Shocking Swedish ‘science’

Over the last few years there has been something of a diet revolution going on in Sweden. It appears that increasing numbers of Swedes are eschewing the conventional advice to eat a low fat, high carbohydrate diet, and instead are opting for something altogether lower in carb and higher in fat – the so-called ‘low-carb/high-fat (LCHF) diet. Interest in this way of eating was particularly sparked by Dr Annika Dahlqvist, and more recently has been championed by Dr Andreas Eenfeldt over at dietdoctor.com.

So significant has this shift been, that it’s reported that about a quarter of Swedes have given LCHF a go, and the country has suffered from something of a butter shortage lately.

However, not everyone is happy about this dietary trend. Just this week saw the publication of a study in Nutrition Journal which laments it [1]. The study, conducted by Swedish researchers, assessed trends in food consumption in the north of Sweden, along with weight and cholesterol levels, from 1986 to 2010.

First of all, though, let’s be clear on two things:

1. The data regarding dietary intake was self-reported – something which is known to be fraught with inaccuracy.

2. The data is epidemiological in nature, which means it can never tell us anything more that the associations between things, and certainly not that one thing is causing another.

Anyway, the researchers point our attention to the fact that fat intakes fell from 1986-1992. At this time, by the way, and through the study period as a whole, average weight was climbing. So what does that say, on the face of it, for the effectiveness of low-fat eating for weight control?

But then fat intakes started to rise in 2002 for women and 2004 for men. The concern that comes loud and clear in the paper is that this was paralleled by a rise in cholesterol levels which the authors describe as a ‘deep concern’. However, by their own admission, cholesterol levels didn’t start to climb until 2007. The inference is that increased fat intake led to the rise in cholesterol. But are we really expected to believe that it took 3-5 years for cholesterol to rise in response to an increase in saturated fat intake? That doesn’t seem quite right to me.

Also, while overall fat and saturated fat were increasing, other changes in the diet were occuring too. For example, the Swedes drank progressively more wine, and ate more rice and pasta too. But there is no mention in the study that there is a possibility that these foodstuffs might contribute to changes in cholesterol levels (or weight).

Another problem is that this sort of study is based on averages from a population. We cannot tell, therefore, what’s happening on an individual level. Is it possible, for instance, that those who adopted a LCHF diet lost weight while those who did not gained, overall? We’ll never know. Even if we did, it would not matter much seeing as, as we discussed before, this was a big old epidemiological study anyway, which will really never enlighten us about anything much at all.

And why does any rise in cholesterol matter anyway? Well, in the minds of the researchers, raised cholesterol will inevitably translate into an increased risk of cardiovascular disease.
The authors also cite this evidence:

Evaluations of 14 randomized trials of statins have concluded that a reduction of LDL cholesterol by 1 mmol/L leads to a 12% reduction in all-cause mortality and a 19% reduction in CHD mortality [2]. The suggestion here, if cholesterol-lowering is good, raised cholesterol must be bad.

There’s a couple of problems with this thinking, though. First of all, the study they quote was based on data obtained from studies of cholesterol-lowering drugs (statins). Lowering cholesterol with drugs is not the same as lowering it through diet, and one cannot extrapolate from one to the other.

Secondly, there’s a very good chance, in my opinion, that statins don’t even work through cholesterol reduction. For example, they reduce the risk of stroke, even though cholesterol does not appear to be an important risk factor for stroke. They also appear to reduce the risk of heart disease in people with normal or low cholesterol levels. Further evidence for the fact the statins probably do not work through cholesterol reduction comes from a ton of evidence which shows that many approaches which improve cholesterol do not have broad benefits for health including fibrates, resins, torcetrapib, ezetimibe, hormone replacement therapy and, last but by no means least, dietary change (lower fat or fat modification).

But let’s get back to basics for a moment. Does saturated fat cause cardiovascular disease? Major recent reviews of the evidence suggest not [3-5]. It should be noted that this evidence is epidemiological in nature, so we can’t be certain that saturated fat does not cause problems from this evidence. However, the lack of an association between saturated fat and cardiovascular disease strongly suggests that eating more of it is unlikely to be a problem.

Are the authors aware of this evidence? Maybe, maybe not. What they do is, first of all, cite the deeply flawed work of Ancel Keys. Then they go on to state this:

However, a recent review on the role of fats and fatty acids on human health concluded that the relationship is more complex [6]. Trans fatty acids increase the risk, fish or n-3 long-chain polyunsaturated fats decrease the risk, but the data are conflicting or insufficient to convict or free total fat intake or other fat fractions with respect to CVD risk. Thus, further research is needed, especially focusing on long-term dietary intake.

