A user guide to saturated fat

For decades, consuming saturated fat has been considered an unhealthy practice that can lead to heart disease. This is based mostly on the observation in experimental trials that replacing saturated fat with unsaturated fat lowers low-density lipoprotein (LDL) cholesterol, and that LDL cholesterol itself is linked to heart disease.1

But is this harmful reputation warranted?

Recently, better quality research has demonstrated that saturated fat’s effect on heart disease is a lot more complicated. Factors that need to be considered include individual responses to saturated fat intake, food sources of saturated fat, and how the rest of the diet changes when a person increases their saturated fat intake.

Highlighting these points, in a recent article, 19 leading researchers concluded that evidence does not support the general advice to reduce saturated fat intake, and that the topic is far more nuanced than commonly reported.2 A similar article was also published in a major mainstream cardiology journal in 2020.3

All of this is further confused by the fact that most studies combine all sources of saturated fat together. That means saturated fat from a steak is counted the same as saturated fat in cookies, cake or other baked goods, which have a combination of saturated fats, trans fats and sugars.

How can someone make sense of all this? This guide explains what is known about saturated fat, discusses the scientific evidence about its role in health, and explores whether we should be concerned about how much of it we eat.

Disclaimer: The effect of any food or nutrient on human health, such as the development of heart disease, is incredibly difficult to study because heart disease and many other medical conditions develop over decades.

Researchers have therefore had to rely on observational studies or short term trials using surrogate markers of heart disease such as LDL cholesterol. While many guidelines recommend lowering intake of saturated fats, this is largely based on lower quality epidemiology studies. Therefore there is a lot of uncertainty around how much saturated fat people should have in their diet.4

This guide is our attempt at summarizing what is known. It is written for adults who are concerned about saturated fat intake and their health, specifically their risk of heart disease or risk of dying prematurely. Discuss any lifestyle changes with your doctor. Full disclaimer

For even more details and relevant research on connected topics, see our guides to healthy fats, vegetable oils and cholesterol. Also see our list of core scientific studies related to heart disease, cholesterol and saturated fats.


First, what is saturated fat?

A fat (or fatty acid) is classified as saturated or unsaturated based on its molecular structure. Every fatty acid contains a chain of carbon and hydrogen atoms.

fat

Saturated fats don’t have any double bonds between their chain of carbons, allowing more hydrogen atoms to be attached to the carbon atoms. This means they are “saturated” with hydrogens. This structure makes them solid at room temperature.

By contrast, an unsaturated fat contains at least one double bond between its carbon atoms — notice in the illustration fewer hydrogen atoms attached to the carbons with the double bond. This chain is now “unsaturated” with hydrogen atoms and remains liquid or semi-liquid at room temperature.

Learn more in our guide, Healthy fats on a low-carb diet.


Which foods contain saturated fat?

Saturated fats are found in both plant and animal products. Many foods we eat contain a combination of saturated and unsaturated fats. For instance, although olive oil, nuts, and avocados are typically considered unsaturated fat sources, these foods provide some saturated fat as well.

Here are the amounts of saturated fat in some popular low-carb foods:

  • 1 tablespoon (14 grams) coconut oil: 13 grams
  • 3.5 ounces (100 grams) pork belly: 10-12 grams
  • 3.5 ounces (100 grams) ribeye steak: 8-12 grams
  • 1 ounce (30 grams) dark chocolate (70-85% cacao): 7-9 grams
  • 1 tablespoon (14 grams) butter: 7 grams
  • 1 ounce (30 grams) cheese: 5-7 grams
  • 1 tablespoon (14 grams) tallow: 6 grams
  • 1 tablespoon (14 grams) lard: 5 grams
  • 1 ounce (30 grams) macadamia nuts: 4 grams
  • 3.5 ounces (100 grams) chicken drumstick: 4 grams
  • 1 medium avocado (200 grams): 4 grams
  • 1 tablespoon (14 grams) heavy cream: 4 grams
  • 1 tablespoon (14 grams) olive oil: 2 grams

Keep in mind that many other keto-friendly foods contain at least a small amount of saturated fat.


Saturated fat and health risks: the evidence to date

Guidance to reduce saturated fat is based on studies which show 1) a causal link between saturated fat and LDL cholesterol and 2) a causal link between LDL cholesterol and coronary heart disease.5 However, convincing evidence for a direct link between saturated fat and heart disease is lacking

Let’s take a closer look at what systematic reviews of observational studies and controlled studies tell us about saturated fat intake and the risk of coronary heart disease (CHD), other diseases, and death from any cause.

