What is the ‘Fat Information Service’ up to? Part 2

Last week I wrote about the Unilever-funded Fat Information Service and the claim on its website that “The evidence shows clearly that the risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats.” The claim was made by dietician Dr Carrie Ruxton, and to support her claim she referenced a review of dietary studies published in 2011 [1]. The most recent incarnation of the study was published last year. I’ve read them both, and neither appears to contain evidence to support Dr Ruxton’s assertion.

In an email I asked Dr Ruxton to refer specifically to the part of the review which supports he claim, and she provided me with this:

One [sic] page 19 of the 2011 Cochrane review, it is stated that: “dietary saturated fat reduction (through reduction and/or modification of dietary fat) may be protective of cardiovascular events overall, reducing them by 14%”

The implications for practice on page 29 also states that: “Dietary change to reduce saturated fat and partly replace it with unsaturated fats appears to reduce the incidence of cardiovascular events”

However, ‘cardiovascular events’ covers a multitude of conditions and events, not all of which are heart-related (e.g. stroke and circulatory problems in the legs known as ‘peripheral vascular disease’). To not understand the difference between ‘heart disease’ and ‘cardiovascular events’ either shows a fundamental lack of understanding or intellectual dishonesty (as I suggest to Dr Ruxton in an email to her which I reproduce in full below). There were also things about the ‘positive’ evidence which casts considerable doubt on whether any change in dietary fat was responsible for whatever benefits were seen (see below).

I also point out this critical fact: when the reviewers looked at heart-disease related outcomes (heart attack), there was no reduced risk associated with lower-fat or modified fat diets.

All these findings are the same across both 2011 and 2012 versions of the review.

Here’s my email response in full:

Hi Carrie
Thanks for your response.

The most recent incarnation of this review was published in 2012 (though it is, essentially, the same review as the one you refer to).

With regard to the 14 per reduction in ‘cardiovascular events’, this is a composite endpoint which included not just heart disease-related outcomes (remember, your claim was about heart disease), but also cardiovascular deaths (not all will be cardiac in nature) and cardiovascular morbidity (which may also include non-cardiac events such as stroke and peripheral vascular events).

In other words, you cannot use this evidence to support your claim, as the outcomes were not confined to ‘heart disease’. It is almost inconceivable to me that you either do not understand the difference between ‘heart disease’ and the composite outcome used in the review, or are attempting to pass them off as the same thing. Your response demonstrates either a failure to properly interpret the findings of this review or intellectual dishonesty.

Plus, statistical significance disappeared once systematic differences in care or non-fat-related differences in care were controlled for. In other words, there is considerable doubt whether fat reduction or modification had any benefits at all.

The review did look specifically at the impact of either lower-fat diets or fat-modified diets on risk of myocardial infarction (which is obviously of direct relevance to your claim). Here’s the summary of this evidence as it appears in the review:

There was no clear effect of altering dietary fat intakes (compared to usual diet) on myocardial infarction (RR 0.93, 95% CI 0.84 to 1.02, I2 6%, 64,891 participants, 2068 people with fatal or non-fatal myocardial infarcts, peffect 0.13) ( Analysis 2.1). Neither was there any effect of any of the distinct dietary fat changes: modified fat intake RR 0.91 (95% CI 0.72 to 1.16, I2 45%, 11,831 participants, 579 people with at least one myocardial infarct, peffect 0.46); reduced fat vs usual fat intake RR 0.97 (95% CI 0.86 to 1.08, I2 0%, 50,522 participants, 1203 people having a myocardial infarct, peffect 0.54); and reduced and modified fat vs usual intake RR 0.90 (95% CI 0.72 to 1.11, I2 0%, 2538 participants, 286 people with myocardial infarcts, peffect 0.32).

In summary, no statistically significant effects were found on risk of heart attack.

There was nothing at all in the review that supports your claim that: “The evidence shows clearly that the risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats.”

Would you please respond?

Kind regards

John Briffa

 

In her response to me, Dr Ruxton accused me of being “rather pedantic.”

Really?! Is it pedantic to point out that the claim she made was in no way at all supported by the review she cites? Is it ‘pedantic’ to point out the evidence which specifically contradicts her claim?

But, Dr Ruxton explains all when she tells me that:

While the Cochrane review used the terminology of ‘cardiovascular events’, the consumer tends to understand ‘heart disease’ better and this is why I chose this term for my press quote.

But as we know and as Dr Ruxton should know, ‘cardioavascular events’ and ‘heart disease’ are not the same thing at all.

And Dr Ruxton has nothing to say at all on the fact that when impact on risk of heart attack was assessed, no benefits were found at all.

Dr Ruxton also tells me that:

The view that reducing saturated fats and replacing them with unsaturated fats lowers heart disease risk is not at all controversial and is supported by public health bodies including NHS Choices…

and supplied this link http://www.nhs.uk/Livewell/Goodfood/Pages/Fat.aspx and this extract:

“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.
Eating a diet high in saturated fat can cause the level of cholesterol in your blood to build up over time. Raised cholesterol increases your risk of heart disease. Foods high in saturated fat include …butter
Eating unsaturated fats instead of saturated can help lower blood cholesterol. Unsaturated fat … is found in … sunflower and olive oils”.

