I almost have to apologize to you for having you read this. But the clamor of the newly re-frightened public and confident pronouncements of the media (you know, those people who report nothing antagonistic to Big Pharma and healthcare because industry advertising dollars now dominate air time and they love scary health headlines) makes it necessary. It’s prompting absurd headlines like “Coconut oil as bad as beef lard.” What is shocking about this American Heart Association (AHA) announcement is that there is almost nothing new here, just a rehashing of old arguments, despite all the media fanfare.
We’ve been hearing it for years: Cut total fat and saturated fat, eat more unrefined grains for heart health and reduction of cardiovascular risk. The panel members of this recent AHA Presidential Advisory (refreshingly, only one panel member admitted to deep and substantial ties to the pharmaceutical industry, uncommon for such committees) reiterated several arguments:
- Reducing saturated fat reduces cardiovascular risk
- Replacing saturated fats with polyunsaturates reduces cardiovascular risk
- Replacing saturated fats with refined grains and sugars raises risk
- Replacing saturated fats with unrefined grains reduces risk
By now, these arguments should be familiar to you, as they have been repeated countless time by the media, doctors, and the drug industry.
What is astounding about this document is that many of the old, tired arguments and bad science are still being held up as proof of, for instance, saturated fats as a cause for heart disease. The same twisted and misrepresented data, most from the 1950s and 1960s, that was originally used to prop up the arguments are once again offered as proof, such as the 1960s Los Angeles VA Study in which 850 elderly men living in a VA home had consumption of a saturated fat-rich diet compared with a polyunsaturated oil-rich diet (soybean, safflower, cottonseed, corn). There were 70 deaths among the saturated fat group compared to 48 in the polyunsaturated group–small numbers, but concerning . . . but the original study failed to factor in that there were twice as many smokers among the saturated fat group. Also, the number of cancers in the polyunsaturated group was twice that of the saturated fat group. In other words, there may have been a reduction in heart disease deaths, but the total effect was nil, suggesting the apparent heart benefit was illusory, a statistical anomaly and due to mismatched groups with regards to smoking. (Incredibly, the AHA panel trumpet reductions in total cholesterol over and over again, a worthless observation given the nearly useless nature of total cholesterol, since it typically drops because HDL cholesterol contained within drops–not good.) All four of these old studies similarly are plagued by serious problematic flaws. Yet these flawed studies were once again held up as the reason that the AHA sticks to its argument that replacing saturates with polyunsaturates reduces cardiovascular risk by 30%.
Despite this astounding recycling of flawed and outdated data, the AHA panel did concede that the advice offered by AHA and doctors for years to replace fats with carbohydrates does not work and may even increase cardiovascular risk. They should have conceded this years ago, but at least they do so now—better late than never. And this is a big, though mentioned only minimally, admission. What they should have said is that “You know how we’ve recommended cutting fat and increasing grain consumption? Not only did it not work in reducing cardiovascular disease, but it added to the nation’s burden of type 2 diabetes and obesity.” No such admission will ever be made, of course—too much liability, too much loss of credibility, too much loss of revenues.
The best funded and largest trial studying a lower fat diet was the Women’s Health Initiative that began in 1993 and compared 30,000 women consuming their usual “high-fat” diet (37% of calories as fat) with 20,000 women instructed to reduce their fat and include more whole grains. This study was indeed mentioned by the AHA panel. But, as many conventional dietary thinkers have done in past, they dismiss the lack of any reduction in cardiovascular events, cancers, or weight as a fluke.
Given the lack of real evidence that reducing saturated or total fat reduces cardiovascular risk, the panel then resorts to the weakest source of data of all: observational epidemiological studies, the sorts of studies that rely largely on questionnaires on what participants ate, a study design that is widely accepted to almost never establish cause-effect relationships, only potential associations or hypotheses. The deficiencies in such studies have been widely debated (here is a terrific summary by journalist Gary Taubes). Note that it is this very same study design, for example, that led doctors to prescribe Premarin because in observational studies this form of horse estrogens was shown to reduce breast, endometrial, and other cancers, as well as cardiovascular disease, causing the drug to be the #1 top selling drug for many years—until the proper prospective, blinded study demonstrated that, not only did Premarin not reduce cancer or heart disease, it increased the incidence of both. This occurred, of course, after millions of women had been exposed to the drug. (More about the Premarin debacle here.) This has been the problem that has plagued observational epidemiological studies all along, but that does not stop the scientists who embrace such study design (the AHA panel’s Walter Willett is the chief proponent of this method) to make pronouncements such as “Red meat consumption causes heart disease and cancer.” And, by the way, a growing body of epidemiological data suggest that polyunsaturates are linked to causing cancer. In other words, taking epidemiological data seriously leads to false conclusions, confusion . . . and spectacular headlines.
The media reported this as if it was some new big study, a new revelation, a confirmation of conventional medical wisdom, when it is little more than a tired, old chronology of an astounding collection of blunders. And why would you believe anything that comes from an organization that labeled Crisco, Count Chocula, and Cocoa Puffs “heart healthy”? Oh, by the way, remember that AHA advice to keep sodium intake to no more than 2300 mg per day? That has now been conclusively shown to increase death from cardiovascular disease.
Encouragingly, the panel made a lengthy acknowledgement of the lipoprotein and metabolic distortions—small LDL particles, reduction in HDL, rise in triglycerides, rise in abnormal postprandial lipoprotein metabolism, increased blood sugar, inflammation—that develops with carbohydrate consumption, a small step in the right direction, but only mechanistic. But, perhaps in another 10, 20, or 30 years, the AHA panel will be saying something like “Grains and sugars should be consumed in minimal amounts and, in the setting of strict carbohydrate limitation, the atherogenicity (heart disease-causing potential) of saturated fats is disabled. It is therefore clear that saturated fat consumption is benign and does not contribute to cardiovascular risk.” Perhaps this will only happen, however, only if Big Pharma develops drugs to “treat” the patterns that emerge from such a dietary shift.