We’ve been told for decades that saturated fat clogs coronary arteries. Butter, cheese and ice cream are supposed to be the enemies of a heart-healthy diet. But three cardiologists challenge the conventional wisdom. Instead of shunning saturated fat they emphasize “walking 22 min a day and eating real food.”
Food Flip Flops Create Confusion:
It is hard to give up entrenched beliefs. We cling to our dogmas the way a drowning man holds on to a life preserver. Eventually, though, the weight of the evidence forces people to accept a new paradigm. That was true for the flat earth defenders. Perhaps it’s time for the diet dictocrats to reconsider their demonization of saturated fat.
The New Paradigm:
Three cardiologists have broken ranks with many of their colleagues in an editorial published in the British Journal of Sports Medicine (April 25, 2017). These are not just any old cardiologists.
One is Rita Redberg, MD, MSc. She is Professor of Medicine at the University of California, San Francisco, and Director of the UCSF Women’s Cardiovascular Center. She is editor of one of the world’s pre-eminent medical journals, JAMA Internal Medicine. Pascal Meier, MD, is an interventional cardiologist at University Hospital Geneva and The Heart Hospital, University College London Hospitals. He is Editor-In-Chief of Open Heart (BMJ), associate editor of the BMJ (British Medical Journal) and associate editor of the Cochrane Heart Group. Lead author, Aseem Malhotra, MD, is consultant cardiologist at London’s Lister hospital and at the Frimley Health NHS Foundation Trust. He has emphasized an anti-inflammatory diet, exercise and stress management in helping control heart disease.
Here is the radical title of their article:
“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”
If you think their title is heretical, just read the first paragraph of their editorial:
“Coronary artery disease pathogenesis and treatment urgently requires a paradigm shift. Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong. A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults. Similarly in the secondary prevention of CHD there is no benefit from reduced fat, including saturated fat, on myocardial infarction, cardiovascular or all-cause mortality. 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.”
That introduction challenges the very foundation of modern medicine. In particular, it threatens the cardiology community, the nutrition authorities and the diabetes experts. For decades, these health professionals have told patients that saturated fat is the source of all evil when it comes to heart disease, diabetes, and death.
Any study that contradicted this message was discounted or ignored. But what does the evidence actually reveal?
The Science of Saturated Fat:
The cardiologists who authored the new paper point out that most heart attacks occur in coronary arteries where there is little plaque. They go on to challenge their colleagues with more heresy:
“The limitation of the current plumbing approach (‘unclogging a pipe’) to the management of coronary disease is revealed by a series of randomised controlled trials (RCTs) which prove that stenting significantly obstructive stable lesions fail to prevent myocardial infarction or to reduce mortality.”
In other words, the stable calcified plaque visible in coronary arteries and that causes narrowing of the vessels may not be as dangerous as many cardiologists or their patients have been led to believe.
The authors suggest that inflammation within the wall of the artery is the true culprit. They liken this inflammation to a pimple. When it ruptures (“analogous to a pimple bursting”) inflammatory compounds cause a blood clot that quickly leads to a heart attack.
Reducing Inflammation:
The editorial in the British Journal of Sports Medicine emphasizes that a Mediterranean diet reduced heart attacks and deaths dramatically even though it did not lower LDL cholesterol. The cardiologists conclude:
“It is the alpha linoleic acid, polyphenols and omega-3 fatty acids present in nuts, extra virgin olive oil, vegetables and oily fish that rapidly attenuate inflammation and coronary thrombosis.”
They go on to pin the tail on insulin resistance. These cardiologists suggest that chronically elevated insulin levels are “at the root of heart disease, type 2 diabetes and obesity.” Instead of worrying about LDL cholesterol, they say we should be “replacing refined carbohydrates with healthy high fat foods.”
Exercise is also central to their program. They point out that “30 min of moderate activity a day more than three times/week” lowers insulin resistance.
Push Back from Medical Mainstream:
You will not be surprised to learn that this message has not gone over well with mainstream medicine. Other cardiologists have labeled the editorial as “misleading.” That’s about the nicest thing the cardiology critics have offered.
