Total Fat in Diet Dr Esselstyn
- News & Views
- Saturated fat is not...
- Saturated fat is not the major issue
Observations From the Heart Saturated fat is not the major issue
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6340 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6340
- Article
- Related content
- Metrics
- Responses
- Peer review
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
SATURATED FAT IS A MAJOR ISSUE and is part of the Inflammatory process we call Coronary Artery Disease. Re: Saturated fat is not the major issue
In the mid-1990s, as one of the reviewers for the American Heart Association, the first author introduced a then controversial theory stating that Coronary Artery Disease (CAD) is the result of an inflammatory process which impairs the ability of the coronary arteries to dilate and increase coronary blood flow when needed, thus producing regional blood flow differences resulting in angina [1-3].
In recent years, individuals promoting various dietary and lifestyle changes – particularly those promoting LowCarb-Keto diets have focused on obesity. They justify this dietary approach by showing potential weight loss, and showing reductions in cholesterol levels – or when that fails – stating that cholesterol and saturated fat are myths and not responsible for inflammatory coronary artery disease [4].
This claim - that saturated fat and cholesterol are not responsible for the development of inflammatory CAD - cannot be taken seriously, and completely ignores the fact that the Inflammation and Heart Disease Theory itself, includes and explains the impact cholesterol and saturated fat have on this inflammatory process [3,5]. Such claims introduce yet another misconception regarding the frequently misunderstood process of "clogging of the arteries" as the narrowing of the coronary lumen so frequently referred to, is actually a late process in the inflammatory change of CAD [6-12].
Further work has also demonstrated that the relationship between weight loss, changes in lipids and other blood tests, do not correlate well [13] with actual tissue changes – viz. CAD – thereby limiting the discussion and emphasizing the need for quantitative measurements [14, 15] of the impact of LowCarb-Keto, and other diets, before physicians and others, can claim health benefits from these or other diets [16,17].
References:
1. Fleming RM. Chapter 29. Atherosclerosis: Understanding the relationship between coronary artery disease and stenosis flow reserve. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999. pp. 381-387.
2. Fleming RM. Chapter 30. Cholesterol, Triglycerides and the treatment of hyperlipidemias. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999, pp. 388-396.
3. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
4. Malhotra A, Redberg R, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. British J Sports Med 2017;51:1111-1112.
5. 20/20 Segment on Heart Disease and Inflammation. https://www.youtube.com/watch?v=Hvb_Ced7KyA&t=22s
6. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316(22):1371-1375.
7. Fleming RM., Kirkeeide RL, Smalling RW, Gould KL. Patterns in Visual Interpretation of Coronary Arteriograms as Detected by Quantitative Coronary Arteriography. J Am Coll. Cardiol. 1991;18:945- 951.
8. Fleming RM, Harrington GM. Quantitative Coronary Arteriography and its Assessment of Atherosclerosis. Part 1. Examining the Independent Variables. Angiology 1994;45(10):829-833.
9. Fleming RM, Harrington GM. Quantitative Coronary Arteriography and its Assessment of Atherosclerosis. Part 2. Calculating Stenosis Flow Reserve Directly from Percent Diameter Stenosis. Angiology 1994;45(10):835-840.
10. Fleming RM. Shortcomings of coronary angiography. Letter to the Editor. Cleve Clin J Med 2000;67:450.
11. Fleming RM. Coronary Artery Disease is More than Just Coronary Lumen Disease. Amer J Card 2001;88:599-600.
12. Fleming RM, Harrington GM. TAM-A.7 Sestamibi redistribution measurement defines ischemic coronary artery lumen disease. 56th Annual Meeting of the Health Physics Society. (American Conference of Radiological Safety) West Palm Beach, FL, USA, 30 June 2011. http://hpschapters.org/2011AM/program/singlesession.php3?sessid=TAM-A
13. Fleming RM, Harrington GM. What is the Relationship between Myocardial Perfusion Imaging and Coronary Artery Disease Risk Factors and Markers of Inflammation? Angiology 2008;59:16-25.
14. The Fleming Method for Tissue and Vascular Differentiation and Metabolism (FMTVDM) using same state single or sequential quantification comparisons. Patent Number 9566037. Issued 02/14/2017.
