Editorial Claims Bad Rap for Saturated Fat, Disputes Dietary Dogma.

The contention that dietary saturated fats aren’t the bad guys that policies and guidelines have portrayed for decades has reemerged in the literature, this time in an “Observations” opinion piece in published in BMJ.

“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,” according to the author, Dr Aseem Malhotra (Croydon University Hospital, London, UK). “Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks.”

Moreover, he writes, “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.”

To back his claims, Malhotra cites reports suggesting that:

·         Low-saturated-fat diets cut levels of lower-risk large, buoyant LDL particles rather than the small, dense LDL particles thought to worsen cardiovascular disease.

·         Dietary saturated fat may actually protect against cardiovascular risk.

·         Low-fat diets promote an atherogenic pattern of blood lipids and worsen insulin resistance.

·         Low total-cholesterol levels are “associated with cardiovascular and noncardiac mortality, indicating that high total cholesterol is not a risk factor in a healthy population.”

·         Even in secondary prevention, no cholesterol-lowering drug besides statins has shown survival benefit, supporting the hypothesis that the benefits of statins are independent of their effects on cholesterol.

·         The “Mediterranean diet” confers three times the survival benefit in secondary prevention, compared with statins; it led to a 30% improvement compared with a “low-fat” diet in the PREDIMED study.

“It’s risky to pick and choose studies on which to base judgments” and to tell only part of a large story, according to Dr Alice H Lichtenstein (Tufts University, Boston, MA), who directs her center’s Cardiovascular Nutrition Laboratory.

In just one example cited for heartwire , she said that “the PREDIMED trial did show that in high-risk people the Mediterranean diet achieved a 30% improvement over a ‘low-fat’ diet.” However, a low-fat diet in PREDIMED meant 37% of calories from fat, not the usual definition. “And the benefit was seen only for stroke, an outcome most closely associated with blood pressure, not plasma cholesterol levels,” Lichtenstein said.

She continued, “Based on the totality of the data, the best advice we can give is to consume a moderate-fat diet (25% to 35% of energy) and substitute polyunsaturated fat for saturated fat—that is, vegetable oils for animal fats, including meat and dairy—all within the context of a calorie intake that is consistent with achieving and maintaining a healthy body weight. Given the plethora of food choices currently available, that should not be a difficult task.”

Source: Medscape.com

Saturated fat heart disease ‘myth’

The risk from saturated fat in foods such as butter, cakes and fatty meat is being overstated and demonised, according to a cardiologist.

Dr Aseem Malhotra said there was too much focus on the fat with other factors such as sugar often overlooked.

It is time to “bust the myth of the role of saturated fat in heart disease“, he writes in an opinion piece in the British Medical Journal.

But the British Heart Foundation said there was conflicting evidence.

It added reducing cholesterol through drugs or other means does lower heart risk.

Studies on the link between diet and disease have led to dietary advice and guidelines on how much saturated fat, particularly cholesterol, it is healthy to eat.

Millions of people in the UK have been prescribed statins to reduce cholesterol levels.

Dr Malhotra, a cardiology registrar at Croydon University Hospital, London, says 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”.

Saturated fat

  • Saturated fat is the kind of fat found in butter and lard, pies, cakes and biscuits, fatty cuts of meat, sausages and bacon, and cheese and cream
  • Eating a diet that is high in saturated fat can raise the level of cholesterol in the blood, which increases the risk of heart disease, according to NHS Choices.
  • Most of us eat too much saturated fat – about 20% more than the recommended maximum amount.
  • The average man should eat no more than 30g of saturated fat a day.
  • The average woman should eat no more than 20g of saturated fat a day.

He says saturated fat has been “demonised” and any link with heart disease is not fully supported by scientific evidence.

The food industry has compensated for lowering saturated fat levels in food by replacing it with sugar, he says, which also contributes to heart disease.

Adopting a Mediterranean diet – olive oil, nuts, oily fish, plenty of fruit and vegetables and a moderate amount of red wine – after a heart attack is almost three times as powerful in reducing mortality as taking a statin, writes Dr Malhotra.

However, Prof Peter Weissberg, medical director at the British Heart Foundation, says studies on the link between diet and disease frequently produce conflicting results.

Unlike drug trials, it is difficult to carry out a controlled, randomised study, he says.

“However, people with highest cholesterol levels are at highest risk of a heart attack and it’s also clear that lowering cholesterol, by whatever means, lowers risk.”

Cholesterol levels can be influenced by many factors including diet, exercise and drugs, in particular statins, he adds.

“There is clear evidence that patients who have had a heart attack, or who are at high risk of having one, can benefit from taking a statin.

“But this needs to be combined with other essential measures, such as eating a balanced diet, not smoking and taking regular exercise.”

Statins are a group of medicines that can help lower rates of cholesterol in the blood.

Cholesterol can also be reduced by eating a healthy, balanced diet, maintaining a healthy weight and doing regular physical activity.