Notice that nowhere in these extracts is the claim made that replacing saturated fat with a ‘healthier’ fat reduces the risk of heart disease. And quite right too, seeing as there is essentially no evidence to support that idea.

In her response to the original piece, Dr Ruxton tells us that:

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.

Actually, I am not sure any of us are entitled to our opinions, when we have abundant evidence to look to. We know that reducing saturated fat or replacing it with other fats does not reduce the risk of heart attack, stroke, risk of death from cardiovascular disease or overall risk of death (all findings from the review Dr Ruxton herself quotes). And this is what really matters.

In my experience, individuals who do not believe that saturated fat poses hazards for health hold that view because they have read and assimilated the research and found nothing to incriminate saturated fat in terms of its influence on health.

Not only do we have the evidence being discussed here, but we also have several recent reviews of the epidemiological evidence that simply fail to link saturated fat and heart disease [2,3,4].

Anyone can make an honest mistake, of course, but I think Dr Ruxton compounds her error by refusing to accept the facts even when they were put in front of her face.

In her response to the previous post, she describes herself as an ‘independent dietitian’. Personally, I believe that use of the word ‘independent’ here is stretching it a bit, seeing as the Fat Information Service (and, I assume, Dr Ruxton) is bankrolled by Unilever.

To my mind, either Dr Ruxton does not have the ability to interpret the review she cites or has misinterpreted it and misled us. Only she will know the truth. The rest of us will just have to decide for ourselves.

References:

1. Hooper L, et al. (2011). Reduced or modified dietary fat for preventing cardiovascular disease. The Cochrane Library

2. 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):659–69

3. 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

4. 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

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:

Screen shot 2013-07-24 at 22.09.35

Dr John Briffa’s best-selling ESCAPE THE DIET TRAP – lose weight without calorie-counting, extensive exercise or hunger is available in the UK and US

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58 Responses to What is the ‘Fat Information Service’ up to? Part 2

  1. Elizabeth 23 July 2013 at 2:25 pm #

    Actually, I am not sure any of us are entitled to our opinions, when we have abundant evidence to look to.

    Well, she’s entitled to her opinions just like the flat-earthers and the creationists and everyone else. She’s just not entitled to pass them off as facts.

    Great post; thanks for sharing!

  2. Dr John Briffa 23 July 2013 at 2:30 pm #

    Elizabeth

    “Well, she’s entitled to her opinions just like the flat-earthers and the creationists and everyone else. She’s just not entitled to pass them off as facts.”

    Yes, you’re right. I stand corrected!

  3. NM 23 July 2013 at 2:33 pm #

    Since Dr Ruxton makes extensive use of Cochrane meta-analyses, perhaps she’d like to comment on this one that you referenced earlier:
    http://www.drbriffa.com/2011/07/12/massive-review-shows-conventional-advice-to-reduce-or-change-fat-intake-does-not-prevent-disease-or-save-lives/

  4. Lucy 23 July 2013 at 2:36 pm #

    The advice from the NHS choices link, which the general public, not knowing any better, will believe and slavishly follow, is absolute bulldust from start to finish. Cutting down on saturated fat and replacing it with inflammatory, toxic, highly processed ‘vegetable’ oils will only result in MORE disease not less. If you have ‘high’ cholesterol, there’s every chance you already have disease, more than likely caused by high blood sugar/insulin and/or inflammation from said oils, combined with a high carb/low fat diet (aka ‘healthy’). The cholesterol didn’t cause it, it’s there to try and put it right and if you remove saturated fat from the diet you a) don’t address the cause of the disease and b) have no ‘building materials’ with which to put it right. Of course Dr Ruxton is working for Unilever who produce the toxic slime they call ‘spread’, and also the frankly pointless Benecol for the high cholesterol they caused. Sound marketing strategy Unilever. Create a market, sell a solution. Brilliant.

  5. William L. Wilson, M.D. 23 July 2013 at 2:45 pm #

    Recently I had a similar slug fest with James Kenney from the Pritkin center on a Linkedin discussion. James has a PhD in Nutrition and favors a plant based diet. He also considers saturated fat to be the source of all evil in the world.

    http://www.pritikin.com/home-the-basics/about-pritikin/our-experts/1437-jay-kenney.html

    I learned from my interactions with James that these folks will never change their minds regardless of the evidence before them. To them low fat eating seems to be some sort of religious experience.

  6. Dr John Briffa 23 July 2013 at 2:46 pm #

    NM

    The irony is that this is the precise review that Dr Ruxton used to make her claim that: “The evidence shows clearly that the risk of developing heart disease is reduced when saturated fats are replaced with unsaturated fats.”

    The problem is (at the risk of labouring the point) that the review showed no such thing.