15. Fleming RM, Fleming MR, Chaudhuri TK. Replacing Cardiovascular Risk Factors with True AI and Absolute Quantifiable Measurement (FMTVDM) of Coronary Artery Disease. Inter J Res Studies Med & Health Sci. 2019;4(11):11- 13. ISSN:2456-6373.
16. Fleming RM, Fleming MR, Chaudhuri TK. Are we prescribing the right diets and drugs for CAD, T2D, Cancer and Obesity? Int J Nuclear Med Radioactive Subs 2019;2(2):000115.
17. Fleming RM, Fleming MR, Chaudhuri TK, Harrington GM. Cardiovascular Outcomes of Diet Counseling. Edel J Biomed Res Rev. 2019;1(1):20-29.
Competing interests: FMTVDM issues to first author. First author developed the Inflammation and Heart Disease Theory.
16 February 2020
Fleming Fleming, Ph.D., M.D., J.D.
Physicist-Cardiologist
Matthew R Fleming, BS, NRP (FHHI-OI-Camelot); Tapan K. Chaudhuri, MD (Eastern Virginia Medical School)
FHHI-OI-Camelot
Los Angeles, CA
Re: Saturated fat is not the major issue
Several years ago there was a great study in Africa where farmers were given ad lib eggs or so for breakfast, and they looked at both their total cholesterol and LDL, and VLDL and what they found to their surprise is that eggs did not increase the cholesterol level.
Some of them ate upto 10 eggs! This study clearly shows that it is not the amount of cholesterol ingested as long as they are active it is metabolized easily.
Rani Madhavapeddi Patel, PhD.
Competing interests: No competing interests
01 February 2015
Rani Madhavapeddi Patel
Nutritionist
11450 S 44th Street Phoenix, AZ 85044
Re: Saturated fat is not the major issue
The debate on how nutrition relates to heart disease as well as other common chronic diseases has moved beyond isolated nutrients such as saturated fat and sugar in the USA. The emerging zeitgeist for chronic disease prevention and management is a diet based on whole plant foods. Large healthcare organisations such as Kaiser Permanente now support this approach:
http://www.thepermanentejournal.org/issues/2013/spring/5117-nutrition.html
Leading specialists such as Dr. William Roberts, a prominent cardiovascular pathologist and the editor of the American Journal of Cardiology, now recommend the same low-fat plant-based diet as that pioneered by Dr Caldwell Esselstyn in the prevention and management
http://www.cbc.ca/news/health/heart-disease-treatment-using-vegetables-o...
Dr Garth Davis is a bariatric surgeon who has fully embraced whole foods plant based nutrition and has become very active in publicly promoting this approach. He is one of a growing number of doctors in North America who have incorporated plant based nutrition into their medical practice.
Here's an article Dr. Davis published on a social media site dated 27 May 2014:
"So I post a picture of a vessel loaded with fat and tell people to use common sense. I then get a bunch of responses trying to teach me physiology, even though that is my expertise. The fact that I actually go to the meetings where this is discussed and debated, the fact that I actually study the journal articles, the fact that I actually treat patients and have for 12 years, seems to not matter much to some people. So lets get scientific. And this is just the tip of the iceberg.
What matters when you eat is your post meal state. This is far more important than baseline fasting lipid values. A key study was done by Vogel who measured vessel response via duplex sonography after fatty and non fatty meals. AFter a fatty meal there is measurable vasoconstriction. The effect is like putting your finger over a hose. The velocity of the blood increases causes sheer force. He also showed that after a high fat meal the blood was loaded with fat, some of it is oxidized LDL which is exactly what you see in the picture from yesterday. Vogel, R. A., et al. (1997). "Effect of a single high-fat meal on endothelial function in healthy subjects." Am J Cardiol 79(3): 350-354.
Now I certainly don't think added sugar is good for you. Excess calories will create fat. Problem is that sugar itself, in a single meal, is not inflammatory at all, but fat is extremely inflammatory provoking. This study feed people juices vs cream and the difference in inflammation is dramatic. Deopurkar, R., et al. (2010). "Differential effects of cream, glucose, and orange juice on inflammation, endotoxin, and the expression of Toll-like receptor-4 and suppressor of cytokine signaling-3." Diabetes Care 33(5): 991-997.
