“Steve Blake presents accurate, understandable information.”
Understanding Fats and Oils:
A Scientific Guide to their Health EffectsDr. Steve Blake, ScD
May 2014
“I know your book and it is very good.”
Dr Frits Kamp, Biophysik, DZNE - Adolf Butenandt-Institute, Biochemistry, Ludwig-Maximilians University, Muenchen, Germany.
$9.95 to download the entire 268 page PDF book. Your comments, suggestions, endorsements, or criticisms are welcome.
Please see below for the Introduction, a detailed table of contents and a list of charts, figures, and graphs.
Introduction
You can make dietary choices that will promote vigorous good health and a slim, fit body that is free of disease. Your choices of what to eat are the keys to excellent health. This book is designed to empower you with the knowledge needed to choose wisely from the tempting array of food that surrounds us.
While every aspect of our diet is important, this book focuses on how you can get the healthy fats and oils you need to maintain good health—and how you can avoid the unhealthy fats and oils that contribute to disease. Excellent scientific studies have shown the power of a healthy fat balance to keep us disease-free. A healthy balance of fats and oils can greatly reduce our risk of heart disease, obesity, arthritis, diabetes, strokes, and breast cancer.
Whole, intact beans, nuts, and seeds are all bursting with healthful nutrients. These whole beans, nuts, and seeds do not promote obesity or heart disease. Only in the last century have these beans, nuts, and seeds been routinely plundered for their oils. Oils squeezed out of these healthful whole foods are one of the leading causes of disease worldwide.
Chips and fries, while undeniably tasty, are loaded with unhealthful fats. Liquid oils and solid fats have no fiber, so we do not get the message from our stomachs to stop eating. Like white flour, these oils have been depleted of their healthful vitamins and minerals—they have been transformed into “empty calorie” junk food.
In the Garden of Eden, any food choice was healthful. In a modern restaurant or supermarket, many of the food choices can be perilous to your health. Our food industry, now taking in well over two trillion dollars per year in the United States alone, has altered our food choices. Our food industry has many priorities other than the health of its customers. In many cases, food marketing is decided in corporate boardrooms based upon profit. Unfortunately, the most profitable foods are often the least healthy. Attempts by our government to make our food more healthful are frequently thwarted by well-funded lobbies.
We now know that food choices contribute to the widespread chronic diseases of today, and we also know that food choices can prevent and even reverse them. Your diet is powerful. We know more than ever about the artery-clogging fats in milk and meat—and the contaminants that modern industry introduces into the animals they come from. Modern medicine, for all its heroic efforts, has not tackled the primary cause of so many chronic diseases: diet.
Americans spend the most money per person on health and yet two-thirds of us are overweight. The wars on cancer and heart disease are being lost. Half of Americans are on prescription medication. Over 100 million Americans have elevated blood cholesterol levels. Even our youth are experiencing “adult onset” diabetes and high obesity rates. All of these problems can be solved with a change in food choices. In our much-publicized health care debate, we have largely ignored the fact that a healthy diet with the right balance of fats and oils can prevent most chronic diseases. A change in diet is the only way to make our health care system viable.
Who do we trust for health and nutrition information? Real nutrition science has been buried under an avalanche of bought science and endless uninformed opinions. Even the best researchers can be biased when it comes to the foods that their mother served. So many popular books push the author’s personal diet without a true understanding of the health effects of fats and oils. I have based the information in this book on hundreds of clinical and intervention trials that look at the relationship between diet and health. I have carefully screened these studies for funding bias, since studies funded by industries are consistent in the support of their own products.
My own study of nutritional biochemistry is based upon the analysis of diets for nutrients. I have developed software to analyze the balance and amount of the important fats and oils in daily diets. Dietary analysis is a convenient and scientific way to show which foods contribute, for example, an excess of saturated fats to a daily diet. I will show you the healthy and harmful components of fats and oils that are revealed by these analytical techniques.
You can become healthier and less dependent on insurance and doctors by choosing healthy food. You can choose to eat less saturated fat and less junk food. My goal is to help you make these choices.