Notice, absolutely no mention of saturated fat here at all.

And what of the more reliable intervention studies? What happens when individuals adopt a diet lower in fat or change fat consumption in a supposedly healthier direction? Well, a recent huge meta-analysis [7] of this evidence showed:

Reduction of dietary fat, modification of dietary fat, or both did not reduce the risk of death due to cardiovascular disease.

Reduction of dietary fat, modification or dietary fat, or both did not reduce overall risk of death.

The authors of this study report that there was evidence that reduction and/or modification of fat led to a significant reduction in risk of ‘cardiovascular events’ (basically a collection of fatal and non-fatal heart attacks and strokes). However, there’s a couple of things worth bearing in mind here:

First of all, dietary fat change did not lead to a significant reduction in risk of either heart attack or stroke when taken in isolation. Also, some of the studies used in the analysis did not just employ changes in dietary fat, but other strategies too (for example, nutritional supplements were given to the treated group). This obviously makes it impossible to discern what elements of the treatment were effective. Crucially, when such studies were removed from the analysis, overall risk of cardiovascular events was not lowered at all.

In other words, the best available evidence (intervention studies) tells us that modifying our diet in the way that the Swedish authors would us believe is healthy has, in fact, no benefits for health. Of course, the natural logical conclusion to draw from this is that a move to a higher fat diet is not inherently harmful.

Of course you won’t learn any of this from the ‘study’ itself, nor the way it’s been reported. Here’s a typical example. And here’s a quote from the study’s lead author from the article I’ve linked to – Professor Ingegerd Johansson of the University of Umea:

…these results of this Swedish study demonstrate that long-term weight loss is not maintained and that this diet increases blood cholesterol, which has a major impact on risk of cardiovascular disease.

The first idea simply cannot be concluded from this study. And there’s a pile of evidence to suggest that the second assertion is just plain wrong. And this from a professor, no less. Someone needs to give this professor a lesson in science.

References:

1. Johansson I, et al. Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutrition Journal 2012, 11:40

2. Baigent C, et al: Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005, 366:1267–1278.

3. Mente A, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Arch Intern Med. 2009;169(7):659-669

4. Siri-Tarino PW, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Am J Clin Nutr 2010;91(3):535-46

5. Skeaff CM, et al. Dietary fat and coronary heart disease: summary of evidence from prospective and randomised controlled trials. Annals of Nutrition and Metabolism 2009;55:173-201

6. Food and Agriculture Organization of the United Nations (FAO): Fats and fatty acids in human nutrition. Report of an expert consultation. Rome: FAO Food and nutrition paper 91; 2010. ISBN ISBN 978-92-5-106733-8.

7. Hooper L, et al. Reduced or modified dietary fat for preventing cardiovascular disease.
Cochrane Database Syst Rev. 2011 Jul 6;7:CD002137

42 Responses to Shocking Swedish ‘science’

  1. Tom 12 June 2012 at 5:48 pm #

    Dr Briffa,

    Have you seen this:

    http://www.guardian.co.uk/business/2012/jun/11/why-our-food-is-making-us-fat

    Very interesting and bears out much of your advice on diet, eating and weight. I’m always puzzled as to why the dietetic profession continue to push complex carbs as a healthy diet in diabetes-this would suggest huge commercial pressures are at play.

    Any comments?

    Thanks,

    Tom

  2. Wifezilla 12 June 2012 at 8:08 pm #

    The fact that low carb is really taking off in Sweden is making some people desperate. Their careers are based on the “fat is bad” model.