So you have a state after a fatty meal where you are inducing flow changes and inflammation and increasing lipids!!!! Meanwhile, sugar does not create any of these issues. Sørensen, L. B., et al. (2005). "Effect of sucrose on inflammatory markers in overweight humans." Am J Clin Nutr 82(2): 421-427.
There has never been an animal model of atherosclerosis created with feeding carbs but many with feeding saturated fat. Population studies from EPIC, to ADVENTIST, to FRamingham, to so many others show definite relationship between high saturated fat and heart disease.
Chew on this. The National Geographic Blue Zone study found places where people had exceptional longevity. None of these places eat a high fat diet. They eat MAINLY CARBS. The Okinawans live long healthy lives eating yams and rice. If carbs ae so bad why are they so healthy. You may say processed carbs are different and they are in that they lack fiber. Otherwise though, sugar is sugar.
There are NO long living high fat consuming people. None. Please do not say the Inuits. They live to 50 at best and actually do have heart disease. GJ, f. and V. B (2014). for the origins of the Eskimos and heart disease, facts or wishful thinking? A review. Canadian Journal of Cardiology.
Of course people love to say the Masaii don't have heart disease. That is because they die at 45-50 before their 1 st heart attack, but autopsy studies show they do have atherosclerosis.
The bashing of sugar is backed by this belief that sugar causes insulin to rise and insulin is the real problem, so we should eat steak instead of bananas. Problem is that insulin rises higher after a steak than it does after a banana. A fatal flaw to the argument. Holt, S. H., et al. (1997). "An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods." Am J Clin Nutr 66(5): 1264-1276.
The fact is it is not as simple as fat or sugar. It is really a combination. You don't usually just eat plain sugar. A doughnut has more calories from fat than sugar. Most sugars are combined with fat, so the insulin release cause the fat to be stored. Eat a banana and there is sugar but no fat to react to the insulin.
The other absolute thing you have to understand is that active interventions aimed at reducing fat have actually reduced heart disease. THERE ARE NO STUDIES THAT SHOW INCREASING SATURATED FAT DECREASES HEART DISEASE. NONE!!! It is absolutely preposterous. Ornish showed that you can absolutely reverse heart disease with a low saturated fat diet. The North Karelia project showed that an organized government program to reduce saturated aft and cholesterol can work extremely well. Ornish, D., et al. (1998). "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 280(23): 2001-2007.
I sit across from patients everyday review their diet logs. I operate on them and see their insides. I cut open vessels and clear out cholesterol plaques. You can choose to believe a blogger or a journalist or you can trust in science that has been around for a long time. You choose."
Competing interests: No competing interests
31 May 2014
Colin Walsh
GP
Freelance
Cardiff, Wales
Re: Saturated fat is not the major issue
Dear Dr Godlee,
Black in October I meant to congratulate Dr Malhotra on his courageous paper published in the BMJ on saturated fat and Statins. I write now to provide my support following the recent articles in the press concerning Professor Collins' comments on the article of Dr Malhotra and on an article published in the BMJ by Dr Abramson et al.
For many years I have been confused about the demonization of saturated fatty acids (SFAs) and have concluded that there is insufficient evidence to support the prevailing view. The closest that I can get to a mechanistic story in this respect, is that SFAs might bind to Toll receptors and induce an inflammatory response, but more recently, evidence has been presented that this is not a unique property of SFAs (unsaturated FAs may bind). Due to the current government advice, we have taken 'our collective eyes off the ball' and have ignored the role of carbohydrates, as Dr Malhotra has so correctly (in my opinion) pointed out. I also believe that it is the association of SFAs with cholesterol that has fuelled the prejudice against SFAs.
I should state that my background is basic science in both the UK and in Germany. Originally I worked on Cancer in London and then moved to Munich, to the Max Planck Institute, to work in a Neuroendocriology group. In the latter part of the 1990s I moved back to the UK, where as part of my interest in the control of cell survival and cell death, my group published on Fluvastatin. We found that this compound induced apoptotic death of endothelial cells, albeit at rather high concentrations (microM). This phenomenon was mitigated by the ability of glucocorticoids to block (reduce) Fluvastatin–induced cell death.