I look forward to your comments and suggestions,
Steve Blake, June, 2012
A special thanks to Dr. William Harris, M.D. for his generous support of this book project.Table of Contents—Complete
INTRODUCTION ..... 2
TABLE OF CONTENTS—COMPLETE ... 5
LIST OF FIGURES ......... 12
CHAPTER 1: INTRODUCTION TO DIETARY FATS AND HEALTH... 15
UNDERSTANDING DIETARY FATS AND OILS .... 15
SATURATED FACTS . 16
MONOUNSATURATED FACTS ..... 17
JUST THE ESSENTIALS ...... 17
TRANS FATTY ACIDS, THE BREAD AND BUTTER OF DISEASE .... 18
THREE KINDS OF FAT ...... 19
WHAT HAPPENED TO OUR FATS AND OILS? .. 19
COMPARING THE OILS IN FOOD ......... 20
COMPARING FATS AND OILS ...... 21
DIGESTION AND TRANSPORT OF FOOD FATS ........ 22
HOW EPA IS MADE IN THE BODY ....... 22
EICOSANOIDS—CELLULAR ACTIVISTS ........ 24
PUTTING IT ALL TOGETHER ....... 24
CHAPTER 2: SATURATED FATS, THE HARD FACTS . 26
HOW SATURATED FATS ARE USED IN OUR BODIES ......... 26
How excess saturated fats increase blood cholesterol ..... 26
Saturated fats and disease .. 27
Saturated fats and diabetes . 28
SATURATED FATS AND BLOOD CHOLESTEROL ....... 28
HOW MUCH SATURATED FAT IS TOO MUCH? ......... 29
SATURATED FATS MADE IN THE BODY ......... 30
SATURATED FATS IN FOOD ........ 31
SATURATED FATS IN DIETS ........ 35
STRUCTURE OF SATURATED FATS ....... 42
Length of saturated fatty acids ..... 43
The acid delta end and the methyl omega end ........ 43
REFERENCES: ......... 45
CHAPTER 3: MONOUNSATURATED FATS . 47
OLEIC ACID ... 47
DOUBLE BONDS ...... 49
OMEGA-9 FATTY ACID ..... 50
DOUBLE BONDS AND OXIDATION ....... 51
CIS AND TRANS CONFIGURATIONS ..... 52
BIOLOGICAL IMPORTANCE OF CIS AND TRANS BONDS ... 53
COMMON MONOUNSATURATED FATTY ACIDS ....... 54
SHORTHAND NOTATION ... 54
OTHER MONOUNSATURATED FATTY ACIDS .. 55
COMMON AND UNCOMMON MONOUNSATURATED FATTY ACIDS ...... 57
REFERENCES: ......... 58
CHAPTER 4: ESSENTIAL FATS .... 59
THE MEANING OF ESSENTIAL .... 59
ACTIVATION OF ESSENTIAL FATTY ACIDS .... 59
ALA AND LA ARE NEEDED INSIDE OUR BODIES ... 59
OTHER LONG-CHAIN POLYUNSATURATED FATTY ACIDS . 61
LINOLEIC ACID, THE EASY ESSENTIAL FATTY ACID ........ 61
Food sources of linoleic acid ....... 62
Linoleic acid in common diets ..... 64
The structure of linoleic acid ....... 65
ALPHA-LINOLENIC ACID, THE HARD-TO-GET ESSENTIAL FATTY ACID....... 66
Food sources of ALA .. 66
ALA in oils and fats .... 67
ALA in some common diets . 68
STRUCTURE OF ALA ....... 70
WHY ALA AND LA CANNOT BE MADE IN THE BODY ..... 71
REFERENCES: ......... 73
CHAPTER 5: TRANS FATTY ACIDS, THE BREAD AND BUTTER OF DISEASE ......... 75
INTRODUCTION ...... 75
DIETARY SOURCES OF TRANS FATTY ACIDS . 75
ALTERNATIVES TO PARTIALLY HYDROGENATED OILS .... 77
Frying ....... 77
Snack foods ....... 77
Bakery products ......... 78
THE RISKS OF REDUCING TRANS FATS ......... 78
Palm and other tropical oils ........ 78
Animal fats to replace hydrogenated oils ....... 78
Designer oils ..... 79
CHOOSING FOOD LOW IN TRANS FATTY ACIDS ...... 79
Worldwide variation in trans fatty acid intake ........ 79
Trans fats in food in America ....... 80
Labeling deceit .. 81
ABSORPTION AND METABOLISM OF TRANS FATTY ACIDS ........ 81
HEART DISEASE AND TRANS FATTY ACIDS ... 82
TRANS FATS AND BLOOD LIPIDS ......... 82
DIABETES AND TRANS FATTY ACIDS ... 83
TRANS FATTY ACIDS IN INFANTS AND CHILDREN .. 84
TRANS FATTY ACIDS FROM DAIRY PRODUCTS AND BEEF ......... 84
STRUCTURE OF TRANS FATTY ACIDS .. 85
CONJUGATED LINOLEIC ACID .... 90
REFERENCES: ......... 94
CHAPTER 6: THREE KINDS OF FAT, TRIGLYCERIDES, PHOSPHOLIPIDS, AND CHOLESTEROL .... 97
TRIGLYCERIDES IN FOOD, IN FAT CELLS, AND IN BLOOD ......... 97
Uses of triglycerides in the body .. 97
