Saturated fat does not clog the arteries...
An editorial recently published in the British Journal of Sports Medicine (http://bjsm.bmj.com/content/early/2017/03/31/bjsports-2016-097285) is a really important paper for everyone to understand. While Americans have been following traditional medical advice on the matter of diet and heart health for the last four or five decades, we as a nation have steadily gotten sicker and sicker. As a lot of the language in this piece may be too wonky for most, I will give you the highlights with some further clarification. Although this is an opinion piece, the authors base their positions on sound and legitimate data. Much of this is counter to what most of us "know" about diet and heart disease but as the authors say (in a very politically correct way), "There is no business model or market to help spread this simple yet powerful intervention." I prefer a more direct approach that says: "Good health makes a lot of sense, it just doesn't make a lot of dollars." to explain why everyone doesn't know this information and practice this lifestyle. Like it or not, the keys to good health and longer life are cheap and easy. Unfortunately, we are caught in a system that has convinced us to eat a "healthy diet", which is actually making us sick, and then has convinced us to turn to a pharmaceutical solution to get us healthy again (which never does, but instead makes us "customers for life"). Finally, the information which we have taught to our practice members for years is beginning to see the light of day; so please read on.
"Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong."
No real explanation necessary. Eating fat just does not lead to "clogged" arteries. I will not go into the long and storied history of the politics, money, and corruption that brought this myth into the zeitgeist of American thinking, but just know it is simply not true. Ask yourself this: If eating fat clogged your arteries and ultimately lead to a heart attack, why don't your fingers and toes fall off first? The arteries here are much smaller than those in your chest. There is a reason the arteries around your heart become a problem (a story for another day), but it's not because the fat you are eating is clogging them up.
"It is instructive to note that in an angiographic study of postmenopausal women with CHD, greater intake of saturated fat was associated with less progression of atherosclerosis whereas carbohydrate and polyunsaturated fat intake were associated with greater progression."
Whaaatt??? But I thought saturated fat was bad and healthy whole grains (carbohydrates) and heart healthy polyunsaturated fats (vegetable oils) were good. Is this the Bizarro universe? Read on.
"The inflammatory processes that contribute to cholesterol deposition within the artery wall and subsequent plaque formation (atherosclerosis), more closely resembles a ‘pimple’"
Perfect analogy. Again the stupidity and corruption that led to the "high cholesterol causes arterial plaques" idea is too long and convoluted to get into here, but suffice it to say that it is much more likely that a zit will rupture on the inside wall of your artery, leading to a big puss plug (gross, isn't it?) that will stop blood flow to the heart and lead to trouble than it is that an artery will slowly clog shut from fat buildup introduced into your blood from the fat you eat (oh, did I mention this doesn't actually happen?).
"Stenting significantly obstructive stable lesions fail to prevent myocardial infarction or to reduce mortality"
So the theory here is that your artery is clogged (from all that fat and cholesterol you eat, you bad, bad person) which is reducing blood flow to your heart, so we'll just put in a stent, which is basically a mesh tube that will "open up" the clogged artery thereby increasing blood flow and preventing your heart attack. Hooray! Problem is, it doesn't work. It may alleviate chest pain, but won't save you from a heart attack. Why? See the zip explanation above.
"In comparison with advice to follow a ‘low fat’ diet (37% fat), an energy-unrestricted Mediterranean diet (41% fat) supplemented with at least four tablespoons of extra virgin olive oil or a handful of nuts (PREDIMED) achieved a significant 30% (number needed to treat (NNT)=61) reduction in cardiovascular events in over 7500 high-risk patients."
Ok, this one is a bit wordy, and also a bit silly as the authors characterize a "low fat" diet as one of 37% fat. The USRDA states that 20-35% fat with less than 10% saturated fat should be your goal, so 37% is not considered "low fat" in this country. But notice that increasing fat consumption by nearly 10% actually reduces heart issues.
"Decades of emphasis on the primacy of lowering plasma cholesterol...has been misguided."