  7. Dr John Briffa 23 July 2013 at 2:49 pm #

    William

    “I learned from my interactions with James that these folks will never change their minds regardless of the evidence before them. To them low fat eating seems to be some sort of religious experience.”

    Yes, it does feel like that sometimes. I have nothing against religion per se, though my understanding is that it something based on faith (not fact). And then, of course, we have the issue of conflicts of interest…

  8. Anna 23 July 2013 at 2:58 pm #

    Unfortunately for her, the whole thing smacks of just touting the line for organisations who may or may not remunerate her. Opinions such as hers are a dime a dozen. Well-thought out, clearly articulated, evidence-based points of view are much more valuable, as you have noted.

  9. Dr John Briffa 23 July 2013 at 3:04 pm #

    Anna

    “Well-thought out, clearly articulated, evidence-based points of view are much more valuable, as you have noted.”

    As far as the conventional nutritional establishment is concerned, I’ve learned not to hold my breath…

  10. NM 23 July 2013 at 3:11 pm #

    That saturated fat is benign or helpful should surely be the null hypothesis: after all, it is what we evolved to consume over millions of years and aeons of ice ages. It was the primary dietary component of healthy hunter-gatherers even today. This ancient food is how we managed to evolve our large brains. Every successful society in the history of humanity has prized it. Again, that it is an important part of human nutrition should thus be the null hypothesis. Instead, the mainstream narrative turns such basic, first-principle critical thinking on its head, and somehow demands of us that we disregard the evidence of the totality of our evolution, and assume that, somehow during the last 100 years, this sine-qua-non of human nutrition suddenly did an about-turn and started causing a cascade of modern diseases. Maybe it did! But such an extraordinary claim should require EXTRAORDINARY evidence!

    Of course, people might argue that infectious diseases and early mortality masked the fact that our aeons-beloved saturated-fat was always going to be a cardiovascular killer in the end. This doesn’t work, though, because there is a clear substantial increase in CVD in the young – not to mention all the other effects and diseases associated with the Metabolic Syndrome. However else they suffered, traditional societies gorging on saturated fat did not die of heart disease in their fifties, and nor did their children develop type-2 diabetes. Not until introduced to sugars, starches and seed oils, that is. Then they caught up very quickly. But, of course, people like Dr Ruxton turned logic on its head and blamed the pre-existing benign variables rather than the newly-introduced ones!

    And none of this is pedantic. This hideous mangling of logic is one of the reasons that type-2 diabetics are now encouraged, counter-intuitively, to consume starch-based diets. Why on earth is someone with an inability properly to regulate glucose being put on a high-glucose diet? Because it is assumed that high-fat diets (which do not require as much insulin regulation, so SHOULD be the default) will cause these people to have CVD. If Dr Ruxton stopped to consider *why* diabetics have the increased risk of CVD in the first place, the answer should horrify her, suggesting that pushing starch and seed-oil based diets on diabetics is a kind of negligence bordering on medical genocide.

  11. Lew 23 July 2013 at 6:07 pm #

    So these saturated fat plonkers would like us to believe that humans have evolved with a mechanism of storing excess energy intake in the form of saturated fat and that (a) the later use of those stores of saturated fat will cause cardio vascular disease? and (b) mothers should stop breast feeding their babies because breast milk contains about 2% saturated fat – which adds up to a huge amount on a grams per Kg body weight?

    I

  12. David 23 July 2013 at 6:17 pm #

    NM, Dr Ruxton would appear to a great deal of experience in the sugar industry, so I expect she will be difficult to convert.

  13. eddie watts 23 July 2013 at 6:45 pm #

    towards the end you have this “Anyone can make an honest, of course, but I think Dr Ruxton compounds her error by refusing to accept the facts even when they were put in front of her face.”

    i think it is meant to say “anyone can make an honest mistake”

    great write up, enjoyed this 2 part post.
    will there be more?

  14. NM 23 July 2013 at 6:52 pm #

    Lew: it’s even worse than that! Breastmilk contains a significant amount of cholesterol too, and enzymes to make sure the baby can absorbe every drop.

    So a baby comes out needing large amounts of fat and cholesterol, and spends much of its early life in deep dietary ketosis.

    Thus, from the moment we’re born, we thrive on fat – especially stable saturated fat. That this of all nutrients has been demonised will make future generations shake their heads in bewildered astonishment.

    But in the meantime, there is nothing here we can say, and no evidence we can give, that will convince the likes of Dr Ruxton to think again. Also, make no mistake: she believes *we* are made flat-earther conspiracy theorists and pities us for our quixotic “beliefs”.

    She will never, ever question her own beliefs. She nestles comfortably in the nest of half-baked homilies that have provided such comfort for her heretofore, and so it can never be in her interests to question the basis of the commonplace banalities she believes are “science” too deeply, lest the first thread she pulls unravels this whole nest.

