Two major studies conclude that saturated fat does NOT cause heart disease

One of things I try and do on this blog is right what I see as nutritional wrongs. So, if there’s a common perception that artificial sweeteners are better than sugar for weight loss, but there’s really no evidence for that, then I’m inclined to write about it. If the evidence suggests that margarine is likely to be unhealthier than butter, I’ll write about that too. Similarly, I’ve been keen to point out that it appears that saturated fat, widely taken as to be artery-clogging and heart disease-provoking, is nothing of the sort.

I have written more than once about this, most recently here. This review of the literature found no evidence that saturated fat causes heart disease. And it’s a shame (in my opinion, anyway), that this study got no mainstream publicity.

The same, appears to be true, of a recent report published in the Annals of Nutrition and Metabolism [1]. You can read a complete version of this report here. The whole edition of this journal was dedicated to reporting an ‘Expert Consultation’ held jointly by the World Health Organization (WHO) and Food and Agriculture Organization (FAO) of the US. The consultation took a wide, sweeping look at the relationship between fats, physiology and health, and took place in late 2008. One of the things that was inevitably a focus of the consultation was the link between saturated fat and heart disease.

The ‘experts’ responsible for assessing this relationship looked at two lines of evidence: epidemiological studies and intervention studies. Let’s look at both in turn.

Epidemiological studies look at the relationship between factors (such as smoking and lung cancer, exercise and dementia, saturated fat and heart disease) in populations. These studies can only really tell us about associations between things, but can’t generally be used to inform us if one thing is causing another. Nevertheless, if saturated fat does truly cause heart disease (like we’ve been told for the last few decades), then the epidemiological evidence should show that higher levels of saturated fat are associated with a higher risk of heart disease (also known as ‘coronary heart disease’ or ‘CHD’ for short).

Well, according to the WHO/FAO report, there is no association. Here’s what the report states:

“Intake of SFA [saturated fatty acids] was not significantly associated with CHD mortality…

and also

SFA intake was not significantly associated CHD events [e.g. heart attacks]…”

And now on to intervention studies

In such studies, individuals a subjected to some sort of intervention (such as a medication, increased exercise or dietary change). The relevant intervention in this area is to put people on a low saturated fat diet diet, and see how they fare compared to individuals who are not subjected to this change. Unlike epidemiological studies, intervention studies can prove ‘causal’ links between things. For example, if eating less saturated fat leads to a reduced risk of heart disease, then it’s a pretty good bet that saturated fat causes heart disease (all other things being equal).

So, what did the WHO/FAO report find with regard to relevant intervention studies? Here’s what:

“…fatal CHD was not reduced by…the low-fat diets…”

Just this week saw the publication of another huge study which assessed the relationship between saturated fat and heart disease [2]. This study was actually an amalgamation (meta-analysis) of 21 epidemiological studies. Taken all together, this review monitored almost 350,000 people over between 5 and 23 years. And here’s what it found:

1. No association between saturated fat and risk of heart disease

2. No association between saturated fat and risk of stroke

You know what this all means, don’t you? That there really is no evidence that saturated fat causes heart disease or cardiovascular disease generally.

Despite all this evidence to the contrary, I suspect the idea that saturated fat causes heart disease will perpetuate for some time. One reason for this has to do with cholesterol. There is some evidence that saturated fat puts cholesterol levels up, and we all know that cholesterol causes heart disease, right? So, if saturated fat puts cholesterol up, it must increased the risk of heart disease too. Well, this line of argument assumes that cholesterol causes heart disease, and actually the evidence shows this is far from assured. But even if it did, the logic is still faulty. We could use the same logic to claim that if something causes cholesterol to fall it must be good for heart health. So, if arsenic and cyanide reduce cholesterol, should we all be swigging these poisons down every day?

Anyway, while the ‘cholesterol causes heart disease’ paradigm is prevalent, I think saturated fat is going to be in the firing line. Shame, because at worst it appears an innocent bystander.

Another reason that saturated fat is likely to get a hard time for some time yet has to do with the fact that paradigms do tend to change very slowly. And at least some of this has to do with a reluctance some of us have to changing our minds about things we ‘know’. Some of us feel we ‘know’ saturated fat causes heart disease, because we’ve been told it so often and consistently we’re not even inclined to challenge this notion. And if we happen to be health professionals or academics who, at least in part, define ourselves by our ‘knowledge’ and ‘intelligence’, it can be mightily difficult to admit that we were wrong.

Not being a literary type, I’m not really a quote person either. But I do know at least one. It is British economist’s John Maynard Keynes’ assertion that When the facts change, I change my mind. What do you do, sir? How I would like to see health professionals and Government departments take a leaf out of Keynes’ book, and make pronouncements regarding saturated fat and other dietary factors based on science fact (not fiction).

References:

1. Fats and Fatty Acids in Human Nutrition. Annals of Nutrition and Metabolism, 2009; 55 (1-3).

2. Siri-Tarino PW, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Am J Clin Nutr 13 January 2010 [epub ahead of print].

85 Responses to Two major studies conclude that saturated fat does NOT cause heart disease

  1. Margaret Wilde 15 January 2010 at 5:15 pm #

    “It is British economist’s John Maynard Keynes’ assertion that “When the facts change, I change my mind. What do you do, sir?””

    That’s a great quote you’ve given us, Dr Briffa! Thank you.

    It’s very disturbing that Government agencies condemn ‘fatty food’ so stridently. I remember reading years ago about very young children in a family actually dying because their food contained so little fat! – Their well-meaning but ill-informed parents were under the impression that a low fat intake was healthy and had thought they were doing their best for their children.

    The highly paid government ‘experts’ who are constantly given airtime are clearly not reading up-to-date research as you are doing, Dr Briffa, and yet keeping up with new research should be part of the job description, surely? – I wonder if/when anyone who has suffered harm because of accepting the ‘expert’ advice will sue for professional negligence, or whatever the correct terminology is…

  2. Dr John Briffa 15 January 2010 at 5:24 pm #

    Margaret

    “I wonder if/when anyone who has suffered harm because of accepting the ‘expert’ advice will sue for professional negligence, or whatever the correct terminology is…”

    I don’t want to be unduly cynical, but my sense is that only once we have one more more class actions instigated by those who appear to have suffered at the hands of unsupportable and unscientific advice, will real progress be made.