Over the years since working on Statins in the laboratory, I have become concerned by the somewhat indiscriminate use of these powerful drugs (it is not widely noted that Statins block numerous cellular pathways and this may have positive and negative effects on the body, depending on cellular circumstances). People are being 'treated' who are otherwise perfectly well. Others are being treated despite known conditions, such as Cardiomyopathy. There is no double that the incidence of side effects is higher than that currently reported and that some of these, as you are well aware are quite serious. The problem, of course, is the way these side effects have been reported or rather, not reported officially. I must admit that I have been stunned by the recent 'headlines' from web articles in the Telegraph, Times and Guardian. The Times reports, ' Statins do not cause side-effects, scientists admit' and the Telegraph, 'Statins may have no harmful side effects, as controversial paper withdrawn'. These are blatant mistruths!
Dr Malhotra's comments have been twisted. He is not suggesting that Statins are not useful, rather, they are apparently not useful for those with a very low risk of cardiovascular events (and I would agree, more focus should be made on dietary considerations-more beneficial than taking Statins). The Telegraph article suggests that Professor Collins has not challenged Dr Malhotra's comments with regard to the 10 year death, he seems to have challenged his quote of the 'uncontrolled observational study', presumably the one by Zhang et al., 2010. I must state for the record, that uncontrolled Phase IV studies, to continuously monitor side effects, are an industry standard. Once in the 'real word', there can be no way of making blind, case control studies. The criticism alleged in the Telegraph has no foundation in this respect.
Further to the Times and Telegraph articles, I take great exception to the quote made in the Guardian concerning Professor Collins' assertion of, 'Serious disservice to British and international medicine'. This is qualified in the Guardian article by the suggestion that the alarm caused, is killing more people than had been harmed by the paper on the MMR vaccine. This statement, in my opinion, is unforgivable, and knowing what happened to Andrew Wakefield concerning the MMR work, constitutes a veiled threat.
What we need to do now is open-up the debate regarding the use of Statins for individuals with minimal risk of cardiac events. What is the true incidence of side effects and how does this relate to underlying genetic predisposition to, for example, muscle damage?
Yours sincerely,
Chris J. Newton Ph.D.
Director, Centre for Immuno-Metabolism, Microbiome and Bio-Energetic Research, UK and Max Planck Fellow, Munich, Germany
Competing interests: No competing interests
20 May 2014
Chris John Newton
Medical Research
CIMMBER and Max Planck Fellow
Carlton House, Hull, East Yorkshire
Re: Saturated fat is not the major issue
Dr T Colin Campbell, emeritus professor of nutritional biochemistry at Cornell, wrote a rebuttal of a New York Times article on saturated fat that cast doubt on its role in heart disease. Campbell provides the missing context that helps reveal the big picture of disease in relation to diet:
http://nutritionstudies.org/fallacious-faulty-foolish-discussion-about-s...
An extract from Campbell's article:
"..In my experience, this more wholistic ('w' intended) understanding of diet, health and disease is best illustrated by the remarkable demonstrations of Esselstyn[38] and Ornish[45] showing that advanced heart disease can be reversed by whole foods, not by changes in single nutrients like saturated fat (actually cured when the diet is maintained). Esselstyn's findings are especially telling with his 26-year follow-up findings (reported in the [documentary] film, Forks Over Knives) and his new much anticipated report[46] involving a much larger number of subjects. These findings involve whole foods and do not depend on selective treatment of individual risk factors and events of the heart disease process."
Competing interests: No competing interests
08 May 2014
Colin J Walsh
GP
Freelance
Cardiff, Wales
Re: Saturated fat is not the major issue
The Zhang paper reported that almost 1 in 5 (17.4%) or 18,778 out of 107,835 patients treated with a statin in a routine care setting had a "statin-related adverse event documented." The most commonly documented side effect was myalgia or myopathy with others including musculoskeletal and connective tissue disorders , general disorders, hepatobiliary disorders, gastrointestinal disorders, memory problems and drug intolerance.1,2
In fact the overall initial rate of discontinuation for all causes that occurred at least once for the 107,835 patients analysed in the study was far higher at 53.1% (57,292 patients) for reasons that also included the drug being "no longer necessary" or the patients not wanting to take it.