  3. rod tucker 12 June 2012 at 8:47 pm #

    Hi Dr Briffa
    I agree with you that the evidence suggesting that saturated fat is harmful is not very convincing. However, I think your reporting of the review by Hooper et all is incomplete. The authors state that “This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular
    events by 14%”, a review re-iterated in the conclusion, “Dietary change to reduce saturated fat and partly replace it with unsaturated fats appears to reduce the incidence of cardiovascular events”. The 14% reduction is a a relative risk reduction with 95% confidence intervals of 0.77 and 0.96. In other words, the benefit of reducing saturated fat on cardiovascular events might be as high as 23% or as low as 4 %!
    What is interesting is that in the conclusion, the authors state “…but replacing the saturated fat with carbohydrate (creating a low fat diet) was not clearly protective of cardiovascular events”. As a low carbohydrate advocate (I have lost and maintained a loss of 20 kg after adopting such a dietary approach), I find it some reassuring to see the authors acknowledge the lack of benefit of increased carbohydrate consumption. I feel looking at the data that there is clearly some benefit from not eating too much saturated fat but feel that reverting to my former high carbohydrate diet would be determintal to my health. Indeed, a piece in the times today (http://www.thetimes.co.uk/tto/health/diet-fitness/) suggests that it should be the bun and not the burger which we should throw away.
    So, i’m sticking with my low carb diet and intermitent fasting and high intensity interval training – never felt healthier!

  4. rod tucker 12 June 2012 at 9:09 pm #

    Sorry, forgot to add this reference looking at intervention, RCTs which replaced saturated fat with polyunsaturated fats. The data is not great – there aren’t many studies but it still seems to echo the findings of Hooper et al (2011) showing that reducing saturated fat with polyunsaturated fats is beneficial in terms of reduced risk of cardiovascular events,
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843598/?tool=pubmed

  5. Ian Day 12 June 2012 at 9:26 pm #

    This report is discussed in detail here, including discussion of the published paper.

    http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=1&t=30262

  6. Dr John Briffa 12 June 2012 at 9:28 pm #

    Rod

    However, I think your reporting of the review by Hooper et all is incomplete. The authors state that “This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14%”, a review re-iterated in the conclusion, “Dietary change to reduce saturated fat and partly replace it with unsaturated fats appears to reduce the incidence of cardiovascular events”.

    I actually covered this in the above post, saying:

    First of all, dietary fat change did not lead to a significant reduction in risk of either heart attack or stroke when taken in isolation. Also, some of the studies used in the analysis did not just employ changes in dietary fat, but other strategies too (for example, nutritional supplements were given to the treated group). This obviously makes it impossible to discern what elements of the treatment were effective. Crucially, when such studies were removed from the analysis, overall risk of cardiovascular events was not lowered at all.

  7. Dr John Briffa 13 June 2012 at 1:13 pm #

    Tom

    Agree with you regarding commercial pressures! And, to me, suggesting that diabetics should include starchy carbs at every meal is, well, mad. Most importantly, though, is the fact that the public are slowly and surely educating themselves, questioning conventional advice, rejecting that advice and managing their diabetes (and general health) better through better nutrition. Basically, as time goes on, the grip that the dietetic profession (and the food companies that influence their beliefs) is loosening. Sweden provides a good glimpse of the potential for change without political will.

    I will take a look at the article you linked to. Thanks.

  8. Diane Smith 14 June 2012 at 9:13 pm #

    Thanks for posting on this topic John.
    My thoughts on this study when I saw reports on it were that it would be very difficult and unreliable to draw conclusions about the effects of a LCHF diet by studying the general Swedish public as a whole. A much better study would compare the long term health effects of two groups – one following LCHF and the other the standard, recommended Swedish dietary guidelines.
    This study just looks like another attempt to scaremonger, keep the low fat, high carb status quo and make the low carb high fat followers look like misguided fanatics dicing with death!

    p.s. got depressed when I went into my local supermarket today and couldn’t find one single variety of kids yoghurt that wasn’t a)low fat and b)full of sugar…sigh…it makes it so difficult…I try to teach my kids about true healthy eating but they get a different message from all the products aimed at them, marketing and even what they get taught in school.

  9. Diane Smith 14 June 2012 at 11:50 pm #

    Did you see the documentary on BBC 2 last night? The tide is beginning to turn.
    http://www.bbc.co.uk/iplayer/episode/b01jxzv8/The_Men_Who_Made_Us_Fat_Episode_1/

  10. Pat 15 June 2012 at 5:11 pm #

    Hi, I am interested in low carb diets having lost 3-4 comfortably in this way some years ago. I also found it easy to order in restaurants. During this time I had was diagnosed with an under active thyroid and was having regular blood tests. These also tested for cholesterol as the levels commonly rise with the thyroid condition. Never once was any concern raised regarding my cholesteral levels. Also Atkins introduces small amounts of carbs into the diet anyway so the diet remains broader than many people and the critics think. Most of the weight was lost before the thyroid treatment so there was no connection there.

