I had a press release recently alerting me to the presence of the Fat Information Service. On the face of it, this ‘service’ seeks to provide us with balanced and accurate information and advice about the sorts of fat we should be eating in our diets. It claims, among other things, to provide “Access [to] reliable information about the role and benefits of dietary fats and oils, including how to differentiate good fats from bad fats” and help us “Understand the facts from fiction when it comes to dietary fats and oils.”
It is funded by Unilever – manufacturer of a range of margarines and other food products that are, supposedly, good for cardiac health. This does not mean that the advice offered by the Fat Information Service is inherently bad. But it does mean there’s a conflict of interest here which might, somehow, influence the ‘expert’ advice it offers through its hired hands.
In this section of the site Dr Carrie Ruxton (a ‘registered dietitian and public health nutritionist with more than 20 years experience in nutrition and health’) tells us that:
“The evidence shows clearly that the risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats.7”
The study that is referenced here is this one: Hooper L, et al. (2011). Reduced or modified dietary fat for preventing cardiovascular disease. The Cochrane Library (7).
The most recent incarnation of this review was published in 2012 [1]. I’ve read them both but did not recall seeing any evidence supporting Dr Ruxton’s claim, so went back to check.
This research comes in the form of so-called meta-analyses (amassing together of similar studies) which assessed the effects of:
1. changes in the nature of the fat in the diet (e.g. swapping saturated fat for polyunsaturated fat) – fat ‘modification’
or
2. changes in the amount of fat in the diet (e.g. a low-saturated diet)
or
3. both
on risk of cardiovascular diseases such as heart attack and stoke. Before we get on to some of the negative findings of this study (and there are plenty), let’s focus first of all on the stand-out ‘positive’.
The study, apparently, found that: “reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14%…”
‘Cardiovascular events’ is an example of a ‘composite endpoint’. Essentially, what this means is the lumping together of lots of different outcomes together. With regard to composite endpoints, the wider we cast our net, the more likely we are to find a result that is ‘statistically significant’. Cardiovascular events’ were, in this research, made up of
“cardiovascular deaths, cardiovascular morbidity (non-fatal myocardial infarction, angina, stroke, heart failure, peripheral vascular events, atrial fibrillation) and unplanned cardiovascular interventions (coronary artery bypass surgery or angioplasty).”
As far as cardiovascular events go, one could not cast one’s net any wider. Oh, and it should perhaps be borne in mind that any benefits seen here were only seen in men (none in women).
The strength of this evidence was described by the authors of the review as ‘moderate’, meaning that:
“further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.”
This sounds circumspect, and for good reason too. That’s partly because many of these studies did not just test the impact of lowering or modifying fat in the diet. Some, for instance, employed other dietary changes (e.g. in some, dietary supplements were given). This can bias results in favour of the ‘active’ (low- or modified-fat group). When these differences were taken into consideration, the reduced risk of ‘cardiovascular events’ disappeared.
Also, in about half the studies assessed, there were differences in the ‘systematic care’ that people received. This is another thing that could bias results in favour of the ‘active group’. Again, when differences in systematic care were factored into the equation, the apparent benefits of low- or modified-fat eating evaporated.
In other words, the results suggest that any benefit seen in terms of cardiovascular event reduction was not due to any change in fat intake per se, but other changes employed in the studies.
The authors performed a statistical strategy known as a ‘funnel plot’ which seeks to determine if there is a likelihood that some evidence exists which has not been published. The authors concluded that: “…it is likely that a few small studies with more cardiovascular events in the intervention groups may be missing from the review.” If this is the case, then this would actually worsen the results seen in the groups eating low- or modified-fat diets.
Getting back to Dr Ruxton’s claim, though, what evidence is there that “risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats.”? It appears that what Dr Ruxton is referring to here are studies of fat ‘modification’. So, did this review find that fat modification reduced the risk of heart disease?
Err, actually no. The review found that even after long-term modification of fat, there was no reduced risk of heart attack. There was no reduced risk of death due to cardiovascular disease or overall risk of death, either. Precisely the same results were found, by the way, for approaches in which fat reduction (rather than modification) were the order of the day.
