In a commissioned,
peer-reviewed and foot-noted
“Observations” column published October 22, 2013, in the
prestigious BMJ (British Medical
Journal), interventional cardiologist
Aseem Malhotra presented this stunning conclusion: “It is time to bust the myth
of the role of saturated fat in heart disease and wind back the harms of
dietary advice that has contributed to obesity.” The ground shook and a tsunami
rolled around the world. Ripples were even felt in the mainstream.
Dr. Malhotra reminds us that,
“Saturated fat has been demonized ever since Ancel Keys’s landmark ‘seven
countries’ study in 1970. This concluded that a correlation existed between the
incidence of coronary heart disease and total cholesterol concentrations, which
then correlated with the proportion of energy provided by saturated fat. But
correlation is not causation; and Keys
cherry-picked his data. Nevertheless, we were advised to cut fat intake to
30% of total energy and saturated fat to 10%.” That was and is a core
recommendation incorporated into the “Dietary Guidelines for Americans” from its
inception in 1980 to this day.
“The mantra that saturated
fat must be removed to reduce the risk of cardiovascular disease has dominated
dietary advice and guidelines for almost four decades,” Dr. Malhotra continues.
“Yet scientific evidence shows that this advice has, paradoxically, increased
our cardiovascular risks. Furthermore, the government’s obsession with levels
of total cholesterol, which has led to the overmedication of millions of people
with statins, has diverted our attention from the more egregious risk factor of
atherogenic dyslipidaemia.” Translation: Low HDL and high triglycerides, plus
small-dense LDL lipoprotein particles (“Pattern B” LDL) accompanied by systemic
inflammation, all of which are potent cardiovascular disease risk factors.
To explain how that comes
about, Dr. Malhotra continues, “The aspect of dietary saturated fat that is
believed to have the greatest influence on cardiovascular risk is elevated
concentrations of low density lipoprotein (LDL) cholesterol. Yet the reduction
in LDL cholesterol from reducing saturated fat intake seems to be specific to
large, buoyant (type A) LDL particles, when in fact it is the small, dense (type
B) particles (responsive to carbohydrate intake) that are implicated in
cardiovascular disease.” Translation: Reduced saturated fat intake = fewer
large buoyant (type A) LDL particles; Increased carbohydrate intake = more
small dense (type B) LDL particles. Conclusion: Saturated fat: good;
Carbohydrates: bad.
Dr. Malhotra covers some
familiar ground as well: “Scientists universally accept that trans fats – found in many fast foods, bakery products and
margarines – increase the risk of cardiovascular disease through inflammatory
processes.” And he nicely clarifies a point: “Consumption of processed meats,
but not red meat, has been associated with coronary heart disease and diabetes
mellitus, which may be explained by nitrates and sodium as preservatives.” But
he comes back to saturated fat with this: “Indeed, recent prospective cohort
studies have not supported any significant association between saturated fat
intake and cardiovascular risk. Instead, saturated fat has been found to be
protective.” See his citation here.
“In previous generations
cardiovascular disease existed largely in isolation,” he says. “Now two thirds
of people admitted to hospital with a diagnosis of acute myocardial infarction
really have metabolic syndrome – but 75% of these patients have
completely normal total cholesterol concentrations. Maybe this is because total
cholesterol isn’t really the problem,”
he quips (emphasis mine). Metabolic Syndrome is “the cluster of hypertension,
dysglycaemia, raised triglycerides, low HDL cholesterol, and increased waist
circumference.” Do these sound familiar? Does it apply to you? Does it worry
you, yet?
Dr. Malhotra reminds us that,
“The notoriety of fat is based on its higher energy content per gram in
comparison with protein and carbohydrate,” but he cites Richard Feinman and
Eugene Fine’s work on “metabolic advantage” to show that “different diet
compositions showed that the body did not metabolize different macronutrients
in the same way.” “The ‘calorie is not a calorie’ theory has been further
substantiated,” he adds, “by a recent JAMA study showing that a low fat diet resulted in the greatest decrease in
energy expenditure, an unhealthy lipid pattern, and increased insulin
resistance in comparison with a low carbohydrate and low glycaemic index diet.”
This is beginning to sound like a broken record.
So, will this message
resonate? Were there aftershocks? Sure, I was startled awake one morning with a
‘teaser’ on an early morning TV news program. Later, the Diet Doctor, Andreas
Eenfeldt, featured it here. The BBC Health News featured it here,
and they also had a morning show video segment. The latimes.com had this piece by Melissa Healy. And early tremors were
registered at paleodietlifestyle.com here. Maybe
it will resonate this time, if enough people hear it, over and over…
Finally, Dr. Malhotra comes at it from a different angle: “When you take
the fat out (of food), the food tastes worse.” “The food industry compensated
by replacing saturated fat with added sugar. The scientific evidence is
mounting that sugar is a possible independent risk factor for the metabolic
syndrome.” He’s now come full circle. “Saturated Fat is not the major issue,”
the title of the piece shouts. The sub-title, “Let’s bust the myth of its role
in heart disease…” Bravo! This stake to the heart will help. But ‘SFAs = bad’
is an undead concept that will persist to eat away at our health, like a zombie
apocalypse.
You’re doing a remarkable process. Hold it up
ReplyDeleteI totally agree with what you have said!!
ReplyDeleteReally enjoyed reading your blog
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