Again, here the authors are being politically correct. I suffer form no such malady so let's just say it like it is: "Decades of emphasis on the primacy of lowering cholesterol has been a disaster for Americans...but a windfall for drug companies." As Dr. Tim Noakes has said "To put patients on statin drugs without knowing their particle size is malpractice in my opinion." This issue of particle size is important but again, a discussion for another day. Just understand that this unrelenting drive to lower your cholesterol (especially the "bad" LDL) through a low fat diet and drug treatment has done much more harm than good.
"And in those over 60 years, a recent systematic review concluded that LDL cholesterol is not associated with cardiovascular disease and is inversely associated with all-cause mortality."
This means the lower (that's right, lower) your "bad" LDL cholesterol, certainly as you get older, the faster you die. This has been known for a long time. Ever wonder why you never heard it?
"Replacing saturated fat with linoleic acid containing vegetable oils increased mortality risk despite significant reductions in LDL and total cholesterol (TC)."
This is true, despite government statements to the contrary such as this, that would lead you to a different conclusion: "Some kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol...In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol." (https://health.gov/dietaryguidelines/dga2000/document/choose.htm) As already stated, saturated fat consumption does not increase your risk for heart disease, but notice how the second part of this statement insidiously leads the reader to believe that vegetable oil is good for you. The position that unsaturated fats do not increase, and may in fact decrease, blood cholesterol may be true (complicated process) but that doesn't mean anything good for you. In fact, you should stop using vegetable oils (except olive oil) for many reasons; and notice that the quote doesn't say anything about vegetable oils actually being heart healthy...because they're not. You are just left to make that inference on your own. This is the same trick played by drug companies who hock cholesterol-lowering drugs. Pay attention next time you see a commercial for these products; they tout the drug's ability to lower cholesterol up to 50% or more, but never mention an actual reduction in heart attacks...I wonder why???
"A high TC to high-density lipoprotein (HDL) ratio is the best predictor of cardiovascular risk"
. This is the ratio between total cholesterol (TC) and HDL (the supposed "good" cholesterol - again a story for another day). The higher the ratio (meaning the lower the HDL number), the greater the risk of heart disease. This is true but as the next quote will show, the importance of this ratio is in what it is really telling us. The drive to raise the HDL "good cholesterol" as a means of improving heart health is as much folly as the dietary fat - heart disease myth. This was shown by the drug companies themselves who spent billions (yes, billions) of dollars developing drugs to raise HDL, only to find that they either had no benefit, or worse, increased heart attack and death! The next quote tells us why a bad ratio is bad, and why raising HDL levels in and of itself does no good.
"A high TC to HDL ratio is also a surrogate marker for insulin resistance"
Almost a throw away line in the paper, but the most important words written. A bad ratio is a marker for insulin resistance (read pre-diabetic or diabetic). Insulin resistance is caused by excess sugar (read processed carbohydrates) consumption, not by fat consumption (notwithstanding the fact that the government and the medical community counsel diabetics to eat a low fat diet). So a bad TC to HDL ratio, which is the best predictor of heart troubles, is caused by carbohydrate consumption, not fat consumption. Don't believe it, read on.
"A high TC to HDL ratio drops rapidly with dietary changes such as replacing refined carbohydrates with healthy high fat foods."
This means that as you remove refined carbohydrates from your diet, your HDL goes up, which lowers the TC to HDL ratio (a good thing). But the HDL goes up because your body is getting healthier because you've eliminated the carbohydrates which are killing you. As we have seen, raising your HDL by whatever other voodoo you may do has no health benefit. The higher HDL is a result, not a cause of better health! Want a healthier heart? Stop eating refined carbohydrates.
"And just 30 min of moderate activity a day more than three times/week...helps reverse insulin resistance...within months in sedentary middle-aged adults. This... suggests even a little activity goes a long way."
. You don't have to run marathons or have the body of a 21 year old to improve your heart health. And while even moderate exercise helps reverse insulin resistance, you know what works better? That's right, stop eating refined carbohydrates.
"Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 min a day and eating real food. There is no business model or market to help spread this simple yet powerful intervention."
Back to where we started. Good health makes a lot of sense, it just doesn't make a lot of dollars. Walking is free. Eating real food might actually be cheaper in the long run because you will find you eat less. But even if this way of living costs you some money, even if it's more than you spend now on exercise and diet, one of my other favorite expressions applies here: "You can pay the farmer, or you can pay the doctor."
The choice is yours.