In support of her claim that “risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats” Dr Ruxton cites a study that shows no such thing. I’ve contacted Dr Ruxton and she tells me she’s consulting people internally at the Fat Information Service responsible for doing ‘background research’ and putting text on the website. Let’s see what comes out of this. However, it seems to me that Dr Ruxton has grossly misrepresented the findings of the review.
My feeling is this is not good enough from a person working for an organisation that purports to provide accurate advice about dietary fats. Is the endgame here for us to be better informed about how to eat to improve our health? I honestly doubt it. My sense is the Fat Information Service is a kind of dietary propaganda machine that exists to convince people of the nutritional virtues of margarine over butter. My advice: don’t swallow it.
References:
1. Hooper L, et al. (2012). Reduced or modified dietary fat for preventing cardiovascular disease. The Cochrane Library. Published online 16 May 2012 DOI: 10.1002/14651858.CD002137.pub3
UPDATE: As of some time on 24 July 2013 clicking on the link to where Dr Ruxton makes her unsubstantiated claims on the Fat Information Service website returns this page:
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companies view their donations to charity as advertising expenses i think.
and we know how well advertising does work in fact!
also this is one of those “if you tell the lie enough and repeat it enough then people will start to believe it” situations
Based on today’s post on the Fat (Dis)Information Service site, they have not taken your questions to heart . . . . .
http://www.fatinformationservice.org/news/growing-trend-for-butter-over-margarine
Sad.
I used to shrug when I came across this sort of bad interpretation of science but now I seem to be getting really annoyed. I have just watched a BBC pseudo documentary on how “favourite supermarket foods” can help with weight loss during the programme I learned.
That almonds are high in fibre and protein which is why they make you feel satisfied. That in an experiment involving eating over 14000 calories of “extra” almonds over a month the weight gain of only a pound (a couple of glasses of water) was explained by the fact that all the evil fat was retained in the almonds and not digested.
I learned that sugary soup before a meal would lead to me eating about 17% less calories of my macaroni cheese main meal.
I learned that calcium in dairy (low fat sugary yogurt) was really helpful in aiding weight loss because of its impact on my hormones.
So during this bonkers show I saw that calorie in / out didn’t matter if I eat nuts. That by eating soup I would eat less calories which obviously do matter when they are contained in macaroni and that calcium is a key factor in influencing hormones which manage fat storage. The only common theme was that “fat is bad”
This programme was probably seen by millions and although not sponsored by big food was paid for by me as a licence payer.
Is the high fat food I’m eating making me angry??
“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.” Joseph Goebbels
@Andy, I saw that program too. A very good example of how to keep everyone confused and in the dark about food, nutrition and weight and give them no useful information whatsoever.
“butter also contains around 3-4% trans fats, which have been associated with raised cholesterol levels”
To support that statement they reference:
http://ajcn.nutrition.org/content/66/4/1006S.full.pdf+html
That paper said nothing of the sort, though it did say this:
“In a report from the Framingham Heart Study (24), consumption of margarine was significantly associated with risk of future CAD, although use of butter was not.”
Besides, the trans fats in butter (vaccenic acid and conjugated linoleic acid) have quite different health effects to the trans fats in margarine (elaidic acid)
Is Dr Ruxton unaware that if her name is on the exceedingly brief statement she is assumed to have actually written it herself?
The mere fact that she is putting her name on something she didn’t write is sufficient to demonstrate that she is not attempting to provide an honest personal assessment of the evidence provided by the meta analysis.
And then there’s the fact that whoever did write it apparently subscribes to the well known belief that women aren’t people; as a woman I do get very tired of this…
I was indoctrinated at medical school in the 70’s re: saturated fat and heart disease. To be fair I was also told that Eskimos,the Masai and Polynesian islanders all had high intakes of saturated fat but low incidence of cardiovascular disease. These ‘curiosities’ were then dismissed. Also dismissed was the apparent low incidence of cardiovascular disease prior to the 20th century when people ate all the fat on meat that they could, including dripping, and butter and full cream milk. No one consumed corn oil or sunflower oil and very few ate margarine as it was grey; colouring it being prohibited by law. Come the early 1920s and margarine goes yellow and stats to sell, and heart disease goes up. When the switch to vegetable oils occurred in the early 70s, heart disease continued to rise, and I believe has not significantly decreased , although deaths have due to medical intervention I argue, and not diet.