  3. Margaret Wilde 15 January 2010 at 5:45 pm #

    “I don’t want to be unduly cynical, but my sense is that only once we have one more more class actions instigated by those who appear to have suffered at the hands of unsupportable and unscientific advice, will real progress be made.”

    I think you are right, John.

  4. Chris 15 January 2010 at 7:09 pm #

    We’re lacking a few key concepts to get the case across. It is not just a question of persistence with the old and resistance to the new. The issues range much wider in society. I am working on something. My family complain I am obsessed, a rift is developing with siblings, my thoughts isolate me from the rest of humanity, my thoughts distract me, I miss motorway junctions for being lost in thought. It’s madness, John, but truly I would go insane if I didn’t persist and run with my convictions. Luckily, one or two people express recognition and support in the ideas I run with.
    ‘Trick and Treat’ (Barry Groves) resounds with me because of the lengths he goes to illustrate the corruption. The burgeoning cost to the health service is unsustainable.

    I have developed one or two conceptual tools that contribute to a wider expose. Something, even I am not quite sure yet, is dropping out of this melange (sometimes blancmange) of thoughts in my head. When it does I’ll have some weaponry to counter this madness. Once it’s complete I will willingly share the reasoning and concepts.

    Thanks for the blog and thanks for the references, John. You are a source of great inspiration.

  5. Hilda Glickman 15 January 2010 at 8:38 pm #

    It is not nutritionists but dieticians who perpetuate these myths. It is all so simple. Eat fat that we were meant to eat such as unprocessed nuts and seeds, free range meat , oily fish. Keep away from ALL processed fats that have been made in a lab. However the problem is the way in which animlas have been raised. Eat organic grass fed beef (if possible). See Dr Myhill-fab site on healthy eating. Hilda Glickman Nutritionist

  6. Hilda Glickman 15 January 2010 at 8:38 pm #

    Hilda Glickman says:
    It is not nutritionists but dieticians who perpetuate these myths. It is all so simple. Eat fat that we were meant to eat such as unprocessed nuts and seeds, free range meat , oily fish. Keep away from ALL processed fats that have been made in a lab. However the problem is the way in which animlas have been raised. Eat organic grass fed beef (if possible). See Dr Myhill-fab site on healthy eating. Hilda Glickman Nutritionist

  7. Peter Silverman 15 January 2010 at 9:21 pm #

    It seems like most recent research absolves saturated fat of causing heart disease but implicates it as a cause of breast cancer and other cancers.

  8. Edward 15 January 2010 at 9:27 pm #

    In physics at least (my former field of study) paradigms tend to over-shoot – rather like cartoon characters going past the edsge of a cliff – until the evidence for rebuttal is way past the seemingly necessary level. They then flip remarkably quickly.

    It has even been suggested that the paradigm shift requires a generational change, so that those who know “how it is” have retired and been replaced by those brought up on the new evidence.

  9. Catherine Dignan 15 January 2010 at 10:30 pm #

    It is very difficult to change entrenched ideas particularly when they are peddled as gospel by the medical profession, who I am reliably informed don’t receive much in the way of nutritional training. But at least some progress has been made in the last ten years: the benefits of fish oils, for example, have been recognised and not lumped together in the “all fats are bad for you” mantra as they were until quite recently, in spite of the fact that fats and cholestorol itself are essential building blocks needed by the body.
    As regards saturated fats, Dr Natasha Campbell McBride has some interesting things to say about these and cholestorol in her book “Put Your Heart in Your Mouth”. Referring to cholestorol, she says “If you are found at the scene of the crime you are likely to be blamed for it”. Damaged cholestorol is another matter.

    So what is it that damages cholestorol? She describes how the endothelium becomes injured and the liver sends more and more cholestorol in an attempt at repair in a never ending process of inflammation with the presence of C-reactive protein, not cholestorol being the universal marker for heart attack and stroke. This process of chronic inflammation as the root cause of most degenerative diseases of the Western world has been described by many writers in the field. In addition, as far back as 2002, Dr Briffa pointed out in his book “Ultimate Health” other factors such as damaged fats, especially hydrogenated fats and trans-fatty acids, the presence of homocysteine and the importance of controlling insulin by avoiding and excess of refined foods and too much sugar or anything which converts quickly to sugar such as processed carbohydrates. The link between cardiovascular health and the development of other major diseases such as diabetes, poor thyroid function and probably also dementia,too, makes sense since many of these also point to a lack of nutrients rather than the presence of one single substance as a likely explanation of such epidemics. Nutrients such as magnesium, Vitamin D, B vitamins, co-enzyme Q10, selenium and many others are probably lacking in sufficient quantitiy in the modern diet. As the saying goes, if it is a plant, eat it; if it’s made in a plant then don’t.

    There are probably many factors underlying the process of chronic inflammatory disease as well as diet. Gum health is known to be important as well as lack of activity. A recent study linked the number of hours spent watching TV directly with poor vascular health. In one sense, although they often died of infections, the Victorian working classes were apparently much healthier than us because their lives were more physically demanding.

