Ten years ago, my mother had a triple bypass and was encouraged to switch to olive oil. Olive oil, she was told, had a positive impact on cholesterol. But, she should be careful not to eat too much of it.

When we questioned that, the response was "it's still fat."

That didn't make sense to me. Sure, it was fat--but, it was apparently a fat that had a positive impact on cholesterol (and, thus, artery blockage). So, what were its downsides? What was the negative effect?

We never got an answer, and it turned out not to be urgent since my mother's cardiologist pushed her toward cholesterol medication. I didn't want her to take it after reading the potential side effects, but he and her regular doctor convinced her that there was no way to lower your cholesterol as much as she needed to with just dietary changes.

I was skeptical about that whole "no other way" thing. In law school, I'd lowered my cholesterol by nearly 100 points in six months just but cutting way back on fat. I didn't know anything, then, about fiber or good fats or the various foods that helped cholesterol. I just cut my fat intake to the bone and my cholesterol dropped like a stone.

After a triple bypass, though, she was understandably skittish about experimenting and started the medication.

I didn't have much occasion to think about it again until a couple of years ago, when my own cholesterol started climbing into the danger zone. Naturally, the go-to solution was to start me on medication, but I still hated that list of side effects and I had that early experience to tell me that the "no other way" argument probably didn't hold water.

I did lower my LDL by 69 points in four months, but that's another story for another day. The story I came here to tell is about how, after years of questioning doctors and a good bit of time invested searching the internet in vain, I got a straight answer about what "it's still fat" means.  And, it's not something you should fear.

There are, apparently, two concerns about eating too much "good fat" when you have cholesterol issues:

  • Fat has a lot of calories. That's not likely to come as a surprise to anyone, but for some reason instead of saying, "These fats are good, but they have a lot of calories, so watch your total intake," the medical profession has decided to shorthand to "it's still fat". Which, as I may have mentioned, is meaningless and unhelpful. So, the upshot is that if you eat a lot of good fats, your recommended daily caloric intake is still your recommended daily caloric intake. For this, the medical profession has had us all uncertain about good fats for years.
  • If the percentage of unsaturated fat in your diet gets too high, your body can't process it normally and it starts to act like bad fat. This, obviously, is a more serious concern...until you consider what "too high" means. Many studies over the past several years have shown that getting about 1/3 of your calories from fats is heart healthy, so long as your saturated fat intake is very low and those fats are coming from sources like olives, nuts and fish. 

In short, "it's still fat" seems to mean that if you eat too many calories because good fats are dense with calories, you'll gain weight (probably not news) and that it's important to balance your caloric intake among fats, carbohydrates and protein (which, if it's news, is something your doctor should have told you anyway).

It took me exactly ten years to sort that out, so I'm hoping this post will save you some time.