  11. Feona 15 June 2012 at 8:55 pm #

    I watched the BBC2 programme mentioned by Diane, too. I remember John Yudkin’s book ‘Pure, White and Deadly’, mentioned on the prgramme, which was among the first books to point out the dangers ofthe increasing levels of sugar we consume. Yudkin was vilified and mocked for his work, but he was clearly right – and this over 30 years ago!

  12. JustMEinT 15 June 2012 at 11:26 pm #

    Got to love a headline that (might) read…..
    The butter you ate with your meal seven years ago is killing you today! Geesh when will they back off this nonsense? Rhetorical – but the answer almost appears to be when we cease making money off it!

    Tasmanian Cyncic – Clare

  13. Everett 16 June 2012 at 1:46 am #

    The bothersome thin in all of these studies is the degree to which any kind of fat or protein is cooked. I think this makes a big difference.

  14. Jennifer Eloff 16 June 2012 at 2:27 am #

    Here is a more honest study, I think:
    Associate Professor of Medicine from Stanford University, named Dr. Christopher Gardner, A nearly 30-year vegetarian, has long been interested in why diets work to produce the health results that they do. In March 2007, he published a highly-publicized one-year randomized trial in the prestigious Journal of the American Medical Association called “A TO Z: A Comparative Weight Loss Study” looking at the efficacy of the Atkins, Zone, LEARN and Ornish diets in a side-by-side comparison. The results Dr. Gardner found were stunning: the Atkins low-carb diet produced the most weight loss, the largest reductions in body mass index (BMI), the highest gains in HDL “good” cholesterol, the biggest drops in triglycerides, and the most significant dip in blood pressure. He is committed to continuing to let the science guide where his research takes him next which makes him one of the most intellectually honest nutritional researchers of our time.

  15. Theresa Stabb 16 June 2012 at 9:31 am #

    Looked at the Independent article and one of the comments linked to this video (hat-tip to ‘DevonshireDozer’) : http://www.youtube.com/watch?index=0&feature=PlayList&v=XPPYaVcXo1I&list=PL23A51822E7997EB3
    Worth a watch!

  16. Andy McGhee 16 June 2012 at 9:35 am #

    Hi Dr Briffa,

    Apologies for this comment I am an avid follower of yours and with like minded nutritionalists. We are always going to be fighting the politics and backhanders from big corporate agencies that are willing to sell at any cost to make substantional profits, statins need I say more!

    Andy

  17. Cristina 16 June 2012 at 12:01 pm #

    Thank you for excellent articles. You mention studies suggesting that high LDL and over all cholesterol is correlated to CVD and death, but you also mention that it is not clear if it is lowering the cholesterol or other mechanisms. Is there any studies that prove that statins lowers the risk of CVD and death?
    I see in my work that statins don’t seam to be the cause of better health at all, but rather a healthier lifestyle is. Im Swedish and over the 20 years I worked with health I have not seen any health benefits with the last years hype of LCHF, the contrary, there is simply no compliance at all in these recommendations. I believe people tend to forget the advice these diets give us on eating a lot of vegetables, and they end up eating only fats and meats. This is devastating for most people and for mother earth. It is one of the reasons why we today use 60% of the earths land surface to feed the animals we feed on. If we continue with these irresponsible recommendations there will be invincible problems of no land, nor fresh water left, by 2040 when we calculate being 9 billion people.
    http://www.ted.com/talks/jonathan_foley_the_other_inconvenient_truth.html

    My recommendation is; eat as little meat and fish as possible, no one needs meat more than 3-4 meals a week (including breakfast). Eat mostly vegetarian. Eat 30-50% less food, but always natural, non refined, locally grown, organic food.

  18. Mie 16 June 2012 at 1:09 pm #

    “Secondly, there’s a very good chance, in my opinion, that statins don’t even work through cholesterol reduction.”

    That is unlikely to be the case. See Baigent et al, “Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins”, Lancet 2005. The clinical efficacy of statins is depended on how well they lower the LDL-levels. The pleiotropic effects do count, of course, but it is simply unfounded to state that cholesterol reduction has no part in the matter.

    “Further evidence for the fact the statins probably do not work through cholesterol reduction comes from a ton of evidence which shows that many approaches which improve cholesterol do not have broad benefits for health including fibrates, resins, torcetrapib, ezetimibe, hormone replacement therapy and, last but by no means least, dietary change (lower fat or fat modification).”