  10. Jamie 16 January 2010 at 12:55 am #

    John,

    Thanks for that summary. I like this extract from:
    Review of Fat and Fatty Acid Requirements and Criteria for Developing Dietary Guidelines
    Smit, L.A. ; Mozaffarian, D. ; Willett, W.
    Ann Nutr Metab 2009;55:44-55

    “The 1994 FAO/WHO report recommended a saturated fat intake <10% of energy for adults. The most often cited criteria for saturated fat recommendations are effects on one physiological measure of cardiovascular disease (CVD) risk, namely LDL-C. Saturated fats increase LDL-C, but also increase HDL-C and
    decrease triglyceride levels, resulting in little net effect on total cholesterol:HDL-C compared with carbohydrates [Mensink et al., 2003]. Studies suggesting adverse effects of saturated fat on
    heart disease often use polyunsaturated fatty acids or whole grains and fruits and vegetables as replacements for saturated fat [Mann, 2002]. In contrast, exchanging easily digested carbohydrates for saturated fat (such as in a low-fat diet) would have little predicted net benefit on serum lipids and lipoproteins for reducing risk of CVD, because this would lower HDL proportionally as much as it lowers LDL, and also raises triglycerides [Sacks and Katan, 2002]. Therefore, limits on saturated fat intake should be considered in the specific context of the replacement nutrient, as replacement with carbohydrates
    (particularly easily digestible carbohydrates) may have little benefit.”

    I note too in another passage that reductions in saturated fat only ever showed reductions in CHD after the inclusion of the Oslo study to the meta-analysis. However, this study also included a smoking cessation programme so the effect likely came from that rather than the reduction in SFA.

    Until recently, I was a health professional (nutritionist) that towed the party line on this & other aspects of public health nutrition. And I note too that one of the papers referenced by you John was from the University of Otago where I trained & was written by my ‘fat’ lecturer, Dr Murray Skeaff (who has always been pro-fat but obviouysly also had to tow the line in teaching that SFA was implicated in CHD/CVD).

    I really started to smell a large rodent with what I had be taught when looking at vitamin D circa 2006 – what I had been told about vitamin D wasn’t stacking up. Anyway, I am very glad that I didn’t go on to study dietetics (would most likely have been a lost cause then… I recall cleaning up after a dietician colleague tried to convince a farmer to go vegetarian!), that I have remained open to new information, that I have stayed outside of public health (means I can say what I like in terms of advice given), and that I have been fortunate to tap into like-minded critical thinkers such as yourself Dr Briffa.

    Jamie

  11. Alison Simpson 16 January 2010 at 12:56 am #

    It is not only health professionals and the government that perpetuate these myths about the role of saturated fat and cholestrol in heart disease ….. what about the food industry and big pharma? With the start of the new year, predictably all the press and adverstising is focussed as per usual on the so called healthy alternative of the low-fat if not no-fat diet. There’s too much money being made by big business, so I imagine they are keen to keep these kinds of studies under the radar! As the saying goes ‘Follow the money’!! Keep up the good work John – you’re one of the few medics that talks any sense!

  12. Sue 16 January 2010 at 3:05 am #

    I can’t see how saturated fat is implicated in breast cancer and cancers?

  13. Dr John Briffa 16 January 2010 at 11:02 am #

    Peter

    Can you substantiate your claim that saturated fat is implicated in breast cancer with references?

  14. Derek 16 January 2010 at 11:25 am #

    Back in ’06, I suffered a heart attack. The condition was not recognized for around 6 hours, because I had entered zazen (Zen meditation) to keep calm and transcend the pain of what I thought was a stomach condition such as an ulcer. My heart rate and BP remained normal throughout and it was only an ECG that confirmed heart attack. During a subsequent angiogram, I was told my arteries were in A1 condition. My blood was very clotted and this was genetic and that condition would be addressed.

    I was put on statins, beta blockers, an ace inhibitor and aspirin on leaving hospital, and my life became one big struggle with constant exhaustion and muscle pain. I was also on a low-fat diet. After two years of this, I quit all the drugs except for the low-dose aspirin and got my energy back. My muscles however have remained painful. I have also learned that lowering my cholesterol too much with the statins may have been causing such side-effects and that may be permanent.

    I now monitor my cholesterol and it is according to the “authorities” high. My “sticky blood” is fine. Whether or not the drugs would have extended my life or not, I will never know, as “how long is a piece of string?” I prefer quality to quantity and one thing is certain… we all die sooner or later and in nature, death comes with little warning.

  15. Margaret Wilde 16 January 2010 at 2:38 pm #

    Derek

    If you want to lower your cholesterol you can do so by minimising your sodium intake. See http://rayhayden.us/lowsodium.html

    This is one of the many benefits of sodium reduction that is rarely mentioned.

  16. Susan 16 January 2010 at 5:16 pm #

    Apart from heart disease I have read that high cholesterol is associated with increased risk of Alzheimers disease.
    What’s your comment on this Dr Briffa?

  17. Peter Silverman 16 January 2010 at 5:20 pm #

    Dr. B: you asked for some citations about saturated fat and increased cancer risk.

    http://www.cbsnews.com/stories/2003/07/17/health/main563810.shtml

    http://news.bbc.co.uk/2/hi/health/3221283.stm

    http://www.webmd.com/cancer/news/20081113/saturated-fats-intestinal-cancer-linked

    It looks to me like we don’t have the final answer yet on saturated fat and cancer risk.

  18. Jill H 16 January 2010 at 9:26 pm #

    Jonathan Dawid a physicist at Harvard wrote ‘ Every scientist is aware of the limitations of his craft. How can it be otherwise in a profession where each step of progress requires the consignment of another man’s work (and often one’s own) to the dustbin’. A lack of arrogance and an open mind must be important attributes to a scientist. I remember reading back in 1994 that we were all in danger of suffering overdoses of Vit D because too many foods were fortified with it. Fast forward to 2010! In his book ‘The Great Food Gamble’ John Humphreys writes that we cannot afford to be ‘blind worshippers’ at the alter of science because then you do not spot things that start going wrong, for example what might happen if we turned cows into carnivores. Sometimes intuition and culture are the most important tools we have and sadly the thread is being broken – mothers no longer pass on recipes to children for example in many cases. I lived in Holland for a while and a traditional dish there was stamppot (kale and spicy sausage with lots of other root veggies); my Irish grandmother made a mean Irish Stew (lamb, lots of root veggies and pearl barley when available) All animals of course would be pasture grazed and free ranging to use their own intuition and graze on rich herbs, wild thyme and clover and bird’s-foot trefoil. The animals need no scientists to tell the what is good for them and where they should go to get the nutrition they need. Michael Pollen’ words spring to mind from his book ‘In Defense of Food’ – Eat food, not too much, mostly plants’

  19. Jamie 16 January 2010 at 9:58 pm #

    @ Derek;

    Given your leg pain & your use of statins, I’d suggest a vitamin D test if you haven’t already had one as your vit D status may have been compromised.