  15. William L. Wilson, M.D. 23 July 2013 at 8:39 pm #

    I like Chris Masterjohn’s review of Uffe Ravnskov’s book “The Cholesterol Myths”. Chris seems to have a fairly nuanced view of the cholesterol-heart disease connection:

    http://www.cholesterol-and-health.com/The-Cholesterol-Myths.html#lower

    Chris also has some good stuff on his site:

    http://www.cholesterol-and-health.com/cholesterol-and-disease.html

  16. GB 23 July 2013 at 8:53 pm #

    This seemed a case of industry-funded dietician against independent doctor until I discovered that Dr John is actually a founding member of the Butter Board, bankrolled by Anchor! It looks like neither side is independent after all.

  17. Lew 23 July 2013 at 11:50 pm #

    NM nicely put!
    As a geochemist I find it quite interesting the similarities here to coolidal silica deposition in geothermal pipelines. The maintenance is surface charge on both particle and pipeline seems to me to be fundamental yet I can find little research in this area. Cetainly the surface charge on the endothelium can be disrupted by trauma and inflammation and lipo-protein particles can have their surace charge disrupted by oxidation of fatty acids and in particular polyunsaturated fatty acids. The debate around cholesterol being the cause of atheroma’s seems to irrelevant – only guilty because it was at the scene of the crime?

  18. Dr John Briffa 24 July 2013 at 6:45 am #

    Thanks Eddie – corrected now.

    “will there be more?”

    Well, as long as Dr Ruxton continues to appear to willfully mislead the public even when the facts have been put in front of her face then, yes, I expect the will be more.

  19. Mark Struthers 24 July 2013 at 9:15 am #

    @GB 23 July 2013 at 8:53 pm

    Bias is everywhere, as Malcolm Kendrick has recently noted:

    http://drmalcolmkendrick.org/2013/07/01/bias-bias-everywhere/

    Malcolm quotes Professor Bruce Charlton, who was sacked in 2010 by Elsevier as editor of ‘Medical Hypotheses’. Professor Charlton noted ‘the decline of honesty in science’ when he wrote:

    “Anyone who has been a scientist for more than 20 years will realize that there has been a progressive decline in the honesty of communications between scientists, between scientists and their institutions, and between scientists and their institutions and the outside world.

    Yet real science must be an arena where truth is the rule; or else the activity simply stops being science and becomes something else: Zombie science. Zombie science is a science that is dead, but is artificially kept moving by a continual infusion of funding. From a distance Zombie science look like the real thing, the surface features of a science are in place – white coats, laboratories, computer programming, PhDs, papers, conference, prizes, etc. But the Zombie is not interested in the pursuit of truth – its citations are externally-controlled and directed at non-scientific goals, and inside the Zombie everything is rotten…..

    Scientists are usually too careful and clever to risk telling outright lies, but instead they push the envelope of exaggeration, selectivity and distortion as far as possible. And tolerance for this kind of untruthfulness has greatly increased over recent years.
    So it is now routine for scientists deliberately to ‘hype’ the significance of their status and performance and ‘spin’ the importance of their research.”

    I suspect that Bruce Charlton has exposed Dr Ruxton is a true Zombie.

    PS. I note that yesterday Professor Charlton responded to Malcom’s blogpost. He put Evidence Based Medicine (EBM) firmly into the category of Zombie science … and I wholeheartedly agree with him.

  20. Clive Last 26 July 2013 at 7:12 am #

    Dr Briffa,

    Are/were you a member of the Butter Board as suggested by a contributor on this page?

  21. Dr John Briffa 26 July 2013 at 7:45 am #

    Clive Last

    I was, but not since 2003. If I still were, I would not describe myself as ‘independent’. I have no issue with individuals earning consultancy fees with elements of the food industry, but clearly this jeopardises independence.

    But the most important thing is that, whatever our affiliations (past and present), we strive always to inform individuals as best we can, and not mislead them. Dr Ruxton is entitled to take all the money from Unilever (or any of the other industry bodies she is connect to) she likes. But that does not give her the luxury of misrepresenting the evidence.

    If you have an issue with how I have interpreted the science then please raise it now. If you have evidence which proves my interpretation of the Cochrane review (to which Dr Ruxton referred) is faulty then please reveal it.

    It’s the science that’s the key issue here. The main point, lest it gets forgotten, is that Dr Carrie Ruxton, whether wittingly or not, misled us over the science. Then she compounded the problem by steadfastly refusing to acknowledge it when it was pointed out to her. And then she made claims about me that were patently and demonstrably untrue. She did everything and anything, it seems, not to engage with the issues at hand and deflect from it.

    Anyway, on the plus side, her claims have now been removed from the FIS website. Maybe someone finally realised that she was perhaps bringing herself, the FIS and Unilvever into disrepute and decided to do the right thing.

  22. Basa Andere 26 July 2013 at 7:47 am #

    Well done, Dr B!
    Last time I looked, being “rather pedantic” was a virtue absolutely necessary for conducting good science. :)

  23. NM 26 July 2013 at 7:52 am #

    People who think that simply fingering John as “Dr Butter” is sufficient to discredit his arguments here should look up how the Ad Hominem fallacy works!