  • A 2009 meta-analysis of 28 cohort studies and 16 randomized controlled trials (RCTs) concluded “The available evidence from cohort and randomised controlled trials is unsatisfactory and unreliable to make judgement about and substantiate the effects of dietary fat on risk of CHD.” 6
  • A 2010 meta-analysis of 21 cohort studies found no association between saturated fat intake on CHD outcomes.7
  • A 2014 systematic review and meta-analysis of observational studies and randomized, controlled trials found that the evidence does not clearly support dietary guidelines that limit intake of saturated fats and replace them with polyunsaturated fats.8
  • A 2015 meta-analysis of 17 observational studies found that saturated fats had no association with heart disease, all-cause mortality, or any other disease.9
  • A 2017 meta-analysis of 7 cohort studies found no significant association between saturated fat intake and CHD death.10

Two systematic reviews of clinical trials — considered the strongest, most reliable evidence — found that replacing saturated fats with unsaturated fats may slightly reduce the risk of heart attack and other cardiovascular events. This effect only applied to men, however, and had no impact on total mortality or death from heart disease.11 Other extensive and similarly high-quality reviews have failed to establish any benefit.12

A 2020 Cochrane review of RCTs likewise showed a reduction in cardiovascular events for lower saturated fat intake, but this effect was modest. This study also found no difference on cardiovascular death or all-cause death.13

Recently, Mente and colleagues published a large observational study that examined dietary patterns and lipid data from over 100,000 people in 18 countries around the world. Called the PURE study, its data analysis found that higher saturated fat intake was associated with beneficial effects on a number of heart disease risk factors, including higher HDL levels, lower triglyceride levels, and – what seemed to be the strongest predictor of CHD risk — a decreased ratio of ApoB (found in LDL particles) to Apo A (found in HDL particles). 14

What’s more, although eating a lot of saturated fat was linked to higher LDL cholesterol levels in this study, these elevated values didn’t reliably predict future heart attack events or deaths. Although Like all observational studies, this one cannot show cause-effect relationships, it does indicate that eating less saturated fat (and consequently having lower LDL cholesterol) was not linked to a decrease in the risk of cardiovascular events.

Additional follow up seven years later in the PURE study revealed no association between saturated fat intake and heart disease but did show saturated fat was linked to decreased risk for all-cause mortality and stroke.15 However, this observational study had many limitations.16

As we discuss below, the food or nutrient that replaces saturated fat is critical. Observational trials like these make it difficult to account for the nutrient quality of the food eaten and the food replaced. So the conclusions of PURE, like many large-scale observational studies should be taken with a pinch of salt.

In addition, as we noted in the introduction, recent data has shown us that we need to be much more nuanced when considering the effect of saturated fat on heart disease. We’ll run through the most important nuances next.

Replacing nutrients

The food or nutrient which replaces saturated fat determines whether the switch might be beneficial, neutral or even harmful.17

If you think about the studies which reduced saturated fat intake – what did they replace it with? Carbohydrates (such as refined grains), unsaturated fats, or protein? This really matters.

It’s now clearer that replacing saturated fat with refined carbohydrates does not improve heart disease risk, whereas replacing saturated fat with polyunsaturated fat might.18 This nuance could explain some of the conflicting results from meta-analyses.

Clearly, there’s no point recommending a person reduce their saturated fat intake if they just end up replacing it with sugary cereals and white bread.

Food sources of saturated fat

A variety of foods are rich sources of saturated fat, including red meat, butter, cheese and coconut oil. Most studies combine all sources of saturated fat together. That means saturated fat in cream is counted the same as saturated fat in yogurt or cheese.

Many foods, including meat and dairy, contain other nutrients and non-nutrient components which can influence heart disease risk, such as probiotics, magnesium, potassium and vitamin D. They also contain other types of fats.

For instance, most beef products have nearly equal amounts of saturated and monounsaturated fats. Therefore, even though meat, yogurt and butter are relatively high in saturated fat, their effects on heart disease may be divergent due to these “confounding” factors.