They insist saturated fat clogs coronary arteries and that LDL cholesterol is the unequivocal super bad guy. Studies that suggest anything else are criticized for poor methodology. Cardiologists have complained that the editorial will sow confusion, doubt and mistrust of standard dietary advice.
Who To Trust?
Some of these experts no doubt told their patients to give up on butter and switch to margarine. For about 50 years, health professionals insisted that hydrogenated vegetable oils were heart-healthy. We now know that advice was totally backward. Trans fats (hydrogenated oils) were responsible for a substantial increase in heart disease and no doubt contributed to a great many excess deaths (JAMA Cardiology, online, April 12, 2017).
Nutrition experts also told people to avoid avocados, eggs, coconut oil, chocolate, full fat yogurt, olive oil and nuts. Now we are told that such foods are OK, even though they are high in saturated fats. In fact, research has shown that not only are such foods acceptable, they may be better than the low-fat alternatives we were encouraged to eat. It is hardly surprising that people are confused at best and angry at worst.
Our Readers Share Their Perspective:
Annette in North Carolina has words of wisdom:
“My undergraduate nutrition professor often repeated these simple and wise words: ‘Eat a balanced diet. Balance means variety. Eat it in moderation.’
“I would add: eat foods in their most natural and original state, eating as little as possible from a package or box. I often recall these words when I hear the latest news on diet and nutrition. So many new findings contradict the previous advice.
“Although I am a veterinarian with an interest in nutrition, I have decided that at this point in time, there’s not much point in studying nutrition; it is a primitive and poorly developed field.”
Judy in Boone, NC, shares her experience with fat:
“I’ve struggled with my weight all my life and nothing worked but the Atkins diet. I’d heard so much about how bad it was for you that I hesitated to use it in my mid-60s even though I was obese and had high triglycerides and unbalanced cholesterol.
“Fortunately, I encountered a doctor whose own experience as a diabetic (Type 1) motivated his study of nutrition. The low-carb diet he gave me is from Duke University, but I recognize the structure. Eight months later, 30 lbs gone, blood chemistry balanced (and, yes, I’m exercising by walking up and down the hills in my neighborhood). I’ve added a few blueberries and walnuts to my (2% Greek) yogurt, and I can keep this up.
“Even my husband’s cardiologist is telling him about the current research and that fats aren’t the enemy. So, at least here in the mountains, the word is out. Thank you, Joe and Terry, for being the voice of sanity for so many years. I check any prescription or supplement out with your website before I use it.”
Laura in Indiana offers her perspective on margarine:
“I am not surprised, but I am disappointed that it took them so long to come out with the truth. There was a time when I used margarine and skim milk. But, one very hot day, about 30 years ago, I noticed the margarine was still in fine form –unlike sticks of butter I remembered from earlier years sitting melted on a dish.
“I thought to myself and wondered what each looked like in my warm blood vessels. That is when I switched back to butter and full fat dairy. I am lactose intolerant and am thankful for lactose free milk, cottage cheese, and ice cream — the lactose in butter does not bother me (the higher the fat content, the less lactose).”
Read More About the Science:
If you are having a hard time swallowing the saturated fat story, here are some articles we have written about the research. We encourage you to review the data for yourself.
The People’s Pharmacy Bottom Line:
Please take time to read the editorial in the British Journal of Sports Medicine (April 25, 2017). It is short and well written. You will discover some common sense suggestions:
Exercise! The authors recommend 30 minutes of brisk walking more than three days a week. Who can argue with that?
Eat real food! Cut back on unpronounceable chemical ingredients found in packaged food. Highly processed carbohydrates (white flour) and sugar contribute to insulin resistance, a major problem in heart disease. Good fats are actually healthy for your heart.
Control chronic stress. When you feel overwhelmed and anxious, the body’s hormonal response will shift to a pro-inflammatory state. Brisk walking and deep breathing can counteract chronic stress.
Finally, listen to our radio show with Dr. Mark Hyman on How to Eat Fat & Get Thin. You can listen to the streaming audio for free. Just click on the green arrow inside the black circle at the top of the page.