    Dr Ruxton’s compromising affiliations are not the reason we should distrust her; rather, they provide some context to understand her odd misrepresentation of the science. So the logical inconsistency must come first. THEN we can look for reasons for it (stupidity, bribery, compromise, whatever).

    So, how would pointing out that Dr Briffa used to be Dr Butter ever be justified, logically? If Dr Briffa kept bringing out tendentious epidemiological surveys, and then mangled them into ventriloquising that butter would make one live forever – then his Butter Board experience would be relevant to mention. However, he doesn’t do this, and is very level-headed in analysing the evidence.

  24. Clive Last 26 July 2013 at 8:21 am #

    I have absolutely no problem with your status, past or present, I just wanted to be sure that you are independant and not with vested interests, as it appears that Dr Rushton is.

    Thanks for your reply.

  25. Magarietha 26 July 2013 at 8:25 am #

    This lady has GOT to stop surmising what the consumer “tends to think”. It’s as if she has never heard of the internet – and I’m not talking about private anecdotal blogging. We now have access to sage information and some of her “consumers” will tend to do research too. I don’t know of a single non-medical person who wouldn’t be able to distinguish between all the types of arterial events – no really…

  26. Will 26 July 2013 at 8:39 am #

    Thank you for taking the people tasked with delivering such “public Health” messages. When they are not grounded in firm science and are more based on the re-affirmation of entrenched beliefs, people like you provide a valuable public service in challenging them and, I would hope, making them more careful about their interpretation of the evidence in future.
    Although I agree with your points on this topic, I also have some sympathy with Dr Ruxton, and think that you may have come across as rather pedantic. I think that it’s worth remembering that to improve public health one needs to not only work from a firm evidence base, but also to communicate the findings that will have the greatest effect on public health in an effective way. I agree with Dr Ruxton that “the consumer tends to understand ‘heart disease’ better ” than cardiovascular events, and I think it is a bit too strong to accuse her of intellectual dishonesty, when surely the public would like to reduce their risk of all “cardiovascular events”, and not only those related to heart disease.
    I do think it is entirely reasonable to say that she overstates the evidence supporting the reduction/substitution of saturated fats for the prevention of cardiovascular disease. From your (very useful) interpretation, the support from this review would seem to be suggestive at best and not really worthy of a big announcement on a grand platform that could potentially lead people to make changes to their diet that would do them harm.
    In my understanding the evidence is pretty good that certain saturated fatty acids, when replaced by certain PUFAs, and to a lesser extent MUFAs will reduce cholesterol or “improve” (by current public health interpretations) blood lipids. I know of no good evidence that this results in better health outcomes as a whole (overall mortality). The lack of evidence to support the widely accepted (by most of the public and many health professionals) fallacy that reducing saturated fat intake will definitely improve public health is what needs to be addressed more urgently, but it is a very difficult one to communicate to the public given the duration that the “saturated fat is bad for your heart” message has been the standard.

  27. Dr John Briffa 26 July 2013 at 8:46 am #

    Magarietha

    Yes, I totally agree with you. I sometimes think we ‘health professionals’ dumb things down at the expense of accuracy, but at least now many people are in a position to spot the errors.

  28. Dr John Briffa 26 July 2013 at 8:52 am #

    Will

    You raise some very important points, I think, but I wanted to pick up on one: the issue of ‘intellectual dishonesty’. In my email to Dr Ruxton I stated:

    “Your response demonstrates either a failure to properly interpret the findings of this review or intellectual dishonesty.”

    Notice the ‘or’ in there. I would say now, though, that her failure to acknowledge the plain facts when put in front of her face does actually suggest the latter.

    This is a side-issue though – because as you allude to, what is most important is that people get accurate advice about the impact of diet on health. Some myths and fallacies are quite entrenched, but I know from my experience the truth is getting out there…

  29. Scott 26 July 2013 at 9:23 am #

    If she’s “entitled to her opinion”, why does she bother to quote research at all? The whole point of conducting research is that we can do better than ‘opinion’!

    Also, her point about the NHS is classic! The whole point is that ‘conventional wisdom’ may be mistaken, and hence should be controversial. Her only defence of conventional wisdom is… that it is conventional. And it should not be controversial… because it is not controversial at the moment! The same argument could be used to defend any out-dated theory at any time.

  30. Diane Smith 26 July 2013 at 9:34 am #

    ‘Some myths and fallacies are quite entrenched, but I know from my experience the truth is getting out there…’

    And that, I guess, is what Unilever is worried about and the reason why they have set up The Fat (Dis) Information Service. Just think of the damage to their profits if the trend to eat butter continues increasing!

  31. William L. Wilson, M.D. 26 July 2013 at 9:36 am #

    John—I agree that we need independent nutritional research that is free from the influence of commercial interests. Both of us know the negative influence the pharmaceutical industry has had on objectivity when it comes to drug research.