The shape of triglycerides ... 98
Digestion of triglycerides .. 101
HEALTH EFFECTS OF EXCESS TRIGLYCERIDES .... 102
PHOSPHOLIPIDS .... 102
Phosphatidlinositol .. 105
Phosphatidylserine .. 106
Phosphatidylcholine ......... 106
Phosphatidylethanolamine ........ 106
SPHINGOLIPIDS..... 107
CHOLESTEROL AND OTHER STEROLS ........ 107
Plant sterols ..... 110
REFERENCES: ........110
CHAPTER 7: WHAT HAPPENED TO OUR FATS AND OILS? ..... 111
THE USES OF FATS AND OILS .... 111
HOW OIL USED TO BE MADE ..... 111
MODERN OIL PROCESSING .......112
Changing the seeds ... 112
Cold pressed oils ....... 113
Preparing the seeds, beans, or grains for processing ..... 114
Expeller pressed oils . 114
Hexane extraction of oils ... 114
The loss of lecithin: degumming . 116
Caustic refining ......... 117
Bleaching of edible oils ...... 118
Dewaxing ......... 119
Hydrogenation . 119
Winterization ... 121
Deodorization or physical refining ..... 121
Vitamin E lost in oil processing . 122
Chemicals leaching into oils from bottles .... 122
FAKE FATS ... 123
Interesterification ..... 123
Structured Lipids ...... 124
DAG diacylglycerol .. 124
Fat mimetics and fat substitutes . 124
REFERENCES: ....... 125
CHAPTER 8: COMPARING THE OILS IN FOOD ....... 127
FATS IN FOOD ....... 127
NUTS AND SEEDS . 127
Oleic acid in nuts and seeds ....... 127
Saturated fats in nuts and seeds . 128
Vitamin E in nuts and seeds ....... 129
Alpha-linolenic acid in nuts and seeds ........ 130
Linoleic acid in nuts and seeds .. 131
FATTY ACIDS IN COMMONLY SELECTED FOOD CHOICES ........ 132
Total fat in food ........ 133
Saturated fat in food . 134
Cholesterol in common food selections........ 135
Trans fats in selected foods ........ 136
Monounsaturated fats in selected food ........ 137
Linoleic acid in selected food sources ......... 138
Alpha-linolenic acid in selected food sources ....... 139
EPA and DHA in selected food sources ....... 140
Vitamin E in selected food sources ...... 141
REFERENCES: ....... 142
CHAPTER 9: COMPARING FATS AND OILS ...... 143
WHAT MAKES AN OIL OR FAT HEALTHY? ... 143
A nice balance of the essential fatty acids ... 143
Oils need the protection of vitamin E .. 143
Avoid trans fats ........ 143
Saturated fats .. 144
Organic oils are healthier . 145
Processing can ruin a good oil .. 145
COMPARING FATS AND OILS .... 145
Butter ...... 145
Canola oil ........ 146
Cocoa butter .... 148
Coconut oil ...... 149
Corn oil .. 151
Cottonseed oil . 152
Flax oil ... 152
Lard ........ 153
Olive oil .. 153
Palm oil .. 154
Peanut oil ........ 155
Safflower oil .... 156
Sesame oil ....... 156
Soybean oil ...... 157
Sunflower oil ... 157
Vegetable shortening ......... 158
GENETIC ALTERATION OF OIL SEEDS ......... 159
Mutagenic breeding . 159
Genetic engineering . 160
REFERENCES: ....... 161
CHAPTER 10: COMPARING LESS COMMON OILS.. 162
UNCOMMON OILS . 162
Almond oil ....... 162
Amaranth oil ... 162
Apricot kernel oil ..... 162
Avocado oil ...... 163
Black currant oil ...... 163
Borage oil ........ 164
Candlenut oil ... 164
Caraway oil ..... 165
Cashew oil ....... 165
Cherry oil ........ 165
Chia oil ... 166
Echium oil ....... 166
Evening Primrose oil ........ 167
Gold of Pleasure oil . 167
Grapeseed oil .. 168
Hazelnut oil ..... 169
Hemp oil . 169
Honesty seed oil ....... 170
Macadamia nut oil ... 170
Mango oil ........ 170
Marigold oil .... 170
Nigella oil ........ 171
Niger oil . 171
Nutmeg butter .. 172
Oat oil .... 172
Passionfruit seed oil . 173
Perilla seed oil ......... 173
Pistachio nut oil ....... 173
Poppy seed oil . 174
Purslane seed oil ...... 174
Rice bran oil .... 174
Shea butter ...... 175
Walnut oil ........ 175