    This is flawed reasoning. Lowering LDL-C by any means simply doesn’t work and neither does improving HDL levels with currently known medication – bear in mind that we do know what was the problem with e.g. torcetrapib. This does not mean that lowering LDL-C by diet and/or medication and increasing HDL levels with e.g. exercise and diet does not work. There’s plenty of evidence to suggest that it does.

    And why on earth would you suggest that dietary modification has no effect on blood lipids when there is tons of evidence that e.g. more fat in your diet has a beneficial effect on HDL than diets that are very low in fat (once we leave energy intake, fiber, veggies etc. etc. out of the picture), and also that a diet with a balanced fat intake has a better effect than e.g. diet comprising mostly out of safa or unsaturated fats (see e.g. Ramsden on the issue of n-6/n-3 fatty acids)?

  19. Mie 16 June 2012 at 1:25 pm #

    “Crucially, when such studies were removed from the analysis, overall risk of cardiovascular events was not lowered at all.”

    Could you point out which part in Hooper et al. you supports this claim? Thank you.

  20. Dr John Briffa 16 June 2012 at 2:02 pm #

    Mie

    The problem with the Baigent meta-analysis is that it includes a range of studies using different statins and different doses in different people. If we really wanted to know if statins work through cholesterol reduction (i.e. extent of clinical benefit is closely tied to extent of LDL cholesterol reduction), then we need clean studies in which the only variable is the statin dose. Because of the nature of the studies it includes, the Baigent meta-analysis does not provide strong evidence for the idea that statins work through cholesterol reduction.

    This is flawed reasoning.

    The reasoning is not flawed at all. Cholesterol-improvement through the variety of approaches I listed does not have broad benefits for health. You’d have to be exhibiting quite entrenched bias not to concede that this evidence supports the idea that statins do not work through cholesterol reduction.

    This does not mean that lowering LDL-C by diet and/or medication and increasing HDL levels with e.g. exercise and diet does not work. There’s plenty of evidence to suggest that it does.

    Works to do what? And please cite this plentiful evidence.

    And why on earth would you suggest that dietary modification has no effect on blood lipids

    If you read my blog post again (perhaps more carefully this time), you’ll see that my assertion is not that diet change cannot change lipid profiles, but as is commonly advised (conventional lower fat and/or fat modification approaches) does not have broad benefits for health. You need to focus a bit Mie: the impact on lipid profiles is irrelevant – it’s the impact on health that counts.

  21. Dr John Briffa 16 June 2012 at 2:20 pm #

    Mie (again)

    Could you point out which part in Hooper et al. you supports this claim? Thank you.

    Don’t mean to be rude, but did you read the Hooper meta-analysis?

  22. Mie 16 June 2012 at 5:07 pm #

    “The problem with the Baigent meta-analysis is that it includes a range of studies using different statins and different doses in different people. If we really wanted to know if statins work through cholesterol reduction (i.e. extent of clinical benefit is closely tied to extent of LDL cholesterol reduction), then we need clean studies in which the only variable is the statin dose. Because of the nature of the studies it includes, the Baigent meta-analysis does not provide strong evidence for the idea that statins work through cholesterol reduction. ”

    Now that is a bit of a desperate reach.

    What you’re saying is that there are (as is the case virtually always) issues with the meta-analysis due to the studies included. I agree. However, given the nature of meta-analysis itself this cannot be avoided, only mediated. If we compare Baigent et al. to Hooper et al (of which you mention no similar issue), the former is clearly in a more better position – this is because statins are a much more homogenous issue to study than dietary interventions. Also, the individual studies included do address the issue of dose-response. This is the best available data and thus it makes sense to follow the guidelines set by it.

    If you should have data indicating that it is precisely the case of pleiotropic effects, than please, by all means, do show it.

    “The reasoning is not flawed at all. Cholesterol-improvement through the variety of approaches I listed does not have broad benefits for health.”

    You listed e.g. fibrates and dietary change. Both have health benefits for that part of the population that can be expected to benefit from them. If this was a case of semantics (“broad”), then your point is simply irrelevant. One cannot expect e.g. dietary modifications to do anything for a bunch of people who are either perfectly healthy or at a low risk.

    “Works to do what? And please cite this plentiful evidence.”

    To decrease the risk of cardiovascular disease. Do you truly require data that indicates this?