Although it is true that 92.2% that were re-challenged representing 6579 out of 11,124 patients who at least temporarily discontinued their medication because of side effects were on "a statin" 12 months later, only 15.1% (996) patients were on the same statin or a higher dose which suggests the remaining majority were either on a different statin or a lower dose.
There is a clearly a discrepancy between side effects reported in clinical trials and real world experience. Professor Rory Collins, co-director of the University of Oxford's Clinical Trialists Service Unit, citing a meta-analysis which he co-authored of 27 (predominantly industry funded) RCTs of statin therapy3, recently told the Guardian that "We have really good data from over 100,000 people that show that the statins are very well tolerated. There are only one or two well-documented (problematic) side effects. Myopathy, or muscle weakness, occurred in one in 10,000 people, he said, and there was a small increase in diabetes."4
A double blinded randomised controlled trial published in the Archives of Internal Medicine involving 1016 low risk patients receiving simvastatin 20mg, pravastatin 40mg or placebo revealed that both drugs had a significant adverse effect on energy/fatigue exercise score with 40% of women reporting reduced energy or fatigue with exertion.5,6
In reference to diabetes risk a large observational study involving 153,840 postmenopausal women between 50 and 80 years of age who were enrolled in the Womens Health Initiative study revealed statins had a 48% increased risk of developing diabetes in this group.7
Although there has been evidence of benefit in reducing cardiovascular events and mortality for a heterogeneous group of patients with cardiovascular disease that includes patients with stable angina using standard dose Pravastatin 40mg or Simvastatin 20-40mg from earlier clinical trials, more recent studies have mandated maximum dose therapy for all patients post acute-coronary syndromes. The PROVE-IT study randomised 4162 patients hospitalised with acute myocardial infarction or unstable angina to receive either atorvastatin 80mg or pravastatin 40mg revealing a significant 16% reduction in death and cardiovascular events in the those on maximum dose atorvastatin within 24 months.8 In a systematic review of randomised trials, high dose statin therapy in the setting of acute coronary syndromes demonstrated a 22% reduction in all cause mortality as well as a 25% reduction in cardiovascular mortality.9 Subsequently the European Society of Cardiology recommends that all patients presenting with acute myocardial infarction with high intensity statins early after admission unless contraindicated.10
The primary prevention of cardiovascular disease with a Mediterranean Diet (PREDIMED) study randomly assigned participants who were at high cardiovascular risk to one of three diets: a Mediterranean diet supplemented with extra virgin olive oil (1 litre/week), a Mediterranean diet supplemented with 30g of mixed nuts per day ( 15g of Walnuts, 7.5g of hazelnuts and 7.5g of almonds) or a control diet ( advice to reduce dietary fat). The intervention group had a significant 30% reduction in the primary endpoint of major cardiovascular events ( myocardial infarction, stroke or death from cardiovascular causes).11 Despite the participants in the control group receiving advice to reduce fat intake the difference in total fat were small however there were large differences in the fat subtypes reflected by the supplemental items, specifically olive oil and nuts, which were most likely responsible for most of the observed benefits of the Mediterranean diet. The fact that the control group were still advised to follow a healthy diet suggests a potentially greater benefit of a Mediterranean diet as compared to western diets. The authors conclude that the results of PREDIMED compare favourably with those of the Women's Health Initiative Dietary Modification Trial revealed no cardiovascular benefit for the "low fat" dietary approach.12
Our focus on one specific nutrient or grouping all fats together has unfortunately led to an over obsession on "low fat" diets as being healthy. It is in fact the synergy of nutrient rich whole foods such as vegetables, fruits, nuts, legumes, fish and olive oil that may account for the health benefits of the Mediterranean diet by inducing positive changes in intermediate pathways of cardiometabolic risk through their impact on blood lipids, insulin sensitivity, resistance to oxidation, inflammation and vasoreactivity.13
Most recently a meta-analysis of 72 unique studies with over 600,000 participants from 18 countries led by the Cambridge Medical Research Council concluded that current evidence does not support guidelines that restrict the consumption of saturated fats and encourage consumption of polyunsaturated fats in order to prevent heart disease. The study raised questions regarding current nutritional guidelines that focused principally on the total amount of fat from saturated or unsaturated rather than the food sources of the fatty acid subtypes. One interesting finding was that the consumption of one particular fatty acid (margaric acid) which is a dairy fat, significantly reduced the risk of cardiovascular disease. 14 These findings support those from the dietary intake of saturated fat by food source and incident cardiovascular disease analysis which concluded that a higher intake of dairy saturated fat was inversely associated with lower CVD risk. Otto, Mozaffarian et al explain this finding by stating that "dairy foods, which are a major source of saturated fat in most populations, are also sources of beneficial nutrients including Vitamin D, potassium, phosphorus, and calcium…".15 However Professor Simon Pearce is right to point out that unlike the United States where dairy products are fortified with Vitamin D, this is not the case in the UK where the best sources come from foods such as oily fish and egg yolk. The suggestion of the UK adopting a similar Vitamin D fortification policy may hold some validity but the evidence is mounting that the health effects of the entire food and absorbing nutrients through natural means, not through supplementation, may be key to understanding associations between dietary consumption and health outcomes.