Wheatgerm oil . 175
REFERENCES: ....... 175
CHAPTER 11: DIGESTION AND TRANSPORT OF FOOD FATS ......... 177
DIGESTION OF FATS AND OILS . 177
Digestion of fats in the mouth and stomach . 177
Bile emulsifies fat ..... 178
Digestion of fats and oils in the intestine ..... 179
ABSORPTION OF LIPIDS .. 180
Micelles .. 180
Chylomicrons .. 180
LIPOPROTEINS: TRANSPORT OF LIPIDS THROUGH THE BLOODSTREAM .... 181
Chylomicron transport ...... 182
Very low density lipoproteins ..... 182
Vitamin E and lipoproteins ......... 182
LDL: Low density lipoproteins .. 183
High density lipoproteins .. 184
Measuring blood LDL and HDL levels ........ 185
Measuring total serum cholesterol ..... 185
Ratios of lipoproteins ........ 186
METABOLISM OF FATS AND OILS ...... 186
REFERENCES: ....... 188
CHAPTER 12: EICOSANOID PRECURSORS: HOW EPA IS MADE ... 189
HOW THE ESSENTIAL FATTY ACIDS ARE ELONGATED AND DESATURATED ........ 189
Can our bodies make enough EPA or do we need to eat fish or fish oils? ........ 190
Dietary guidelines and intakes for EPA and ALA . 191
COMPETITION FOR THE DESATURATION ENZYMES ...... 192
The ratio of LA to ALA ...... 193
HORMONES AFFECT DESATURATION ......... 195
NUTRITION AND DESATURATION ...... 197
Other factors that affect desaturation . 198
CONVERSION OF ALA TO EPA, STEP BY STEP .... 198
BLOOD LEVELS OF EPA AND ARACHIDONIC ACID ....... 201
REFERENCES: ....... 202
CHAPTER 13: EICOSANOIDS—CELLULAR ACTIVISTS . 205
EICOSANOID PRECURSORS ...... 205
EICOSANOIDS ....... 205
EICOSANOIDS IN INFLAMMATION ..... 206
THE EICOSANOIDS ......... 207
THROMBOXANES .. 207
The Balance between series 2 and series 3 thromboxanes ..... 208
The biosynthesis of thromboxane ........ 209
LEUKOTRIENES .... 210
Biosynthesis of Leukotrienes ...... 210
Asthma and leukotrienes ... 210
Inflammation and leukotrienes ... 211
PROSTACYCLINS ... 212
Blood clotting and prostacyclins ......... 213
Kidneys and prostacyclin .. 213
Aspirin, Prostacyclin, and Thromboxane ..... 214
PROSTAGLANDINS ......... 216
Biosynthesis of prostaglandins ... 217
Dietary fatty acids and prostaglandins ........ 218
Regulation of prostaglandins ..... 218
PROSTAGLANDIN E, PGE ....... 219
Inflammation and PGE ..... 220
Blood clotting and PGE .... 220
Immune response and PGE ........ 220
Lungs and PGE ........ 221
Digestion and PGE .. 221
Other effects of PGE ......... 221
PROSTAGLANDIN D, PGD ...... 223
PROSTAGLANDIN F, PGF2Α ..... 223
PROSTAGLANDIN J, PGJ ......... 223
PGJ and tumors ....... 223
REFERENCES: ....... 224
CHAPTER 14: HEART DISEASE AND DIETARY FATS ....... 226
INTRODUCTION .... 226
HEART ATTACK RISK FACTORS ......... 226
DIETARY SATURATED FAT AND HEART DISEASE .. 227
DIETARY TRANS FAT AND HEART DISEASE . 230
DIETARY CHOLESTEROL AND HEART DISEASE .... 233
THE EXTENT OF THE PROBLEM ........ 234
HOW HEART ATTACKS HAPPEN ......... 234
TO AVOID A HEART ATTACK ..... 234
ACTIVITY AND FITNESS . 236
STRESS REDUCTION AND RELAXATION ..... 237
REFERENCES: ....... 237List of Figures
Figure 1
How Excess Saturated Fats Raise Blood Cholesterol ... 27
Figure 2
The saturated fatty acid content of one serving of various foods ... 32
Figure 3
The amount and variation of saturated fats in some common nuts and seeds .. 33
Figure 4
A comparative graph of saturated fats in common livestock products .... 34
Figure 5
The amount of saturated fats in two tablespoons of common fats and oils ...... 35
Figure 6
Graph of saturated fat in an Atkin's diet...... 36
Figure 7
Graph of saturated fat in a typical American diet ......... 37
Figure 8
Graph of saturated fat in a Mediterranean diet .... 38
Figure 9
Graph of saturated fat in a transitional vegetarian diet . 39
