1.5 Lard 1.7 Peanut 3.7 Canola (high Erucic) 4.1 Cottonseed 5.4 Canola (low Erucic) 5.5 Corn 6.2 Sunflower 6.8 Soybean 7.0 Safflower 7.6 Dunford, N.
88 Refined Unrefined Unrefined Refined
89 Food for thought.... oxidation products of LDL cholesterol are derived mainly from polyunsaturated fatty acids... Spiteller G. AnnNYAcadSci 2005;1043:
90 Don t oxidize your fats! Choose the right fat for the right heat! (Saturated fats are very heat tolerant. Next would be monounsaturated fats olive oil or high oleic safflower oil.) Eat natural antioxidants at meals fruits, veges, green tea, red wines, fresh, unrefined, unheated oils or seeds.
91 AGE s Advanced Glycation End Products
92 Advanced Glycation End Products (AGE s) Formed in foods (especially meats & fats) during heat processing (glucose-protein or glucose-lipid interactions)
93 Serum AGE Associations (animal & human studies) Pro-inflammatory compounds (AGE s) C-Reactive Protein Vascular dysfunction Pancreatic islet cell dysfunction Linked to insulin resistance, diabetes, renal complications & Alzheimer's Disease Cai, W. Circulation 2004;110: Huebschmann A. Diabetes Care 2006:29(6):
94 AGE Content of Chicken (ku/90 gm serving) Raw 692 Boiled 1 hr 1011 Microwave 5 min 1372 Roasted 4291 Broiled 15 min 5245 Fried 8 min 6651 Nuggets 7764 Breaded, fried w/skin 8965 Goldberg T JADA 2004;104(8):
95 AGE Recommendations Boil, poach, simmer or stew meats Limit roasting, broiling, grilling & frying Limit roasted nuts have raw instead
96 Final Conclusions: Don t Mess with the fats.. Please! For healthy cells & immune function Choose natural, unrefined, unheated fats A Perfect Balance Antioxidants Anti-microbial and other phytonutrient benefits Fatty acid types (poly, mono, sat) Essential fatty acids (n-3, n-6) Fatty acid positions
97 Fat Conclusions: Choose Most Often (daily!)-a+ Extra virgin olive oil, simmer Unroasted nuts esp. walnuts Avocado Dark chocolate 70%+ cocoa Fatty fish
98 Fat Conclusions: Choose Often A- Unrefined seed & nut oils, including flax, sesame, peanut, etc. limited or no heat Lean meats, eggs grass fed if possible cooked on low heat Non-fat or low-fat milk & dairy products grass fed if possible
99 Fat Conclusions: Choose Occasionally B-C Butter, cheeses Roasted nuts Unrefined oils, including coconut, palm fruit, palm kernel oils, canola, soybean and other grain oils use proper heat temperature
100 Refined oils Fat Conclusions: Choose Infrequently D Meats cooked at high heat Inter-esterified fats Packaged foods with an oil as the fat source (unless you know it is not inter-esterified) Hydrogenated fats Most margarines
101 Fat Conclusions Choose Rarely F Fried foods esp. deep fried Partially Hydrogenated Fats
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109 Gladys Dull Living Well with diabetes since 1924 Diagnosed age 7
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