Researchers report that myristic acid (a saturated fat found in many foods like coconut oil, palm kernel oil, butter, cream, cheese and meat) has a greater effect on both LDL and HDL cholesterol levels than most other saturated fats.19

Likewise, there are a number of controlled studies showing that cheese and butter have very different effects on LDL-cholesterol.20 And dairy fat including yogurt and cheese has been shown to be protective against heart disease in observational studies.21

As leading scientists claimed in their 2020 review paper, we should discuss health implications of specific foods rather than lumping them all together as “saturated fats.”22

Overall diet

As described above, the whole diet is important. Most people eating a high-carb diet get their carbs from refined grains and sugars, which themselves may be harmful to health. If a low-carb (but high-saturated fat) diet helps them to omit the harmful types of carbs and consume more non-starchy vegetables, then this could be a net health benefit.

Processed foods that are manufactured to replace naturally occurring saturated fats with refined carbs, sugars, and artificial flavors and fillers are rarely a healthier choice.

Most of the studies on high-saturated fat diets and human health are done against a background of high carb intake. Lipid (fat) metabolism changes a lot when a person cuts carbs, and it is possible that the effect of saturated fat on cholesterol differs in potentially important ways when the background diet is low in carbs.23

Interpersonal differences

Dietary recommendations assume that all people respond the same way to nutrients. In the case of saturated fat, there is clear evidence that there are large differences in how people respond to changing the saturated fat content of the diet.24 Just as the studies show different responses among individuals, so does real life clinical experience.25


What do foods’ saturated fat levels mean for the typical low-carber?

Someone following a typical low-carb or keto diet might consume 30 or more grams of saturated fat most days, which is significantly above the levels currently advised by the US Dietary Guidelines for Americans (about 22 grams a day) and American Heart Association (13 grams).

Is that a problem? We don’t know for sure, but for many people, probably not. In general, the effect of one nutrient on any outcome is very small.26

It’s also important to consider all other factors which might influence a person’s risk of heart disease, and how an increase in saturated fat in the context of a low-carb diet might affect them.

For example, if by eating a low-carb diet (which happens to be high in saturated fat) a person is able to lose 10 lbs (4.5 kilos) of weight, improve their blood sugars and lower their blood pressure, a small rise in LDL cholesterol is unlikely to result in a net increase in heart disease risk.

In fact, weight loss intervention studies that have used low-carb, high-fat diets (including saturated fat) have shown on average no significant change in LDL cholesterol. Instead, they have shown an overall reduction in heart disease risk.27

In summary, for many or even most people, increasing saturated fat intake in the context of a healthful low-carbohydrate diet will have a negligible impact on their heart disease risk.

Videos about saturated fat

Should saturated fat ever be restricted?

Despite evidence that saturated fat itself is not harmful for most people, in some instances limiting it might be beneficial. For instance, results from a recent study suggest that in patients with cardiovascular disease, eating a lot of saturated fat might lead to higher concentrations of small and medium LDL particles — changes that could promote disease progression.28 This study was only three weeks long, so it’s unknown if this potentially detrimental pattern persisted over time.

An earlier study found a beneficial increase in LDL particle size and other improvements in patients with cardiovascular disease who followed a high-saturated-fat, starch-free diet.29 In addition, low-carb diets that were naturally higher in saturated fats showed overall improvement in lipid parameters compared to low-fat diets.30

Importantly, some experts in the field of lipidology and cardiology disagree about whether elevated LDL cholesterol and particle concentrations increase the risk of heart disease when other biomarkers related to heart health, such as inflammation and metabolic health, are within normal limits. This comes in part from studies showing LDL has less prediction for CAD with normal HDL and TG:HDL ratios.31

Although this is not well accepted as medical consensus, it is an emerging area of interest that will hopefully have stronger data one way or the other soon.


Should you be worried about saturated fat?

As discussed above, there is little high-quality evidence to indicate saturated fats are a concern for most people, especially those following a low-carb diet. Overall, the evidence both for and against saturated fats is weak and inconsistent, and individual responses vary greatly.

What’s more, saturated fat research has typically been conducted in people following all types of diets, mostly high in carbohydrates. There is emerging evidence that consuming a lot of fat on a carbohydrate-restricted diet may be even less of a concern and could lead to overall reductions in cardiovascular risk.32

Many low-carb whole foods that provide valuable nutrients and help you feel full — such as meat and full-fat dairy products — are also rich in saturated fat. For people with metabolic conditions that can be improved with a low-carb diet, the benefits of these foods may be more important than a risk that may or may not exist.