  20. Hilda Glickman 16 January 2010 at 11:56 pm #

    Cholesterol is neither good nor bad . It is needed by every cell in the body. It is oxidised cholesterol that is the problem. It is used to patch up damaged arteries caused by free radicals. These cause inflammation so maybe statins work by reducing inflammation. A diet high in antioxidants is vital to prevent this
    Those on stains should read abou coQ10 as statins reduce this in the body. CoQ10 is needed for energy, the heart , almost everywhere in the body.

  21. Sue 17 January 2010 at 3:54 am #

    Peter, those are all news reports – need to read the actual paper.

  22. Sue 17 January 2010 at 4:04 am #

    Peter, just by reading those news articles it doesn’t make me think that saturated fat is implicated in breast cancer and other cancers. I think they are trying to implicate saturated fat anyway they can.

  23. Richard 17 January 2010 at 6:37 pm #

    Re: Fat and cancer. Like sugar, an excess of fat (approx 37% and above of energy in diet) may impair insulin sensitivity… which can upset hormone balance in the favour of the proliferation of cancer tumors.

    Vessby B, Uusitupa M, Hermansen, K, Riccardi G, Rivellese A, Tapsell LC, Nalsen C, Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB & Storlien LH (2001) Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU study. Diabetologia 44: 312-319

  24. Tanya 17 January 2010 at 7:50 pm #

    Re those news reports

    The one about cancer of the small intestine states that rates have been increasing since the 1970s – round about the time then that people started eating more processed foods (which often included trans and polyunsaturates), and were also told to increase their carbs! Coincidence???

  25. Chris 17 January 2010 at 8:44 pm #

    From Catherine,
    “A recent study linked the number of hours spent watching TV directly with poor vascular health. In one sense, although they often died of infections, the Victorian working classes were apparently much healthier than us because their lives were more physically demanding.”

    I’m in agreement, perhaps sedentary lives are an issue and maybe a good basal level of activity intrinsic to lifestyle beats general sedentarianism compensated by an occasional resentful half hour at the gym; an observation that may apply to some visitors I’ve seen at gyms.

    Studies linking hours spent watching TV with poor health have a trait in common with the FSA study into the content of primary school lunchboxes. They can’t say anything about the functionality of food in health but they can implicate behaviour and practice.
    Both share the trait that the results are largely predictable.

    With the TV study, is it the implied inactivity that has consequence, or is it the transmission and reception of all the advertising that directs individuals to stock up on naff groceries, or is it both?
    And the TV is interesting, what about the FSA ‘Mutton Fat Blocks Drains’ anti-saturated fat message that would willfully direct consumers to migrate to polyunsaturated fats? Is that a promoter of good health or a promoter of ill health. And is the marketing of margarine using functional claims applied to it being fortified with omega-3 EFAs (“…unique blend of essential fatty acids”) directing consumers to improved or reduced health? Bear in mind, the polyunsaturates are pro-inflammatory, and we have a poor conversion rate for the ‘healthy’, supposed counter-inflammatory, plant derived omega-3 that is used to fortify the product, a point recently vehemently and impatiently registered in a petition to EFSA by Wnkler and co-signatories.

    If the content of primary school lunchboxes is largely snack foods conjured from sugar, refined carbs and vegetable oils high in polyunsaturated fat how did they come to be there? Nothing to do with the TV and supermarket marketing tricks, then?

    The Victorians had to battle infectious disease. Quacks use the term ‘communicable’ to mean infectious. Our modern afflictions are referred to as ‘non-communicable’. Might that be a misnomer?

    When I travel I see posters of David Cameron proclaiming his intent to, “cut the deficit, not the NHS.” Might a mantra of, “..tough on inflammation, tough on the causes of inflammation.”, be more enlightened?

    Google ‘Mente systematic review’, that’s the study John brought to our attention back in April, and it returns few results. None of our national papers picked up on it. Unilever, one maker of marg, have a marketing budget of £2.6bn: the papers clamour for a slice of that as advertising revenue. That kind of money is corrupting influence. It’s the corruption that kills me.
    John’s correct, these studies and reviews won’t get the coverage they deserve and it is disappointing. Science minister, Lord Drayson, says all is well with coverage of science in the media. Hmm.

    Cath, I like your points, can you provide a link or reference to that TV study?

  26. Jill H 17 January 2010 at 8:53 pm #

    I like your blog Dr Briffa – it gets me thinking. And all the varied and informative contributions get me thinking too. I revisited today Daphne Miller, M.D.s book “The Jungle Effect” to look again at what has been said about the diet of Crete (upon which many of the elements of the supposedly heart-healthy Mediterranean diet are based) And what she seems to conclude is that it is not necessarily what is in the diet that could be a causative factor for heart disease – for example saturated fat – but more to do with the synergy of a diet and therefore what used to be eaten in a protective diet and is now left out. For example if animals are no longer pasture fed – we no longer get from that meat Omega 3 EFA’s along with the saturated fat. In fact what she seemed to discover in Crete (apart from being told that she must eat slowly!!) is a lesson in the importance of synergy. Using a research paper by Antonia Trichopoulou that was published in the New England Journal of Medicine looking at Cretan food and giving it a points rating she found the following ‘To my surprise, all these supposedly healthy foods such as fish, vegetables, fruits, beans, grains and olive oil all had a hazard ratio for death that was only or slightly less than one. Furthermore, foods generally considered unhealthy such as saturated animal fats had a ratio of only slightly more than one. So how could it be that the Med diet as a whole could be so protective against heart disease …..and yet individual parts of the diet did not stand out as being extra protective?’ The conclusion she came to was that it was a perfect example as to why we have to focus on indigenous diets rather than specific nutrients or individual foods. It could be said that the healing effects of a Mediterranean diet could not be distilled down to a handful of specific foods – it was the food synergy – the way the foods interacted in the recipes – for example olive oil and lemon increased the availability of nutrients in the greens and antioxidants in the olive oil and greens prevented lipid peroxidation of saturated fats. And a glass of wine, of course, contained wonderfully protective polyphenols (sadly just the one!)