1. Zhang H, Plutzky J, Skentzos S, Morrison F, Mar P, Shubina M, et al. Discontinuation of statins in routine care settings. Ann Intern Med2013;158:526-
2. http://www.medscape.com/viewarticle/781767
3. Cholesterol Treatment Trialists' (CTT) Collaborators, Mihaylova B, Emberson J, Blackwell
L, Keech A, Simes J, et al. The effects of lowering LDL cholesterol with statin therapy in
people at low risk of vascular disease: meta-analysis of individual data from 27 randomised
trials. Lancet 2012;380:581-90.
4. http://www.theguardian.com/society/2014/mar/21/-sp-doctors-fears-over-st...
5. http://www.medscape.com/viewarticle/765472
6. Golomb BA, Evans MA, Dimsdale JE, White HL. Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial. Arch Intern Med. 2012;172(15):1180-1182. doi:10.1001/archinternmed.2012.2171.
7. Culver AL, Ockene IS, Balasubramanian R, Olenzki BC, Sepavich DM, Wactawski-Wende
J, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's
Health Initiative. Arch Intern Med 2012;172:144-52.
8. http://www.nejm.org/doi/full/10.1056/NEJMoa040583#t=citedby
9. http://www.ncbi.nlm.nih.gov/pubmed/17503884
10. http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocu...
11. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med2013;368:1279-90
12. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295:655-66.
13. Jacobs DR Jr, Gross MD, Tapsell LC. Food synergy: an operational concept for
understanding nutrition. Am J Clin Nutr 2009;89:1543S-1548S
14. Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A. Ward, Laura Johnson, Oscar H. Franco, Adam S. Butterworth, Nita G. Forouhi, Simon G. Thompson, Kay-Tee Khaw, Dariush Mozaffarian, John Danesh, Emanuele Di Angelantonio; Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary RiskA Systematic Review and Meta-analysis. Annals of Internal Medicine. 2014 Mar;160(6):398-406.
15. De Oliveira Otto MC, Mozaffarian D, Kromhout D, Bertoni AG, Sibley CT, Jacobs DR Jr, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr2012;96:397-404
Competing interests: No competing interests
29 March 2014
Aseem Malhotra
Interventional Cardiology Specialist Registrar
Croydon University Hospital
Croydon University Hospital, 530 London Rd, CR7 7YE
Re: Saturated fat is not the major issue
As was mentioned in several of the responses, we should not focus on food in a reductionist manner. The production of animal products can have a beneficial or detrimental effect on the environment. This topic is addressed very well on a Ted talk by Allan Savory entitled Allan Savory: How to fight desertification and reverse climate change
The nutritional characteristics of animal products from livestock fed in a free range setting is distinctly different than the products derived from industrial agriculture. It can be a win-win situation where the environment is improved while producing healthful animal products.
Competing interests: No competing interests
17 December 2013
John Madany
Family Physician
Barrett Hospital
657 Fox Ridge Drive, Dillon MT 59725
Re: Saturated fat is not the major issue
This article builds on a growing consensus. The Swedish peak body for health science (Swedish Council on Health Technology Assessment) recently reviewed 16,000 studies and concluded that low-carb diets are the way to lose weight, improve lipids and reduce metabolic syndrome, despite higher fat in diet.
See - http://www.dietdoctor.com/swedish-expert-committee-low-carb-diet-effecti...