The beneficiaries of this have been agri-business (growers of oil crops) and the margarine manufacturers and pharmaceutical companies who produce the medications that are fed to the victims of cardio-vascular disease.
Unfortunately your book is STILL not available on Kindle in Canada!!
I stand corrected, its available on Kobo!
Really sad that yet again a so called and seemingly well named advisory body cannot be trusted.
At what point will any of these, dare I say self interest groups, actually be held accountable for the misinformation they spin to a largely unaware and gullible public.
Thank You once again Dr John for looking out for our health interests
Well said Dr. B. Well said. Conflict of interest galore. The FIS is a joke, which is unfortunately on the general public. Loving the comments too.
Any half-way intelligent person can see that the grain industry and companies like Unilever are huge, and are of great importance to the economy. Couple this with the fact that giant industries generally, have a lot of influence on how this country is run, and what policies are of use to them. It makes sense to be cynical and suspect that Governments are frightened of offending these giants, and risking an even worse economic situation. When only low-carb eaters remain living long and healthily, someone might take notice; although it is a big ‘might’.
Regrettably I cannot provide the reference to this study but its tenor remains clear in my mind. It looked at arterial plaque and found that a massive 70% came from polyunsaturated fats; 23% from saturated fats; and 7% from other sources. When it is considered that saturated fat in its structure also contains both poly and mono unsaturated fats it can probably be reasonably deduced that saturation is bodily healthy.
When organ transplant surgeons were in search of an immune suppressor it was found that the most potent of suppressants were polyunsaturated fats.
When the late Captain Scott of Antarctic fame was planning his last expedition he sought the best medical advice and was advised to exclude the fat from the pemmican. He took this advice even though it was contrary to the experiences of earlier explorers. It has been suggested that the reason for his party’s sad ending was the lack of saturated fat in the diet. Saturated fat in the pemmican could have saved the lives of those lost as it provides the body with energy, a feature that is ignored. It also provides the body with cholesterol which produces those feel-good hormones of the body.
Earlier in life I was a vegetarian for almost 18 years and shortly after commencing I began to suffer from ill-heath which mistakenly I contributed to middle age; I was then in my mid 40s. Subsequently I had to undergo a quadruple bypass; this was 22 years ago. Upon recovery I abandoned vegetarianism which consisted of masses of poly and mono unsaturated fats. Later, while suffering from angina I was to discover that poly unsaturation caused the symptoms so those were ramped-down. Later still I suffered from chest tightness only to discover that this was caused by monounsaturated fat (olive oil). On endeavouring to keep this out of my diet my health has improved considerably when I was able to abandon prescription medication.
There is more to this tale but today, aged 82, my only complaint is a drag on my left foot which may be the early sign of sclerosis which I have had for the past 5 years. I have not as yet approached the GP but I am hopeful that I may discover some alternative approach to curing it. While I remain hopeful I also remain in excellent health on a diet of masses of saturated fat and red meat and I continue to believe that I have a future.
My apologies for being unable to provide supporting references.
@John
I’m even more cynical, and I’m wondering whether Unilever will be bidding for contracts in the soon-to-be-privatised NHS?!
Following on from Helen’s comment as she is spot on.
In 2008 I remember well when Andrew Lansley first announced the Conserverative Party “Responsibility Deal” – it was 2008. At that time the chairman of the committee to head this initiative was the “Chairman of Unilever”.
This link: http://m.conservatives.com/News/News_stories/2011/03/Responsibility_deal_unveiled.aspx illustrates again their close association with industry.
Surely the best way to take personal responsibility is when that advice is driven by best science that if free from corporate influence? Honest science where scientists are working in an environment that is free of fear from future employment if they write the truth.
might sound facetious, but are not all deaths a cardiovascular event? I mean everyone’s heart stops beating!