    “If you read my blog post again (perhaps more carefully this time), you’ll see that my assertion is not that diet change cannot change lipid profiles, but as is commonly advised (conventional lower fat and/or fat modification approaches) does not have broad benefits for health.”

    This remark would make sense if blood lipids did not have any role in health. But, of course, they do.

  23. Mie 16 June 2012 at 5:10 pm #

    “Don’t mean to be rude, but did you read the Hooper meta-analysis?”

    Well, if you didn’t mean to be rude, you sort of failed. I was taught that one shouldn’t answer a question with another questions. :-)

    So, could you please answer my original question. Thank you.

  24. Friend 16 June 2012 at 5:18 pm #

    Dr Dahlqvist Blog in English by Google:
    http://translate.google.com/translate?hl=sv&sl=sv&tl=en&u=http%3A%2F%2Fdoktordahlqvist.se

  25. Mie 16 June 2012 at 5:20 pm #

    “If you read my blog post again (perhaps more carefully this time), you’ll see that my assertion is not that diet change cannot change lipid profiles, but as is commonly advised (conventional lower fat and/or fat modification approaches) does not have broad benefits for health.”

    Ah, silly me. I apologize for being too hasty when replying. Yes, in case of lower fat you do seem to be correct. However, in terms of fat modification, Hooper et al and virtually all other large meta-analyses done in the 2000s claim that fat modification brings benefits, albeit not very dramatic ones. Of course, given the heterogenous nature of the studies included, it’s VERY hard to pinpoint exactly what kind of benefits a particular group can expect from a certain type of modification (e.g. it’s a very different thing to substitute safa for pufa when you’re getting 20% of your total energy from safa with virtually no veggies of pufa, compared to doing the same when you’re getting 15% of total energy from safa with plenty of veggies and n-3 fatty acids).

    All in all, since safa does not appear to have any health benefits as such, I consider the recommendation to substitute excess amounts of it with unsaturated fatty acids (as a part of a quality diet, since the reductionist approach has its limits) a good move.

  26. Johan 16 June 2012 at 7:05 pm #

    Without getting into the study debated here – I can vouch for the fact that LCHF/Paleo is indeed getting main stream in Sweden. You hear people everywhere talking about reducing carbs and eating real food.
    Many of us just don’t listen to “experts” anymore – It’s so obvious that reducing carbs and eating natural, unprocessed food works. We see it all around us, among family, at work, on various blogs, that people are getting fitter, feeling better, are loosing weight (fat) doing exactly the opposite to what the authorities tell us to do!

  27. Dr John Briffa 16 June 2012 at 7:18 pm #

    Mie

    Something tells me you haven’t read the Hooper meta-analysis, because if you had, there would be no reason for me having to point out to you the evidence for my assertion. Unless, of course, you struggle to understand plain English.

  28. Dr John Briffa 16 June 2012 at 7:30 pm #

    Mie

    However, in terms of fat modification, Hooper et al and virtually all other large meta-analyses done in the 2000s claim that fat modification brings benefits, albeit not very dramatic ones.

    That’s exactly what the Hooper meta-analysis failed to show. Again, did you read it? And then to refer to meta-analyses and, seemingly, not be able to cite them. No very convincing, is it, Mie?

  29. Mats Wiman 16 June 2012 at 7:41 pm #

    The fact that 2.5 million Swedes are practising LCHF IN SPITE OF BEING CONTRARILY ADVISED by the ‘guardians of the final truth’, i.e. the medical authorities must certainly have some weight even for hardcore believers in so-called ‘studies’.
    We are certainly some 20-30000 in Sweden (+many thousands in Norway and Finland) who not only lost 10- kg (I lost 15 in 3 months), but also could throw away all medicines and thus become well again.
    I am a so-called anecdotic withness of that.
    Mats Wiman
    ex.-diabetic

  30. Dr John Briffa 16 June 2012 at 7:57 pm #

    Mie

    Now that is a bit of a desperate reach.

    What you’re saying is that there are (as is the case virtually always) issues with the meta-analysis due to the studies included. I agree.

    No, you’re misrepresenting my point, which is (close attention required here, again, Mie) that the design of statin studies as a whole cannot tell us that cholesterol is a genuine risk factor for cardiovascular disease.

    I’ve also cited evidence which supports the idea that statins work through cholesterol-independent mechanisms. See above. Much of the research which finds cholesterol-modifying drugs or other strategies do not have broad benefits for health (such as a reduction in overall mortality) has been done in the secondary prevention setting (i.e. individuals at generally high risk of cardiovascular events). For someone who purports to be up on the science, you seem blissfully unaware of some of the most relevant findings.