On the other hand, the relationship between saturated fat intake and elevated LDL cholesterol and particle levels seems to vary from person to person, especially for those on a low-carb diet. If your own LDL values increase significantly after adopting a keto or low-carb diet, you may be able to help lower them by cutting back a bit on saturated fat and eating more nuts, olive oil, avocados, and fatty fish.33

Aiming for a saturated intake below 10% of calories, as most health authorities recommend, can be a difficult task that may require detailed tracking of macronutrients, doesn’t necessarily encourage eating naturally, and can diminish pleasure at mealtimes. Limiting fat may also decrease meal satiety and increase hunger and cravings between meals.

Conclusion

An across-the-board recommendation to limit your consumption of saturated fat to a small percentage of daily calories isn’t based on sound scientific evidence. In general, focusing on your whole diet diet is a better health strategy than limiting a single nutrient like saturated fat.

/ Franziska Spritzler, RD

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  1. World Health Organization 2016: Effects of saturated fatty acids on serum lipids and lipoproteins:a systematic review and regression analysis [overview article; ungraded]

    Even weaker evidence suggested those who ate more saturated fat had poorer health outcomes.

    BMJ 2018: Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance [overview article; ungraded]

    Much of the concern with saturated fat can be traced back to the diet-heart hypothesis first proposed in the 1950s by American scientist Ancel Keys. He promoted the theory that dietary fat raises cholesterol levels, thereby increasing the risk of heart disease. After traveling to Europe and conducting informal surveys in different populations there between 1951 and 1952, Keys published a paper suggesting that as a country’s intake of fat increased, its rates of coronary heart disease (CHD) and related deaths likewise increased.

    American Journal of Public Health and the Nation’s Health 1953: Prediction and possible prevention of coronary disease [observational research; very weak evidence]

    Importantly, this was based entirely on observational data, which is considered weak evidence unless correlations are strong and have been repeatedly duplicated in other studies. Even then, this type of research can only show that a behavior and an outcome are associated but not that the behavior causes the outcome.

    Subsequent studies showed no such correlation, further calling into question the validity of his evidence.

    New York State Journal of Medicine 1957: Fat in the diet and mortality from heart disease: a methodological note [observational research; very weak evidence]

    Open Heart 2015: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis [strong evidence]

    Since that time, the focus has turned to more recent studies that correlate saturated fat and LDL.

  2. British Medical Journal 2019: WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach? [overview article; ungraded evidence]

  3. Journal of the American College of Cardiology 2020: Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC State-of -the-Art Review [overview article; ungraded]

  4. Nutrition Journal 2016: The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials [strong evidence]

    BMJ Evidence-Based Medicine 2019: Fat or fiction: the diet-heart hypothesis [overview article; ungraded evidence]

    British Medical Journal 2019: WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach? [overview article; ungraded evidence]

  5. American Journal of cardiology 1984: Lipid research clinics coronary primary prevention trial: Results and implications [randomized trial; moderate evidence]

  6. Annals Nutrition & Metabolism 2009: Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials [moderate evidence]

  7. The American Journal of Clinical Nutrition 2010: Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease [observational studies; weak evidence]

  8. Annals of Internal Medicine 2014: Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis[weak evidence]

  9. British Medical Journal 2015: Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies [observational studies; weak evidence]

  10. British journal of sports medicine 2017: Evidence from prospective cohort studies does not support current dietary fat guidelines: a systematic review and meta-analysis [observational studies; weak evidence]

  11. These two studies showed a slight benefit to replacing saturated fatty acids with PUFAs
    Public Library of Science medicine 2010: Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: A systematic review and meta-analysis of randomized controlled trials [strong evidence]
    The Cochrane database of systematic reviews 2012: Reduced or modified dietary fat for preventing cardiovascular disease [systematic review of randomized trials; strong evidence]

  12. British Medical Journal 2013: Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression[strong evidence]
    British Medical Journal 2016: Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) [systematic review of randomized trials; strong evidence]

    Nutrition Journal 2017: The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials[strong evidence]

  13. Interestingly, of the 12 studies analyzed, 9 showed no significant difference, whereas 3 did show a difference, and the pooled analysis showed a small difference. In addition, there was no documentation of the types of saturated fats consumed.