Great post John and another great find, you’re rapidly becoming the Witch Finder General of the black Ops outfits. Here is a few more. As always, follow the money.
DUK The diabetes charity.
Abbott Bayer Boehringer Ingelheim Bristol Myers Squibb Bupa Bunzl Everyclick First Capital Connect Flora pro.activ Kodak Lilly Lloyds Pharmacy Menarini Merck Serono Morphy Richards Merck Sharp & Dohme Limited Novartis Novo Nordisk Nursing Times PAL Technologies Ltd Pfizer Rowlands Pharmacies Sanofi-aventis SplendaTakeda Tesco Diets
HEART UK -The Nation’s Cholesterol Charity
Abbott Healthcare Alpro UK AstraZeneca BHR Pharma Cambridge Weight Plan Cereal Partners UK (Sh Wheat) Food & Drink Federation Fresenius Medical Care (UK) Limited Genzyme Therapeutics Hovis Kellogg’s (Optivita) Kowa Pharmaceutical Europe Co Limited L.IN.C Medical Systems Limited Merck Sharpe & Dhome PlanMyFood Pfizer Premier Foods Progenika Biopharma s.a. Roche Products Limited Unilever (Flora) Welch’s (Purple Grape Juice)
The British Nutrition Foundation
However, the organisation’s 39 members, which contribute to its funding, include – beside the Government, the EU – Cadbury, Kellogg’s, Northern Foods, McDonald’s, PizzaExpress, the main supermarket chains except Tesco, and producer bodies such as the Potato Council. The chairman of its board of trustees, Paul Hebblethwaite, is also chairman of the Biscuit, Cake, Chocolate and Confectionery Trade Association.
The European Food Information Council
Current EUFIC members are: AB Sugar, Ajinomoto Sweeteners Europe, Bunge, Cargill, Cereal Partners, Coca-Cola, Danone, DSM Nutritional Products Europe Ltd., Ferrero, Kraft Foods, Mars, McDonald’s, Nestlé, PepsiCo, Pfizer Animal Health, Südzucker, and Unilever.
The British Heart Foundation
Unilever Flora margarine.
Regards Eddie
Nothing unexpected here. We have seen it all before. Our political masters, being rich enough that the question of eating cheaper margarine doesn’t ever crop up and being so out of touch with ordinary people that it is not even a real question to them – it is outside their experience. I would like to say that we should do something about it but I have become so skeptical that I doubt anything we do would make them listen. So here’s to the manufacturers of Frosties running the NHS – that should surely improve the health of the nation .
Wow–I never would have guessed that such a servive existed! I find it amazing that up until recenlty, humans never consulted anyone on how to eat. They ate what the could find, catch or kill and they seemed to get along just fine from a health standpoint. Now that most people live on processed foods, we need folks with a PhD in Nutrition to tell us how to eat. Do you sense any irony here?
Modern Nutritional Science has utterly failed us when it comes to outling a healthy diet. Just look at the food served in most hospitals and you will see what I mean.
the contact details given at the bottom of the new articles (dissing butter) reveals the truth – nexuspr are behind it. Nexuspr is a PR company whos stated aim is :
People talk, channels blur, stories create ripples
Influencing the right audiences to share the content and messages we shape, and create a deeper bank of real advocates and connections for you, is ever more critical.
As our latest Nexus research, ‘Shopping Centred’, highlights the influence of family and friends as advisors on buying decisions is paramount.
Which places PR’s role as influencer in a central role to build trust, drive loyalty and create belief before, during and after a customer buys or tries a product. By sharing useful and generous information around the product, good conversation will flow….
PR is about much more than awareness: it’s about shaping opinion and informing customer decisions. And if you don’t know what people are saying, thinking or sharing, then the risk is in talking at them, rather than to them.
Which is why we aim for reactions and outcomes in our work rather than just outputs.
This story of the 3 year old with a rare brain disorder has been in the papers over the last few days:
http://www.dailymail.co.uk/health/article-2368362/Girl-3-rare-genetic-disorder-speaks-words-starting-diet-involves-eating-kilo-CREAM-CHEESE-week.html
Imagine what a difference families might see in their own children if they changed their diets to LCHF instead of drugging them up with orange juice, and Rice Krispies with skimmed milk and a couple of slices of toast with jam every morning…
This is a bad news story for Unilever.