Figure 10
Graph of saturated fat in a whole food vegan diet ........ 40
Figure 11 Graph of saturated fat in a raw food vegan diet ... 41
Figure 12
Graph of saturated fat in a diet for preventing heart disease . 42
Figure 13
Chart of saturated fatty acids .... 43
Figure 14
The structure of a saturated fatty acid ......... 44
Figure 15
Structures of lauric, myristic, palmitic, and stearic acids ...... 45
Figure 16
Graph of oleic acid in nuts and seeds . 47
Figure 17
Graph of oleic acid in common oils ... 48
Figure 18
The structure of unsaturated bonds .... 49
Figure 19
The structures of oleic acid and stearic acid showing a double bond ...... 50
Figure 20
3-D structure drawings of stearic acid (left) and oleic acid (right) . 51
Figure 21
Structural differences between natural cis and trans double bonds ......... 53
Figure 22
3-D drawings of cis and trans double bonds ........ 54
Figure 23
Structural differences with positional isomers in two fatty acids ... 56
Figure 24
Chart of monounsaturated fatty acids with examples ... 58
Figure 25
Important roles for essential fatty acids and their derivatives ........ 60
Figure 26
Graph of linoleic acid content of some common foods ......... 63
Figure 27
Graph of linoleic acid content of some common oils ... 64
Figure 28
The structure of linoleic acid showing the double bond at omega-6 ....... 65
Figure 29
Food sources of the essential fatty acid ALA ...... 66
Figure 30
Graph of ALA content of some common oils ...... 68
Figure 31
Chart of LA and ALA in eight diets with added flax powder ......... 69
Figure 32
Structure of alpha-linolenic acid ........ 71
Figure 33
Delta-5 desaturase and the structure of EPA ........ 73
Figure 34
Chart of trans fat from dairy products versus hydrogenation in 5 countries .... 76
Figure 35
Major sources of trans fats in America ....... 80
Figure 36
Structural difference between natural and trans fatty acids ... 86
Figure 37
Structure of trans oleic acid and vaccenic acid .... 88
Figure 38
3-D structure of trans-oleic, oleic, and stearic acids with melting points ......... 89
Figure 39
Chart of trans isomers in milk fat and from hydrogenation ... 90
Figure 40
Structure of a conjugated fatty acid ... 92
Figure 41
3-D representation of a triglyceride ... 98
Figure 42
3-D representation of trans oleic acid ......... 99
Figure 43
3-D representation of stearic acid ...... 99
Figure 44
3-D representation of natural cis-oleic acid ....... 100
Figure 45
A triglyceride with bent unsaturated fatty acids ......... 100
Figure 46
A triglyceride with straight saturated fatty acids ........ 101
Figure 47
Structure of triglycerides and phospholipids compared ....... 103
Figure 48
Comparing structures of four types of phospholipids . 104
Figure 49
Phospholipids in cell membranes ..... 105
Figure 50
The structure of sphingomyelin, a type of sphingolipid ...... 107
Figure 51
The structure of cholesterol .... 109
Figure 52
The structure of stigmasterol, a plant sterol ....... 109
Figure 53
Some oils have not been genetically engineered or mutated .........113
Figure 54
Some genetically engineered oils ......113
Figure 55
Oils not normally extracted with the solvent hexane ...115
Figure 56
Oils routinely extracted with the solvent hexane .........116
Figure 57
Nutrients eliminated during bleaching of oils .....119
Figure 58
Hydrogenation changes melting temperatures ... 120
Figure 59
Graph of oleic acid in common nuts and seeds .. 128
Figure 60
Graph of saturated fats in selected nuts and seeds ...... 129
Figure 61
Graph of vitamin E, nuts and seeds, alpha-tocopherol (left), total tocopherols (right) .... 130
Figure 62
Graph of ALA in selected nuts and seeds . 131
