Cardiologist Aseem Malhotra, M.D.
More than 40 years ago, health authorities began to assert that dietary saturated fat and cholesterol promote heart disease.
This policy flowed largely from the famed Seven Countries Study … an epidemiological project that spanned the early 1960's and '70's.
Its authors linked higher rates of coronary heart disease to higher cholesterol levels. And they linked higher cholesterol levels to diets providing higher percentages of calories from saturated fats.
Sadly, the authors cherry-picked the evidence to fit their theory that saturated fat promotes heart disease. In fact, some of countries with high saturated fat intakes had low rates of heart disease, but this was deliberately – unconscionably – hidden.
(One of most commonly consumed saturated fats – stearic acid, which abounds in beef and chocolate – doesn't even raise “bad” LDL cholesterol.)
Even though, as scientists correctly say, “correlation is not causation”, U.S health agencies soon began advising Americans to limit fat intake to 30% of total calories, and limit saturated fat intake to 10% of total calories.
In recent years, the idea that cholesterol drives heart disease has crumbled under the weight of new evidence and sharper scrutiny of older studies.
Likewise, ample evidence challenges the claims that statin drugs reduce the risk of heart attacks as substantially as is commonly asserted … and that they reduce heart attack risk by lowering levels of “bad” (a misleading term) cholesterol types.
We've covered the declining credibility of claims about statins and cholesterol … see our sidebar, “Common heart-diet claims crumble”.
Now, a cardiologist's bold essay – published in the prominent British Medical Journal at some professional peril – further undermines the durable but increasingly dubious claim that saturated fat intakes above 10 percent of calories promotes heart disease.
British cardiologist takes conventional wisdom to task
Aseem Malhotra, M.D. – a cardiologist at London's Croydon University Hospital – penned a provocative but scientifically sound essay.
Hopefully, its appearance in such a prominent journal will help push medical practice to a better, evidence-based place.
He says the decades-long focus on lowering people's total and LDL cholesterol to abnormal levels resulted in two serious errors:
Unneeded medication of millions of people, usually with statin drugs.
Distraction from the more serious risk factor … the unfavorable ratios of blood fats called “atherogenic dyslipidemia”.
It's a mouthful, but “atherogenic dyslipidemia” simply means the kind of unhealthful – and all too common – blood fat profile proven to promote arterial plaque.
UK doc says dietary fat doesn't drive body weight
Dr. Malhotra also cited counterintuitive evidence about the role of dietary fat in weight control … which surely is important to heart and metabolic health.
As he noted, one of the earliest obesity experiments, published in 1956, compared groups consuming equal- calorie diets consisting of 90% fat, 90% protein, or 90% carbohydrates.
The greatest weight loss was in the 90% fat group. More recently, the Journal of the American Medical Association published a study showing that – compared with a low carbohydrate, low glycemic index (GI) diet – a low-fat diet caused the greatest drop in calorie burning, an unhealthy lipid (blood fats) profile, and more insulin resistance (a precursor to diabetes).
Dr. Malhotra also points to the United States, where obesity has rocketed even though the percent of calories people get from fat has declined from 40% to 30% in the past 30 years.
Notably, that drop in percentage of calories came about because we now eat more total calories … not because the average number of daily calories Americans get from fat has dropped.
One reason, he says, is that the food industry “compensated by replacing saturated fat with added sugar.” And loads of sugar-like refined flours.
Blood fats (lipids) include the many types of triglycerides, cholesterol, and free fatty acids.
The evidence grows that Americans' grossly excessive intake of omega-6 polyunsaturated fats – from vegetable oils like corn and soy – is a major driver of heart and other inflammation-related diseases. See “America's Sickening ‘Omega Imbalance'
As Dr. Malhotra wrote, scientific evidence shows that advice to reduce saturated fat intake “has paradoxically increased our cardiovascular risks.”
He points out that recent studies “have not supported any significant association between saturated fat intake and risk of CVD.”
Instead, saturated fat has been found protective at intake levels higher than the historically low levels recommended by health agencies.
By itself, and absent other major risk factors, a “high” saturated fat intake level typical of a 19th or early-to-mid 20th century American does appear to harm heart health.
Of course, most Americans got much more exercise in those days, which improves your overall blood fat profile and fights the degenerative processes that lead to unstable arterial plaque … such as inflammation and oxidation of blood lipids (fats and cholesterol).
Heart doctor questions statins, advises “green” whole food diet
Dr. Malhotra also asks why, even though 8 million British people take statins regularly, there's been no beneficial effect on heart disease trends during the past 30 years?
Adopting a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin, writes Malhotra:
“Doctors need to embrace prevention as well as treatment. It is time to bust the myth of the role of saturated in heart disease and wind back the harms of dietary advice that has contributed to obesity.” (BMJPR 2013)
Commenting on the article, Professor David Haslam, Chair of Britain's National Obesity Forum said:
“The assumption has been that increased fat in the blood is caused by increased saturated fat in the diet, whereas modern scientific evidence is proving that refined carbohydrates and sugar are actually the culprits.” (BMJPR 2013)
Professor Robert Lustig – a pediatric endocrinologist at the University of San Francisco – made several cogent comments (BMJPR 2013):
- “Food should confer wellness, not illness. And real food does just that, including saturated fat. But when saturated fat got mixed up with the high sugar added to processed food in the second half of the 20th century, it got a bad name.”
- “Which is worse, the saturated fat or the added sugar? The American Heart Association has weighed in – the sugar many times over. Plus added sugar causes all of the diseases associated with metabolic syndrome.”
- “Instead of lowering serum cholesterol with statins, which is dubious at best, how about serving up some real food?”
And as University of Cape Town exercise-science professor Timothy Noakes said, “Focusing on an elevated blood cholesterol concentration as the exclusive cause of coronary heart disease is unquestionably the worst medical error of our time.”
- British Medical Journal Press Release (BMJPR). Observations: Saturated fat is not the major issue Tuesday, October 22, 2013. Accessed at http://www.bmj.com/press-releases/2013/10/22/observations-saturated-fat-not-major-issue
- British Medical Journal (BMJ). Saturated fat is not the major issue. BMJ 2013;347:f6340 doi: http://dx.doi.org/10.1136/bmj.f6340 (Published 22 October 2013). Accessed at http://www.bmj.com/content/347/bmj.f6340