  27. Dr John Briffa 17 January 2010 at 9:08 pm #

    Jill H

    Thanks for your kind words. And as far as the Mediterranean/Cretan diet goes, we should also perhaps remember non-dietary ‘confounding factors’ including sunlight and psychological and social factors too.

  28. Chris 18 January 2010 at 11:58 am #

    Dr J – a timely post. Ronald Krauss’s meta-analysis (http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1),on the association of saturated fat and heart disease (conclusion: there is no association), did the rounds of the ‘paleo blogs’ earlier this month. This did not seem to get widespread exposure on the news.

    Today I see this story getting widespread coverage “Butter is utterly bad for everyone, says surgeon” (http://www.metro.co.uk/news/809426-ban-butter-and-live-longer-says-top-surgeon).

    The fear of satfat is a meme that will take years to ‘breed out’ of popular consciousness. To much has been invested in creating this myth to allow it to die easily. The pharmaceutical and exercise industries stand to lose millions from the debunking of this myth and the government will lose a lot of credibility from its deconstruction.

    There will be no change soon.
    Keep up the good work.

  29. Joseph 18 January 2010 at 2:50 pm #

    Good Morning Dr Briffa. This morning news contains comments from Mr Kolvekar, a consultant at University College London Hospitals. He suggests that butter should be banned! The first person i though of when i read this was your good self so i though i would post this and see if you have any comment on Mr Kolvekars suggestion?

  30. Dr John Briffa 18 January 2010 at 3:17 pm #

    Joseph

    If we believe that science should inform such advice, then it seems to me the Mr Kolvekar is just plain WRONG regarding his opinion of saturated fat/butter.

  31. Don't call me cynical !! 18 January 2010 at 6:31 pm #

    ..even if I am, sometimes.
    I just took my regular cyber-promenade to the Food Standards Agency pages and I could not help but notice (Joseph) that Kolvekars’ release coincides with the Agencies phase 2 promotion of the anti-saturated fat campaign. Link and Link. Despite my cynicism, I expressly do not want Dr Briffa or any visitors to his blog to think that there may be an implied connection between these reported events or that a leading brand of margarine might be behind them, because without supporting evidence that would be utterly irresponsible. But between you, me, and the gatepost I do know that the pursuit of profit can make perfectly ordinary people do the strangest things, when they work as part of a large and faceless corporation.

    (Jill) As regards synergies is it not so that certain vitamins etc are fat soluble? Although I wonder if (some) Nutritionists sometimes overplay the synergy card, fat solubility of certain vits and mins is definitely a synergy.
    Can someone verify a query about calcium in milk – does reducing the fat content of the milk render the calcium to be less bio-available?

    Finally, healthy green leaves can be high in fat. What should we make of that?
    Watercress is more that 23% fat! Check for your self.
    The packs have nutrition-boxes so have a look when next shopping. You might need reminding that Watercress is mostly water and you just need to work the percentage according to the total amount of ‘dry matter’ which is about 5.9g per 100g of product. Will they launch low-fat watercress, I wonder?

  32. The other (non-dietician)Kate 18 January 2010 at 8:58 pm #

    I was going to comment on the ‘leading heart surgeon recommends banning butter’ too.
    Interesting points in ‘The Independent’s’ comments pages. All back up what people have been writing here and more specifically pointing the finger at the ‘healthy spread’ (something to do with flowering plants!) manufacturer. Can’t name names of course as people seem to be sued for telling the truth (as in the latest Private Eye issue about kidney disease and contrast dye).
    Keep up the good work.

  33. Chris 18 January 2010 at 9:03 pm #

    To cynical and to Kate.
    Unilever do feature as cited on the Advertising Standards Agency (ASA) website as receiving advertising standards complaints with some frequency, so counter ‘healthy spread sentiment’ may be gathering. ASA do have to take FSA nutritional guidance at face value though, and the traceable history shows complaints are not generally upheld.
    ‘Cynical’, I like your points, but had you considered timing of Kolvekars release might have something to do with the anticipated publication of this second reference (Siri-Tarino) Dr Briffa bogs about? Nobody could be sure, and it could also be a reaction to increasing hostility expressed via complaints to ASA. There’s no way of knowing for certain.
    Timing can be serendipitous. Back in Apiril 2008 Mente was just days after the FSA anti-sat-fat launch, and now Siri-Tarino e-pub preempts FSA phase 2 launch.
    Make the most of serendipity.
    That said, are we certain evidence is clear against excess of poly-unsaturates?
    Kate, mis-appropriation of knowledge economy is a common defense tactic as was the case with tobacco industry.

  34. Dr John Briffa 18 January 2010 at 9:33 pm #

    Kate

    I was following comments regarding this ‘story’ on the Daily Mail website. By mid-afternoon, there were more than 300 comments, and almost all of them were in the margarine is rubbish/nothing wrong with butter/don’t talk rubbish vein. Very heartening.

    Then, about 4.00 pm the comments just vanished into the thin air.

    And then the piece was pulled from the front page of the website (usually stories sit there for a day or more).

    All very odd, though I’m sure there’s a rational explanation for all this.

  35. Dr John Briffa 18 January 2010 at 10:20 pm #

    Kate

    Update: comments are back on the Daily Mail piece. You can read the piece and comments here: http://www.dailymail.co.uk/health/article-1244048/Ban-butter-save-thousands-lives-says-heart-surgeon.html

  36. Janet Alton 18 January 2010 at 10:29 pm #

    Worth pointing out (as I do to personal contacts ad nauseam, I’m sure) a couple of related facts that are never mentioned in the context of saturated fat and cholesterol.