    Cochrane Database of Systemic Reviews 2020: Reduction in saturated fat intake for cardiovascular disease [systematic review of randomized trials; strong evidence]

  14. The Lancet Diabetes and Endocrinology 2017: Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study [observational study; very weak evidence]

  15. The Lancet 2017: Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study [observational study; very weak evidence]

  16. These limitations include grouping all carbohydrates together. In just the same way as different food sources and types of fats have different effects on health, so do carbohydrates. PURE also did not take into account trans fat intakes, which is important because industrial trans fats are extremely atherogenic. The study also did not consider the effect of replacing saturated fat with polyunsaturated fat.

  17. Journal of the American College of Cardiology 2015: Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: A prospective cohort study [nutritional epidemiology study; very weak evidence]

  18. At least in the setting of a high-carb diet, studies suggest this may be the case:
    PLOS Medicine 2016: Effects of saturated fat, polyunsaturated fat, monounsaturated fat, and carbohydrate on glucose-insulin homeostasis: A systematic review and meta-analysis of randomised controlled feeding trials [systematic review of randomized trials; strong evidence]

  19. The American Journal of Clinical Nutrition 1997: Individual fatty acid effects on plasma lipids and lipoproteins: human studies [overview article; ungraded]
    Journal of Lipid Research 1997: Effects of medium chain fatty acids (MCFA), myristic acid, and oleic acid on serum lipoproteins in healthy subjects [non-randomized trial; weak evidence]

  20. American Journal of Clinical Nutrition 2011: Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content [randomized trial; moderate evidence]

    European Journal of Clinical Nutrition 2005: Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects [randomized trial; moderate evidence]

  21. Advances in Nutrition 2019: Effects of full-fat and fermented dairy products on cardiometabolic disease: Food is more than the sum of its parts [nutritional epidemiology study; very weak evidence]

  22. Journal of the American College of Cardiology 2020: Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC State-of -the-Art Review [overview article; ungraded]

  23. American Journal of Clinical Nutrition 2006: Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia [randomized trial; moderate evidence]

  24. Proceedings of the Nutrition Society 2019: Determination of variability in serum low density lipoprotein cholesterol response to the replacement of dietary saturated fat with unsaturated fat, in the Reading, Imperial, Surrey Saturated fat Cholesterol Intervention (‘RISSCI’) project [nutritional epidemiology study; very weak evidence]

    American Journal of Clinical Nutrition 2010: Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: The RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) Trial [randomized trial; moderate evidence]

    American Journal of Clinical Nutrition 2015: Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, e-selectin, and blood pressure: Results from the Randomized, Controlled Dietary Intervention and VAScular Function (DIVAS) Study [randomized trial; moderate evidence]

  25. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

  26. Cochrane Reviews 2015: Reduction in saturated fat intake for cardiovascular disease [systematic review of randomized trials; strong evidence]

  27. Nutritional Reviews 2019: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis. [systematic review of randomized trials; strong evidence]
    Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study [non-controlled study; weak evidence]

  28. Of note, these subjects were eating a baseline diet comprised of 55% carbohydrates, and then were changed to a diet of 39% carbohydrates for 3 weeks:

    Public Library of Science one 2017: Effects of a very high saturated fat diet on LDL particles in adults with atherogenic dyslipidemia: A randomized controlled trial [moderate evidence]

  29. Mayo Clinic Proceedings 2003: Effect of a high saturated fat and no-starch diet on serum lipid subfractions in patients with documented atherosclerotic cardiovascular disease [non-randomized trial; weak evidence]

  30. American Journal of Epidemiology 2012: Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials [systematic review of randomized trials; strong evidence]
    Lipids 2009: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low-fat diet[randomized trial; moderate evidence]

  31. Canadian Journal of cardiology 1998: Cholesterol and lipids in the risk of coronary artery disease–the Framingham Heart Study. [observational study; weak evidence]

    Atherosclerosis Thrombosis and Vascular Biology 1997: Relation of high TG-low HDL cholesterol and LDL cholesterol to the incidence of ischemic heart disease. An 8-year follow-up in the Copenhagen Male Study. [non-controlled study; weak evidence]

  32. Lipids 2010: Limited effect of dietary saturated fat on plasma saturated fat in the context of a low carbohydrate diet [randomized trial; moderate evidence]

    Public Library of Science One 2014: Effects of step-wise increases in dietary carbohydrate on circulating saturated fatty acids and palmitoleic acid in adults with metabolic syndrome [non-randomized trial; weak evidence]

  33. This is based on consistent clinical experience of low-carb practitioners. [weak evidence]