    That’s why I support Gary Taubes and Peter Attia and their non-profit NuSci project. They are committed to collecting funds and supporting nutritional research that is free of the influence of commercial interests:

    http://nusi.org/about-us/a-letter-from-the-founders/#.UfJCDeA8LCc

    My youngest son is getting his PhD in nutritional science and I would like to think he can contribute something positive to the world of nutrition without working for some giant food company.

  32. Eddie Mitchell 26 July 2013 at 9:43 am #

    Hi John

    The propaganda can be more subtle than the bent out of shape science you exposed.

    From the Fat Information Service website.

    “The myth: Butter has been around for centuries, while margarine has been around for less than 100 years.

    The facts: Margarine was actually invented in 18691. However, since the world of science is constantly evolving, innovative inventions should not be viewed as posing health concerns. In contrast to butter, the composition of margarine has been adjusted in accordance with the latest nutritional findings over the years (involving both the removal of damaging trans fats and the addition of beneficial plant sterols to help further reduce cholesterol levels).”

    Implication, butter and margarine are on a level par re. consumption time scale. Butter and the virtually identical ghee has been around for at least three thousand years.

    “The myth: Margarine was not made for humans and was designed to fatten up turkeys.

    The facts: Margarine was always intended for human consumption; it was originally developed when the Emperor Louis Napoleon III called for the production of a low-cost substitute for butter.”

    Since when was a cheap substitute ever as good as a natural food ? And many margarine’s now cost more than the real thing. The fact is the sales figures for Flora have plummeted in recent times and let’s hope that trend continues. When a salesman has to bend my arm up my back to convince me his product is better, I head swiftly to the exit. I see they keep well away from talking about hydrogenated vegetable oils.

    “The basic method of making margarine today consists of emulsifying a blend of hydrogenated vegetable oils with skimmed milk, chilling the mixture to solidify it and working it to improve the texture. Wiki

    Regards Eddie

  33. William L. Wilson, M.D. 26 July 2013 at 9:49 am #

    Will–You make some good observations. I am old enough to remember the emergence of fat phobia. I graduated from the University of Minnesota where Ancel Keys worked for many years. I never met Keys but I worked under Franz Halberg, another famous professor who more or less invented the field of chronobiology. Keys died at 101 and Halberg is still working in his mid-90s. It must be that clean Minnesota living!

  34. Liz 26 July 2013 at 9:55 am #

    Thank you Dr John, once again for taking on, and waving the flag for the unjust and inaccurate information that we are fed/bombarded with, in the name of “science” – bad science! It is just so unjust that this is the kind of pseudo information that gets the big headlines and seduces the unsuspecting public into following their advice. It makes me feel so angry and so useless, as if we are fighting against immovable tidal forces. But I do believe the tide is turning slowly, mainly because people like yourself are prepared to take the time and energy to take on these massive organisations that seem to want to control every aspect of our lives. Thank you once again and keep up the good work. PS do love the comments, they have so much interesting and pertinent info to add to the discussion, all delivered with good natured spirit too. Lots of nice, and well informed people out there aren’t there?!

  35. Dr John Briffa 26 July 2013 at 10:13 am #

    Liz

    “do love the comments, they have so much interesting and pertinent info to add to the discussion, all delivered with good natured spirit too. Lots of nice, and well informed people out there aren’t there?!”

    I love the fact that this is your perception, and I agree. I do think that there are far more people out there who want to know the truth and have something to share than people who would perhaps keep people from the truth.

    Thanks for your input.

  36. Dr John Briffa 26 July 2013 at 10:30 am #

    Scott

    “Her only defence of conventional wisdom is… that it is conventional. And it should not be controversial”

    Yes, and it’s a great way to supposedly add credibility and weight to your argument even when the science does not support it and you are demonstrably wrong.

    Many dieticians, in particular, do this ‘appeal to authority’ thing, like it absolves them from the need to be accurate, do the necessary research or think for themselves.

  37. Dr John Briffa 26 July 2013 at 10:38 am #

    Diane

    “And that, I guess, is what Unilever is worried about and the reason why they have set up The Fat (Dis) Information Service. Just think of the damage to their profits if the trend to eat butter continues increasing!”

    I tend to agree with you. I think the truth is out and there’s no putting it back, but of course one can imagine that, for some, damage limitation looks like the correct recourse. The problem with damage limitation for those who attempt it is that it can sometimes backfire. As I suspect the case is here.

    It’s getting progressively harder for corporations to misinform people (wittingly or unwittingly). This, from my perspective, is no bad thing.

  38. Marisa Choguill 26 July 2013 at 1:20 pm #

    Yes, ‘It’s getting progressively harder for corporations to misinform people’ thanks to sites like yours!

  39. Thomas Murphy 26 July 2013 at 1:23 pm #

    For anyone who is interested, this is what Dr. Carrie Ruxton does for her day job:

    http://www.nutrition-communications.co.uk/index.php

    As far as I can tell, this is her own consultancy practice.