    1. Carbohydrates will raise cholesterol as well. Why? Because when your food is being metabolised (turned into sugars for fuel) BOTH fats and carbohydrates are converted into the SAME substance (acetyl coA) as part of the process. Acetyl coA is the basic building block for cholesterol.

    2. Cholesterol cannot be synthesised by the body from acetyl co-A unless insulin is active in the bloodstream/liver. When is insulin at its highest activity? When CARBOHYDRATE has been eaten.

    So it could be argued that a high-carb diet is just as detrimental as a high-fat diet, in the context of cholesterol synthesis.

  37. Tanya 19 January 2010 at 1:33 am #

    Oh – look whose name appears in this article on the Unilever website!

  38. Tal 19 January 2010 at 10:49 pm #

    Dr Briffa,

    I just wish to thank you for your integrity, honesty and courage in writing this post. You have balls that other media doctors and nutritionists do not

    Tal

  39. Jennifer, Geriatric Clinical Nurse Specialist, USA 20 January 2010 at 9:15 am #

    Dr. Briffa and all-
    I applaud everyone for seeing through our mainstream medical/health advisors who are intimate bedfellows with unethical profit driven pharmaceutical and food industries. Your comments are so encouraging. Daily I see the majority of 75 yr and older patients on statins and “low fat heart healthy diets”. Both they and their caregivers (often very fatigued spouses or siblings) ignorantly and obediently suffer for what is simply the result of our modern world’s biggest profit makers. I just want to weep at the unnecessary suffering. Every day I recommend a “trial” off of statins and a reduction in numerous other meds for patients with “dementia”, neuropathies, muscle pain, fatigue, falls etc. But it is an uphill one voice battle. Dr. Briffa your blog has given me new fuel to be (not to be vainglorious) practice Florence Nightingale ethics. Her battle was to provide her patients the basics-clean air, sunshine, and clean environment. These basics plus so much more as you’ve shown in your blogs are still ignored today. I am very tired of my ethical dissonance, working in acute care, but at the same time chipping away at mistruths to advocate for real quality of life into old age. Western society medicine are walking on dangerous grounds while on one hand Palliative or sx management gains esteem but at the same time accept this suffering as inevitable without looking at why it is becoming so prevelant. I could go on. . .
    I’m afraid I’ve rambled and broke whatever blog brevity rules there are but it was cathartic as I have never used any venue to talk about this before.
    I have read chlsterol myth a couple of times (gave it away both times) plus others like yourself. Has anyone developed a simple point by point rebuttal on the use of statins and low sat fats etc. I would like something like that so I can provide talking points to physicians who want to know the truth or question my recommendations. One advantage I may have is the biggest physician group I work with are all trained in critical research appraisal. I have sat through two of their seminars, ironically they never use statin studies as examples of poor studies.
    thankyou for taking time to read this.
    Jgl

  40. Chris 20 January 2010 at 11:51 am #

    Some short points late in the day on this.

    Can “ethical dissonance” always be expressed briefly? My eyes are moist after reading Jennifer above.

    Lunchbox survey is available on FSA webpages.

    Around this time last year stats for new diagnoses of type 2 diabetes during 2008 were released to the media. To refresh memories it was 150,000 for 2008 as against 100,000 for 2007. Have you, Dr Briffa, or anyone heard the stats for 2009?

  41. Kris Johnson, reformed dietitian 20 January 2010 at 8:55 pm #

    On the connection between Alzh. and cholesterol – Inflammation has been associated with Alzh. and many other chronic diseases. The body’s response to inflammation is try to quell the inflammation, and one of the tools it uses is cholesterol. Hence elevated cholesterol is the result, not the cause.

  42. Kris Johnson, reformed dietitian 20 January 2010 at 9:41 pm #

    Here are some links to omega-6 research. (click on my name)

  43. Christer Sundqvist 21 January 2010 at 12:05 am #

    I sure was delighted to receive, read, analyze and share with my friends Dr. Krauss excellent meta-analysis published in an early January issue of AJCN. Needless to say, I was of course reading other blogger’s responses to the mentioned Krauss-paper. I enjoyed reading the discussion in Dr. Briffa’s blog.

    My simple blog posting (in Finnish!) triggered a massive debate on the role of saturated fats in our food. Prominent Finnish scientists from abroad and living in Finland agreed on the importance of this paper. However, low-fat vs. high-fat still is a very controversial issue in Finland. I managed to toggle down a short summary in English. Otherwise the debate is mostly in Finnish, a tongue you might not be familiar with. Anyhow, here is first the short summary, and the the link to my blog.

    Summary in English
    A considerable amount of readers from the USA, Sweden, Spain and Germany drop in on my healthblog. Most of you might not be familiar with the Finnish language. To make your disappointment smaller, I have decided to toggle down a short summary in English, in particular if the news I am delivering might deserve international attention.
    Some days ago the famous lipid scientist Ronald M Krauss sent me his latest meta-analysis in AJCN of saturated fats vs. cardiovascular disease. Being a keen lover of butter and saturated fats, I found Krauss’ paper of utmost importance. Decades of decades the gospel of low-fat has been heard here in Finland. My friend director Pekka Puska is in love with his North-Karelia-project, and his message has dominated the discussion of fat and carbohydrate ever since the early 1970-ies.
    In a scientific meeting organized by simply me, doctor Mikael Fogelholm and director Pekka Puska in February 9th 2009, people of Finland could feel the first real signs of a tide that might be turning. Even here in low-fat Finland things could change for the better: fat is not the number one killer after all! Director Mikael Fogelholm has several times indicated that the national guidelines of nutrition are about to change for the better: less carbohydrates and more fats.
    My discussion of the importance of Krauss’ recent paper has provoked a lively discussion. Several scientists have expressed their support for me and especially for doctor Krauss. We are struck by the astonishing fact: Not a single newspaper in Finland has taken up the issue of saturated fats vs. cardiovascular disease in the light of the new meta-analysis. However, we have seen warnings not to consume too much butter. It is wrongly supposed to ruin your health. I take great pains to summarize and analyze the discussion (in Finnish).
    Please feel free to contact me, should you be interested in nutrition, health and fitness. Those familiar with blog functions might be able to post their comments in other languages than Finnish. Time permitting I will make your comments available for the Finnish audience. I feel the year of 2010 will be a year when the renessaince of fat is gaining importance even here in the far-away country of Finland. Fat lovers unite!

    http://sundqvist.blogspot.com/2010/01/tyydyttyneet-rasvat-eivat-ole.html

    Please feel free to contact me should you need any assistance considering the discussion of fats here in Finland. I’ll be happy to serve you.