That Hooper study also concludes: “There were no clear effects of dietary fat changes on total mortality . . . or cardiovascular mortality”
Hopefully John will allow me the right of reply on this forum since I’m specifically mentioned!
My quote on the Fat Information Service website relates to the impact of switching dietary fats on heart disease risk, not MI or mortality which are specific endpoints. This is an uncontroversial view supported by public health experts, such as the NHS Choices website, which says “We all need some fat in our diet. But too much of a particular kind of fat – saturated fat – can raise our cholesterol, which increases the risk of heart disease. It’s important to cut down on fat and choose foods that contain unsaturated fat”. (www.nhs.uk/Livewell/Goodfood/Pages/Fat.aspx)
I offer general advice and opinion about dietary fats on the FIS website as an independent dietitian – I do not have a remit to promote any particular products or to attack foods such as butter.
I can see that John and many of those who have commented on this forum do not believe the evidence suggesting that saturated fats represent a risk to cardiovascular health. You are, of course, entitled to your opinion, as am I. However, until the science changes, public health bodies, and health professionals such as myself, will continue to advocate reductions in saturated fat and increases in unsaturated fats (whether as olive oil, sunflower oil, nuts, seeds or oily fish) as a means of lowering heart disease risk.
Dr Ruxton: which science in particular do you reference? There is not one RCT that implicates saturated fat in CVD. Furthermore, there is science that’s increasingly suggesting that an overload of unstable, unsaturated fats – particularly those high in omega-6 – are far from benign.
So, have you any science to back up your beliefs on saturated fat, that you have SPECIFICALLY analysed and understood, or are you standing on the atrophied shoulders of barely considered, discredited epidemiology?
I look forward to your specific references!
Thanks to Dr. Ruxton for replying to the various comments, but it is not an adequate reply.
Specifically it is not correct to state that the ‘establishment’ view – that raised cholesterol increases the risk of heart disease – is ‘uncontroversial’.
From the very beginning of the cholesterol story the evidence has been misinterpreted, initially because of poor science but latterly – and more perniciously – because of the involvement of vested interests of many kinds in the purveying of specific food products and drugs.
In fact, far from being ‘uncontroversial’ the demonisation of cholesterol is developing into a major health scandal since the ‘cures’ proposed are causing more ill-health than existed previously.
Before anyone gives dietary advice predicated on the evils of cholesterol they should acquaint themselves with both how it is produced and used in the body and how the – by now – very numerous studies show no biomedical link between it and any disease process.
Dietary cholesterol is only problematic when – either before consumption or as a result of interaction with other ingested materials – it becomes oxidised.
@Dr Carrie Ruxton
You are serious danger of bringing your reputation into disrepute by quoting your misinformed views on this website. You’ll find that both laypeople and qualified MDs who read and post on this forum are not ignorant of the scientific facts surrounding saturated fat, heart disease, cholesterol, statins and their deleterious blocking of the mevalonate pathway etc. They also know what the science truly says about what constitutes a healthy diet.
I suggest you do some background reading on this website; buy some of the books which are mentioned: (authors such as Briffa, Taubes, Yoseph, Kendrick, Volek, Groves et al) then follow up by reading the studies.
You then may have become sufficiently informed to offer not “opinion” but fact based on the science. The information is out there. Dare you become informed?
Yes – thanks to Dr. Ruxton for joining this discussion but sadly you seem to have proven the point of the others for when asked for specific references we hear only crickets . . . . .
So very sad.
As an amateur enthusiast in dietetics for the past 23 years may I add that on reading about the diet and health of the traditional Inuits that CVD was almost unknown. The main cause of death among them appears to have been aneurysms caused through their blood being too thin. Upon changing to the Western diet CVD became prominent. I made mention above about the adverse effect of poly and mono unsaturated fats which would consist of the major part of the Inuit’s diets; no research, as far as I have been able to determine (except that on glycation) shows that it is only in the presence of carbohydrates that fats clog the arteries. The dilemma that this creates is, who is about to abandon bread, cakes, biscuits, pies, fruit puddings, etcetera? I am also aware that cholesterol provides the body with the hormones that are so essential to good health and the feelings of well being. Holding this belief I will stick to my fries, steaks, and meat pies, all made and cooked with saturated fats. Aged 82 and in relatively excellent health I am not about to change course at this advanced stage to life and may it be added that I still retain a healthy libido.