  40. Eddie Mitchell 26 July 2013 at 2:39 pm #

    Well that’s a nice change, a dietician that is not obese. Anyone been watching the BBC series Britain’s Favourite Supermarket Foods ? I have seen four dieticians on the program and three have been very much in the weight loss in progress category. Good grief it makes you wonder eh.

    Regards Eddie

  41. Diane Smith 26 July 2013 at 2:54 pm #

    One of the new articles on her site is entitled ‘High fat diets impair cognitive function’ and goes on to talk about a a trial which showed that men fed a high fat low carb diet adversely affected their mood, speed and attention and that there was a 44% rise in plasma free fatty acids following consumption of the high-fat, low-carbohydrate diet.

    However, the trail only lasted 5 days. It is now well known that it takes at least 2 weeks for the body to adapt to a low carb high fat diet and switch from burning glucose to burning fat and so this trial tell us absolutely nothing about how such a diet affects cognitive function.

    http://www.nutrition-communications.co.uk/news_detail.php?news_id=204

  42. Richard 26 July 2013 at 5:06 pm #

    Thank you Dr Briffa for taking this to “them” and making your point clearly, the fat information service and related website, is in my opinion, just a propaganda machine trying to stop the massive trend to move away from products like margarine and towards butter.

    Keep up the good work, I will certainly be linking to both these articles from my blog to show anyone who missed this what exactly is going on behind our backs.

    Rich

  43. Martyn 26 July 2013 at 5:36 pm #

    In addition to your remarks, I also note that in both quotations from the Cochrane review contain grammatical usage that leads one to the conclusion that there is no sound, research-based evidence supporting Dr Ruxton’s thesis:

    (1) One [sic] page 19 of the 2011 Cochrane review,”… MAY BE protective of cardiovascular events overall…” Emphasis mine.

    (2) The implications for practice on page 29… “Dietary change to reduce saturated fat and partly replace it with unsaturated fats APPEARS to reduce the incidence of cardiovascular events” Emphasis mine.

  44. Dr John Briffa 26 July 2013 at 5:49 pm #

    Martyn

    Yes, indeed. Quite cautious with their language, and I would say even here they are risking over-stating their findings, seeing as statistical significance disappeared once systematic differences in care or non-fat-related differences in care were controlled for.

    Oh, and another thing is that any ‘benefits’ seen were only in men (women showed no benefits at all).

    I don’t think the authors were as transparent as they perhaps should have been in their abstract. The loss of statistical significance when controlling for systematic differences in care and non-fat-related differences in care is important, I think, but was embedded in the text and certainly not made a feature of. There was no mention of any benefits being seen in men only in the abstract either.

  45. Stevie 26 July 2013 at 6:27 pm #

    Once you are reduced to claiming that the results of a trial lasting for five days can be extrapolated to provide accurate predictions for many decades then you have declared yourself to be, for all practical purposes, intellectually bankrupt.

    I’m surprised that the ‘Fat Information Service’ hasn’t managed to rustle up someone a little more plausible; it’s not as if they are short of money…

  46. Dr John Briffa 26 July 2013 at 6:38 pm #

    Stevie

    Leaving the limitations of this study aside, I’d like to pick up on your comments about credibility.

    The FIS website exists to, I think persuade people that margarine in healthier than butter. The problem is, I think the evidence does not point to that at all. In fact, as I’m planning to expand on in a not-to-distant post, the evidence seems to point quite strongly in the opposite direction.

    So, if someone is happy to go along with the conventional wisdom on sat fat, the perils of butter and wonders of margarine, say, then the most likely explanations are:

    1. they haven’t looked at the research

    2. they have looked at it but do not understand it nor how to interpret it

    3. they understand it very well indeed, but will happily mislead people to (usually) make a buck

    It does not matter which category someone falls into – the fact remains that if they are in any of these categories, credibility is always, ultimately, going to be an issue.

  47. William L. Wilson, M.D. 26 July 2013 at 7:23 pm #

    John–I agree. This morning I had scrambled eggs and bacon for breakfast. I usually put olive oil over the eggs but they were out so I used butter. I’m sure this meal would give most Cardiologists a heart attack!

  48. Angela 26 July 2013 at 8:53 pm #

    What seems so often to be forgotten is the fact that Ansel Keys’ claims that form the basis for the whole ‘saturated fat is bad for you’ assumption do not stand up to scrutiny, and could virtually be described as fraudulent.

    The evidence that suggests that decreasing saturated fat reduces cholesterol neglects a number of crucial issues, not least of which is the *type* of cholesterol that decreases in that context. Most cholesterol testing fails to distinguish between the kind that might signify and the kind that doesn’t, and it is the latter which decreases with the decrease in saturated fat intake.

    On the other hand the evidence about the relationship between sugar, insulin and CVD is not only compelling, but demonstrates the mechanisms that connect the two quite clearly. Replacing saturated fat with PUFAs also brings its own health problems in its train…

    This is really no longer much of an open question… but we seem to be condemned continually to repeat the same argumentation and to keep ‘debating’ the issue. It’s getting wearisome!