    Sincerely yours,

    Christer Sundqvist
    Sport Nutrition, PhD
    Finland

  44. Catherine Dignan 21 January 2010 at 1:01 am #

    For Chris and anyone else interested – the reference for the study on sedentary lifestyle and heart disease is as follows:

    Professor David Dunstan, from the Baker IDI Heart and Diabetes Institute in Victoria, Australia.

    Read more: http://www.dailymail.co.uk/health/article-1242494/Risk-dying-heart-disease-rises-hour-watch-TV.html##ixzz0dCJCIjk8

  45. Don't call me cynical !! 21 January 2010 at 11:47 am #

    Coverage of the heart consultants’ press release calling for the banning of butter really added some topicality to the thread.
    I can’t avoid noticing the release is very coincident in time with the launch of the second phase of the FSA anti-saturated fat campaign.
    Oddly, the consultants’ name has appeared in timely coincidence before – as the above link illustrates.

  46. The other (non-dietician)Kate 22 January 2010 at 12:56 pm #

    Thanks Dr J, – I’ll take your word for it that the Daily Mail comments are thankfully more rational than the ‘Oh my God, butter will kill you!’ reporting.

    But, but, it’s the Mail! Not my favourite newspaper, I’m an Indie girl.

    Isn’t it great that at some level there are so many more cholesterol sceptics now!

    Again – keep up the good work. I have MS by the way and I’ll keep trying to spread (oops, sorry) the word on various sites. However, most people know that Omega 3 is better for you than the inflammatory Omega 6.

    Would it be possible for you to include an email alert to track replies to your blog?
    very best wishes,
    Kate

  47. Nigeepoo 22 January 2010 at 8:48 pm #

    RE Fats and Fatty Acids in Human Nutrition, the right hand doesn’t know what the left hand’s doing. From Fats and Fatty Acids in Human Nutrition: Introduction, “In contrast, the high intake of saturated fatty acids, and to an even greater extent trans fatty acids, substantially contributes to the development of cardiovascular diseases.” WHAT?

  48. Jon 25 January 2010 at 9:26 pm #

    An increase of saturated fat may increase you hormone (estrogen) level that would have been depressed by suppressing your thyroid function with poly unsaturated fatty acids (PUFA). This could increase the likelyhood of estrogen-receptor cancers such as breast, etc. The key is to not suppress your immune system with PUFA and maintain sufficient vitamin d levels such that you have proper cellular differentiation and don’t get cancer in the first place because your immune system knows how to fight it.

  49. Hilda Glickman 26 January 2010 at 1:12 am #

    So called polynsaturated fat is also saturated if it is hydrogenised as the hydrogen attaches to the bonds that should be there so not insat any more-a sat fat but a much worse one than meat etc.

  50. Hilda Glickman 26 January 2010 at 2:42 am #

    To Peter Silverman,
    If there are studies which associate eating sat fat with breast cancer this may be because of other aspects of a high sat fat diet and not the fat intself. Saturated fat is from eggs, meat and dairy but these are often raised, produced etc with female hormones given to the animals. This may be the cause if there is one, So eat only organic grass fed meat etc

  51. Peter Andrews 26 January 2010 at 11:07 pm #

    The WHO/FAO is not a single report. Instead it is a set of papers, some of which state that saturated fat does not cause heart disease whereas there are other places such as the Introduction article that say things such as “In
    contrast, the high intake of saturated fatty acids, and to
    an even greater extent trans fatty acids, substantially contributes
    to the development of cardiovascular diseases.”

    While I am a fan of this blog, perhaps the title of this posting is not totally justified — at least in regard to the WHO/FAO report.

  52. Saul Rogers 7 March 2010 at 3:11 am #

    My mother had a series of heart attacks which left her incapacitated.
    She was given statins and beta blockers which she was hesitant to use so they remained untouched.
    Instead she fasted on water for 4 days which got her on her feet and allowed her to walk unaided thereafter. She also replaced the oral spray with cayenne pepper (organic) to great effect.
    Now she supplements with B3 (naicin), magnesium malate, vit c ~1gram/day, Vit D 2000 iu , multi vits, calcium, boric acid, virgin coconut oil.
    Her diet is mainly vegetable with some meat. She avoids too much carbohydrate but when she does consume too much bread for example she experiences lethargy and angina.
    Her progress has been remarkable considering that she has also continued to smoke during the past 2 years since her condition was identified. In her opinion her condition would have been normalised if she had ceased smoking permanently – hopefully this will be the case soon.
    Her diet before her heart attack was high in sugars/carbohydrate.
    Her diet now still contains fats but natural animal fats for the most part and coconut oil. Her stamina and ability to cope with strenuous exercise continues to improve while some of her friends of similar age and condition have significantly deteriorated after following courses of statins and beta blockers and maintaining a low fat diet.

    Thanks for your articles – much appreciated

  53. David manovitch 14 April 2010 at 5:27 am #

    I am a psychiatrist from the UK with an interest in the effects of nutrition upon health in general but mental health in particular. I have become increasingly aware throughout my career of the influences on the practice of medicine of the pharmaceutical companies, those companies producing processed foods and the dairy industry. It is clear that a lot of money has been made by the manufacturers of margarine and polyunsaturated cooking oils, and by the pharmaceutical companies who peddle drugs aimed at the cardiovascular system and most notably Statins. I am appalled at the degree of influence that these bodies exert upon the medical profession and the number of people in the UK now who are on statins.