    And when I ask you to cite the evidence you refer to, you say:

    Do you truly require data that indicates this?

    Just imagine for a moment how that retort would go down with a judge and jury?

  31. Dr John Briffa 16 June 2012 at 8:40 pm #

    Oh Mie, before I (and you) go…

    Here’s the relevant quote from the Hooper meta-analysis that you did not read/did not understand/chose to ignore (delete as applicable)

    There was a reduction in cardiovascular events for any dietary fat intervention compared with usual diet (RR 0.86, 95% CI 0.77 to 0.96, I2 50%, 65,508 participants, 4887 people with cardiovas- cular events, peff ect 0.007) Analysis 1.3. Sensitivity analyses, us- ing Mantel-Haenszel fixed effects meta-analysis, Peto fixed effects odds ratio, and removing the largest study comparisons (WHI with CVD 2006, WHI without CVD 2006) maintained this clear effect of the intervention, while removing studies with a system- atic difference in care between the intervention and control arms, or removing studies with dietary differences other than dietary fat differences both removed the statistical significance of the effect.

  32. Magarietha 17 June 2012 at 8:39 pm #

    Hi Dr. Briffa, the thing is, why did I get so thin on a ketogenic diet and why did my cholesterol (which apparently was of the deadly kind) almost normalise, when no pill on G-d’s earth could ever manage to do that for me. Isn’t it a given that if your lipogram is drastically better that your arteries will benefit from that? Or is it not the case? I’m becoming confused with the scare-mongering – I have my son on the diet too, since he also has familial hypercholesterolaemia and I don’t want anything to happen to him especially.

  33. Reijo Laatikainen 18 June 2012 at 9:00 am #

    “…while removing studies with a systematic difference in care between the intervention and control arms, or removing studies with dietary differences other than dietary fat differences both removed the statistical significance of the effect.”

    I guess this quote of Hooper et al. refers pretty much to Olso-Diet Heart which asked patients to limit “red meat as much as possible”, increase fruit, pulses, “brown bread” and vegetables and fish. This is a copy of the authentic instructions given to patients in the old and orginal Oslo Diet Heart. http://bit.ly/nEQZA9

    Byt the way, it’s interesting how one single study (Mangrovite et al. 2011) seems to have an substantial effect on Ronald Krauss’ opinion on fats and red meat.

  34. Josef Boberg 20 June 2012 at 12:01 pm #

    GREAT POST !

  35. Gaba 2 July 2012 at 1:54 am #

    Why all the studies on other people? Why don’t those Researchers conduct a studies on themselves? Won’t that be more effective?

    After my reading and researching on fats, oils, cholesterol, I decide to conduct a self-study on the effect of consuming more fat/oils, eat less carbohydrate, avoid all processed foods that have sugars, use less (use 1/3 teaspoon) or no sugar in my beverages.

    I ate lot of butter for breakfast, include 1-2 tablespoons of oils (coconut and olive oil) for lunch and dinner, less carbohydrate. Within 4 months, my pot-belly gone; waist decrease from 33 to 30 inch; lost about 3 kg of weight; many allergies like running nose begin to disappear; more energy; feel less hungry. Do not bother about cholesterol-testing or other health screening as they are just number-to-scare-me and commercial-marketing lifestyle.

  36. Mats Wiman 19 September 2012 at 6:05 pm #

    Hello,

    I started LC in January 2008: Lossof 15 kg in 3 months
    1 started HF in April 2008
    I threw away statins, BP medicine and Metformine in May 2008.
    I started to feel well in April and had a HbA1c of 4,5 in late summer 2008.
    Two years later I was declared a “non-diabetic”.
    I have since then consumed 375 kg of saturated fat (Eggs, bacon, butter and coconut oil).
    I am feeling better than ever.

    LCHF@MatsWiman.se

  37. Peter Deadman 5 October 2012 at 8:50 pm #

    A message to Dr. Briffa …
    Have you covered the BMJ’s ‘Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study’. I can’t find it in your search function. thanks

  38. Magarietha 17 April 2013 at 2:23 pm #

    Gee Whiz Dr. Briffa, I’ve been on fully Ketogenic diet for more than a year now and MY cholesterol levels PLUNGED from it. So i’m confused. I have the blood work to prove it.

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