NM and others may be interested in the following RCT which found that a low CHO, high saturated fat diet had an adverse impact on sub-classes of LDL cholesterol, with the authors concluding that a high saturated fat intake “may increase CVD risk by metabolic processes that involve apoCIII”. http://www.ncbi.nlm.nih.gov/pubmed/22948944
In another RCT, high saturated fat intakes adversely affected flow-mediated dilatation, a marker of endothelial (blood vessel) health: http://www.ncbi.nlm.nih.gov/pubmed/15774905
However, it is clear that dietary fat only represents one CVD risk factor out of many (smoking, body weight, family history, dietary GI) and this needs to be considered in an individual context. For example, another RCT found that the LDL cholesterol-raising effects of a high saturated fat diet could be ameliorated by regular exercise: http://www.ncbi.nlm.nih.gov/pubmed/23368827
While the ‘establishment’ view is currently in favour of saturated fat reductions, with replacement by a combination of n3, n6 and n9 unsaturated fats, this is not set in stone and future research findings may turn everything on its head. In my view, we are not at that stage yet, although I wish this forum well in its debate about the relative benefits of dietary fats.
Dr Ruxton
None of those studies demonstrates that you cite demonstrates that reducing saturated fat in the diet reduces heart disease. You’ll know that, of course.
I’ve responded to your former response and well as those you sent me by email here:
http://www.drbriffa.com/2013/07/23/what-is-the-fat-information-service-up-to-part-2/
May I add a further piece of advice to Dr Ruxton?
Kicking off with a study carried out on 14 healthy males simply drops you further and further in the mire; not all of us are male, and we feeble minded women are perfectly capable of grasping that such a tiny sampling frame means the results are worthless…
Stevie
What makes this study particularly uninformative is that it’s based on the impact of diet on ‘surrogate’ markers, not ‘clinical’ endpoints such as heart disease.
This is a diversion because, as we’ve seen, lower saturated fat diets do not reduce the risk of heart disease, as Dr Ruxton knows but perhaps cannot bring herself to admit.
This sort of study simply cannot inform us in the way the reviews being discussed here do, and does not take away from the fact that those reviews found no evidence to support Dr Ruxton’s claims.
Maybe Dr Ruxton hopes we won’t notice and has underestimates people’s intelligence. And maybe she overestimates her own.
In my opinion saturated fat is only potentially harmful when it is consumed in an inflammatory environment. What drives most inflammation in our bodies? That would be excessive sugar, grain based carbohydrates and excessive omega 6 to omega 3 fatty acids.
In other words if you are eating a whole foods diet don’t worry about saturated fat. If your diet consists primarily of processed foods, you probably should worry about all the fat you are consuming.
Dr. Ruxton makes her living lending the sheen of legitimacy to the claims of the food industry. This is her career. I have little doubt it pays well. Perhaps she was able to bill her employers for the posts on this forum?
The “Fat Information Service” is just another in a long line of industry-funded operations to which Dr. Ruxton has provided her expertise. Heard of the “Tea Advisory Panel”? How about the Sugar Bureau? Can you guess what Dr. Ruxton has published on the matter of sugar?
If she expects us to take her seriously as a scientist, she’s going to have to behave like one and fully disclose any and all her competing interests when asserting anything in public.
The rest of us would do well to “follow the money”, as Eddie Mitchell put it so nicely.
Lies like this are so common now that people believe it. I commonly hear, “are there any side effects” like fat is a drug or something, to which I say, yes, there is, you’ll look and feel amazing!
Trouble is, people believe all the rubbish about, well, rubbish food and incorrect fats ‘facts’, and when they hear the truth, their brainwashed minds can’t even comprehend it.
Pass the butter!