    I am persuaded that the omega- six to omega three imbalance that existis in Western diets is a pernicious influence, as is the widespread use of sugar, margarine and dairy products. Cow’s milk is intended for baby cows and not for adult humans. The dairy industry of course tells us that we will suffer from calcium deficiency if we don’t have lots of milk and butter etc. What they don’t tell us is that in China where the consumption of dairy products is extremely low they have very little breast cancer whereas approximately 1 in eight women will develop it in the course of their lifetimes in the so-called Western world. I would like to congratulate Dr John Briffa and others who are publishing their thoughts regarding fat is nutrition in general and cardiovascular health, on the Internet.

    There is also a theory that the Omega 6/ Omega 3 imbalance contributes to inflammatory conditions in general such as rheumatic conditions and the epidemic of depression in Western societies of the last 20 years which may be as a result of this switch to fats rich in omega six fatty acids. This rise in depression has done wonders for the balance sheets of pharmaceutical companies marketing SSRI antidepressants. If you’re not on a statin or an SSRI then there must be something wrong with you!

  54. T 15 September 2010 at 6:23 pm #

    The health authorities are fully aware of the serious flaws and omissions in this meta-analysis. This study was funded by the National Dairy Council, dairy being the number one contributor of saturated fat in the U.S. and many other parts of the world. It was also conveniently published just before the USDA lowered the dietary recommendations of saturated fat for the first time in 20 years, from 10% to 7% of total calories.

    Below is a section from the statement released by the European Heart Network in regards to their opinion of this meta-analysis, titled “European Heart Network position piece: Impact of saturated fat on cardiovascular disease obscured by over‐adjustment in recent meta‐analysis”

    “However, the meta‐analysis (and an accompanying opinion piece by the same authors (4)) is compromised by a number of serious flaws and omissions. These are enumerated and discussed in detail in an editorial from Jeremiah Stamler (5). The most serious of these flaws is an over‐adjustment for serum cholesterol levels. The meta‐analysis involves data from 16 studies that evaluate the impact of saturated fat intake on CHD incidence or mortality, and 8 studies that evaluate the impact of saturated fat intake on stroke incidence or mortality. The authors state that ‘wherever possible, risk estimates from the most fully adjusted models were used in the estimation of the pooled [relative risks]’. It is well‐established that saturated fat intake is associated with increased level of serum cholesterol (6), and that serum cholesterol levels are associated with CHD and CVD (7). Therefore, serum cholesterol levels lie on the causal chain between saturated fat intake and CHD and CVD, and to adjust for serum cholesterol levels in a meta‐analysis will obscure the impact of saturated fat intake on these health outcomes. Yet 7 of the 16 studies included in the meta‐analysis of CHD events, and 4 of the 8 studies included in the meta‐analysis of stroke events were adjusted for serum cholesterol levels. These studies accounted for nearly half of all CHD and CVD events included in the meta‐analyses. Adjustment for serum cholesterol levels will inevitably bias the results of the meta‐analyses towards finding no association between dietary saturated fat intake and cardiovascular disease, but the authors do not mention this limitation in their article. As Jeremiah Stamler asserts in his editorial, what was actually found by the meta‐analysis was ‘a statistically non‐significant relation of SFA [saturated fat] to CHD… independent of other dietary lipids, serum lipids, and other covariates’ (5). A more appropriate and informative analysis would have included non‐adjusted associations between saturated fat and cardiovascular disease. An examination of the forest plots provided in the article shows that those cohort studies that did not adjust for serum cholesterol levels were more likely to find a positive association between saturated fat intake and cardiovascular disease, suggesting that a meta‐analysis of unadjusted data would likely produce positive results. “

    References 5-7
    (5) Stamler J. Diet‐heart: a problematic revisit. American Journal of Clinical Nutrition, 2010; 91: 497‐499.
    (6) Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta‐analysis of metabolic ward studies. BMJ, 1997; 314: 112.
    (7) Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta‐analysis of individual data from 61 prospective studies with 55,000 vascular deaths. The Lancet, 2007; 370: 1829‐1839.

    The full statement from the European Heart Network can be found here:
    http://www.sydan.fi/lehtiarkisto/sydan_210/artikkelit/fi_FI/elainrasvat/_files/83538765767049682/default/EHN%20position%20piece%20-%20sats%20meta%20analysis.pdf

    Below is a published study showing reversal of severe heart disease backed up with angiogram evidence.
    http://www.heartattackproof.com/resolving_cade.htm

  55. david manovitch 2 December 2010 at 9:03 pm #

    I wonder if Dr Briffa or anyone else could comment on the European Heart Network statement, suggesting flaws and bias in the WHO study?

  56. Al 9 July 2011 at 7:16 pm #

    The real reason we will not see a grand proclamation of the truth on this subject is due to economic issues. Medical schools could immediately change their tune on this subject if they wanted to but mainstream medicine is not in the business of health and healing, they are in the business of disease maintenance and symtoms management.

    The main problem with telling people that saturated fat does not cause heart disease is the fact that people will want to reexamine the problem and want an answer as to what is really causing heart disease. Well that might lead people to Linus Pauling and others who have said that heart disease is nothing more than chronic low grade scurvy. If people realize that the cure is nothing more than vitamin C then that will be the end to a multi-billion dollar industry. I’m even open minded enough to believe that getting the cure out to the public might anger some of the population control nazi’s

  57. Claire Boyles 17 October 2011 at 6:21 pm #

    thank you for sharing this information :)

  58. Shocked 24 February 2013 at 11:56 pm #

    Anyone that believes this puss needs their head read. What utter rubbish, i can’t believe doctors who are meant to be intelligent push this crap. So I dare you to prove me wrong Mr smarty pants doctor…..conduct a 1-2 year long experiment where 80% of what you consume everyday is Sat Fats, and put that on your blog. Get the meat and Dairy industry to fund it…..( I bet they won’t because they know the truth) If you’re so confident then put your own butt on the line……….

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