Wednesday, July 24, 2019

Retrospective #158: Demolishing the Saturated Fat Bogeyman


“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 when this commissioned, peer-reviewed and foot-noted “Observations” statement by the now famous British cardiologist Aseem Malhotra appeared in the October 22, 2013 BMJ (British Medical Journal).
Dr. Malhotra reminded 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 still is a core recommendation incorporated into the “Dietary Guidelines for Americans” from its inception in 1980 to this day. It has been immutable dogma.
“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 dyslipidemia.” Translation: Low HDL and high triglycerides, plus “small-dense” LDL lipoprotein particles (Pattern B LDL) accompanied by systemic inflammation.
To explain how that comes about, Dr. Malhotra continued, “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.
“In previous generations cardiovascular disease existed largely in isolation,” he said. “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 suggests. Metabolic Syndrome is “the cluster of hypertension, dysglycemia, raised triglycerides, low HDL, and increased waist circumference.” Do these sound familiar? Do they apply to you?
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 glycemic index diet.”
So, will this message resonate? Were there aftershocks? Sure, the Diet Doctor featured it. Then, the latimes.com had a piece and the BBC Health News featured it, and they also had a morning show video segment. Early tremors were registered everywhere.  Maybe it will resonate this time, if enough people hear it, over and over and over…
 The title of Dr. Malhotra’s BMJ piece shouts, “Saturated Fat is not the major issue.”  The sub-title, “Let’s bust the myth of its role in heart disease…” Bravo! Switching metaphors, 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. Just wait for the 2020 Guidelines, and you will see how intransigent the Dietary Guidelines continue to be in the face of all the evidence. Being charged with protecting the health of Americans for the last 40 years, it is hard to admit you’ve been wrong.

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