Figure 63
Graph of linoleic acid in selected nuts and seeds ....... 132
Figure 64
Chart of food servings to be analyzed ....... 133
Figure 65
Graph of total fat in common foods . 134
Figure 66
Graph of saturated fat in common foods ... 135
Figure 67
Graph of cholesterol in common foods ..... 136
Figure 68
Graph of trans fat in common foods ......... 137
Figure 69
Graph of monounsaturated fat in common foods ....... 138
Figure 70
Graph of linoleic acid in common foods ... 139
Figure 71
Graph of ALA in common foods ..... 140
Figure 72
Graphs of EPA and DHA in food ..... 141
Figure 73
Graph of vitamin E in selected foods ........ 142
Figure 74
Graph of saturated fats in common oils .... 144
Figure 75
Graph of ALA in common oils with ratios of LA/ALA ....... 148
Figure 76
Balancing the essential fatty acids in cooking oils ..... 149
Figure 77
Graph of vitamin E in common oils . 151
Figure 78
Which is the best oil? ..... 155
Figure 79
Graph of oleic acid in common oils . 158
Figure 80
Graph of vitamin E in less common oils ... 163
Figure 81
Graph of gamma-linolenic acid in some oils ..... 164
Figure 82
Graph of oleic acid in some less common oils .. 167
Figure 83
Graph of linoleic acid in some less common oils ....... 169
Figure 84
Graph of saturated fats in some less common oils ...... 172
Figure 85
Graph of ALA in some less common oils . 173
Figure 86
Triglyceride structure, black is carbon, white is hydrogen, and red is oxygen ........ 177
Figure 87
Bitter tonics can stimulate bile after fatty meals ......... 178
Figure 88
How hydrolysis splits two fatty acids off of a triglyceride .. 179
Figure 89
How VLDL becomes LDL, with changes in cholesterol and triglycerides .... 183
Figure 90
Healthiest ratios between total cholesterol and HDL . 185
Figure 91
Involvement of B-vitamins in the metabolic burning of fat ......... 187
Figure 92
Omega-3 and omega-6 eicosanoid precursors ... 190
Figure 93
The formation of eicosanoid precursors ... 192
Figure 94
Graph of ALA content of some common oils .... 194
Figure 95
Chart of the ratio of LA to ALA in selected diets ....... 195
Figure 96
Effects of hormones on the desaturation of ALA ....... 196
Figure 97
Effects of nutrition on the desaturation of ALA ......... 198
Figure 98
Structural changes with delta-6 desaturase converting ALA to stearidonic acid ..... 199
Figure 99
Structural changes of the conversion of stearidonic acid to eicosatetraenoic acid .. 200
Figure 100
Structural changes of the conversion of eicosatetraenoic acid to EPA ....... 201
Figure 101
Types of Eicosanoids . 206
Figure 102
Eicosanoid creation diagram ........ 208
Figure 103
The biosynthesis of eicosanoids from arachidonic acid .. 209
Figure 104
Inflammation triggered by leukotrienes .211
Figure 105
Biosynthesis of prostacyclin ........ 212
Figure 106
Actions of prostacyclin ....... 213
Figure 107
Prostacyclin, thromboxane, and NSAIDs ...... 214
Figure 108
Prostaglandins and their formation ....... 216
Figure 109
Series 1, 2, and 3 prostaglandins .. 217
Figure 110
Chart of eicosanoids and their functions ........ 222
Figure 111
Normal artery on the left and mostly clogged artery on the right ...... 226
Figure 112
Dietary factors that raise blood cholesterol ... 227
Figure 113
Damaged artery in A is healed with a low-fat plant-based diet (courtesy Esselstyn) ... 228
Figure 114
Dietary fat and heart attack risk ... 229
Figure 115
Animal fat versus heart deaths ..... 230
Figure 116
Chart of saturated fat plus trans fat ....... 231
Figure 117
Dietary factors affecting the risk of heart attacks ... 232
Figure 118
Sources of trans fats in American diets (USDA) .... 233