One point to note - the term "Mediterranean diet" comes (from my reading of the subject) from research of a half century ago by Ancel Keys when Greeks and Italians ate more vegetables and less pasta and bread than in the modern Mediterranean diet of recent decades.
The term Mediterranean diet probably needs to be nuanced - "Original Mediterranean diet". The group with best CVS outcomes were from Crete with a 40% fat intake - high olives, olive oil and fish. It was the 1960s and there were few or no processed foods.
Competing interests: No competing interests
10 December 2013
Peter I Parry
Psychiatrist
University of Queensland
Royal Children's Hospital, Brisbane, Herston. Qld, Australia
Re: Saturated fat is not the major issue
I agree with Andrew Renfree that we need to consider the bigger picture of health in relation to dietary patterns, not just focus narrowly on individual nutrients. Even more important is the issue of the environmental impact of our food choices. Unless we manage to maintain a liveable environment nothing else we do really matters.
Malhotra says that eating saturated fat doesn't matter as it has nothing to do with heart disease. Plenty of good quality observational evidence contradicts this. In addition, plausible mechanisms have been worked out as to how saturated fat causes adverse effects - including increased inflammation through activation of the NF-kB protein complex and promotion of blood coagulation via Factor VII (see http://ajcn.nutrition.org/content/67/3/542S.full.pdf). As meat and other animal foods are the main source of saturated fat, a wholefood plant-based diet provides the best protection against heart disease.
The same diet also provides major environmental benefits, according to leading experts. Five years on from James Hansen's dire warning about the increasing risk of runaway global warming
(see http://www.worldwatch.org/node/5798), no serious effort has been made to limit global emissions of greenhouse gases. Robert Goodland, for 23 years the World Bank's main advisor on the environment, has recalculated the contribution of farm animals to global greenhouse gas emissions and arrived at the staggering figure of 51% (this includes the effects of deforestation to make way for animal feed crops, the very powerful greenhouse properties of methane and nitrogen oxides, animal respiration, etc). The good news is that methane does not persist for very long in the atmosphere, unlike CO2, which lasts for hundreds of years. So a substantial cut in livestock numbers would rapidly translate into lower atmospheric concentrations of methane, offsetting the effects of rising CO2 and buying us valuable time for other measures to take effect.
According to Hansen and other leading climate experts, a major global warming tipping point will probably arrive as early as 2017 unless we start to do something now. And Goodland says that by far the most effective and practical thing we can do is to eat less meat. He states that even a 25% reduction in livestock numbers worldwide would probably be enough to stop the arrival in a few years of the first in a predicted chain of tipping points leading to irreversible global warming.
Here's a link to a talk by Goodland in which he sets out the case for changing our diets, if only for environmental protection. He says that other measures such as switching to renewable energy, while essential in the long term, will kick in too late to prevent a dangerous temperature rise.
http://www.drmcdougall.com/health/education/videos/advanced-study-weeken...
Goodland strongly urges everyone who is concerned to improve our chances of maintaining the benign environment on which our civilization depends to get behind the twin goals of reforestation and widespread adoption of a sustainable diet.
Competing interests: No competing interests
10 December 2013
Colin J Walsh
retired GP
None
Cardiff, Wales
Re: Saturated fat is not the major issue
One thing which strikes me on reading of these responses is an overwhelming emphasis on the impact of specific components of foods (i.e. individual nutrients) rather than the actual whole foods themselves.
My understanding of traditional human diets is that numerous populations have until recently thrived on a wide range of differing diets (from very high to very low fat) and that the 'diseases of civilisation' only appear when they are introduced to industrially produced refined food products. It would therefore seem that searching for individual nutrients responsible for various conditions is an oversimplification of a complex issue. Michael Pollen summarised the ideas very well in his book 'In Defence of Food' with the advice that in order to maximise our chances of remaining healthy we should eat real food and not 'edible food like substances'
Competing interests: No competing interests
09 December 2013
Andrew J Renfree
Principal Lecturer
University of Worcester
Henwick Grove, Worcester
Pages
- 1
- 2
- 3
- 4
- 5
- next ›
- last »
Total Fat in Diet Dr Esselstyn
Source: https://www.bmj.com/content/347/bmj.f6340/rapid-responses