  49. Tom 27 July 2013 at 2:24 am #

    John, I am a big fan and fully subscribe to the evidence FOR eating saturated fat and cholesterol. I sometimes find it difficult to articulate this to friends and family who eat their branflakes, bread, pasta, rice etc. in vast quantities. Do you have a summary article online that I can point them too and provoke them to read more?

  50. paulc 27 July 2013 at 7:39 am #

    Just look at the way Corrie (Coronation street) actress Catherine Tyldesley was attacked by the establishment for the following tweet:

    “I’m shocked by some of the nutritional advice available on the NHS. Wholemeal bread, cereal and pasta are good for you?!?! #yeahright”

    here’s a link to the article about it in The Sun and some of the comments will horrify you at just how ignorant the general public really is.

    http://www.thesun.co.uk/sol/homepage/showbiz/tv/soaps/5034239/Corrie-actress-slammed-for-tweet-about-NHS-guidelines-on-food.html

  51. Christopher Palmer 28 July 2013 at 8:08 pm #

    Do you know, it seems so much harder to disprove an established theory by pointing to the absence of evidence than it is to propagate a falsehood for which the ‘evidence’ is pure fiction. Belief and superstitions seem to travel with ease and traverse the world, whilst the truth can have a hard time advancing by just one step.

    The Code of Advertising Standards (or whatever name it goes by) extends to cover websites and their content, so it would seem the Fat Information Service comes under the jurisdiction of the Advertising Standards Authority.

    Anybody can make a mistake and adopt a falsehood for fact, but if a person insists upon propagating a falsehood after (s)he has been made aware of the mistake the that is serious misconduct, and if they make money from persisting with a lie, or assist others to make money from a lie then that is an act of fraud and if we lived in a decent world it would be treated as such.

    We live in a world in which fictional markets are on the rise. A fictional market is one that generates real profits but does so off the back of false claims or half truths. Fictional markets are quite extensive and getting bigger, and the most prominent of them are backed by this cholesterol and saturated fat causes heart disease nonsense. When Mark Price, head of the supermarket Waitrose, recently said of GM, that GM was solution actively seeking a problem to solve he was quite astute in that he described a common trait of fictional markets.

    Once I came to realise that polyunsaturated fats PUFAs are distinguished from saturated fats by virtue of being less stable and more reactive, and that the body utilises these attributes to use PUFAs as the parent molecules from which to build messenger molecules called eicosanoids I realised that the Goldilocks principle as applies to PUFAs and EFAs, especially the omega-6 variety that can be plentiful in margarine, is very finite indeed.

    The Goldilocks principle advises too little is not enough, and that too much is downright dangerous. Over-supply of omega-6 PUFAs is very definitely risky because these species of fats are too easily damaged by oxidation, and once oxidised or radicalised they too easily do damage in turn. All EFAs and PUFAs should be consumed only in very limited quantities that should never exceed the Goldilocks zone.

    I steered as clear of margarine and vegetable oils as I could and soon after I got some significant relief from some of the symptoms of type II diabetes. Most notably bouts of the muscle lethargy and mental dullness that used to be a prominent and frequent complication left me completely. Then when I began intentionally eating a low-carb / high-fat diet I was all but cured of the condition.

    Bill Wilson does well to refer to Chris Masterjohn and his web presence. Chris Masterjohn is quite ardent about the dangers of over-consuming PUFAs and EFAs and his advice extends to defining the limits of these quantities.

    It is fairly plain that when a body sequesters energy as body fat for use when food may not be so abundant it does so by converting excess glucose to fats. Storing fats is efficient because w/w they pack more energy, but the balance of fats that an animal (and us) will produce to store as body fat will greatly favour the families of saturated fats and mono-unsaturated fats. There is a reason: That reason is that to have a surplus of polyunsaturated fats present in body tissues poses additional risks via elevated prospects of oxidative stress.

    The lately departed Barry Groves discussed PUFAs in his book ‘Trick and Treat’. His treatment is a major league exposition favouring the truth and exposing the lie. He makes the point that the different fats to be found in plants follows a simple general rule. Plants that grow in the tropics can associate with saturated fats, while plants that favour more temperate regions and endure cooler average temperatures need to associate with fats that remain fluid at lower temperatures, so for them PUFAs match their requirements. Our kind emerged in Africa, and once ate an ape-diet in which saturated fats will have accounted for a significant proportion of the calories present.

    If we are prepared to be both open minded and holistic (as opposed to dogmatic through ignorance, preference, convenience, or greed) then there is no way we should rush to direct that our association with saturated fats could be in any way maladaptive and harmful. If anything, coming at this puzzle from this inclusive and evolutionary stance directs that supply of PUFAs in the quantities now available in many a modern diet is sufficiently novel, in terms of evolution and adaptation, as to look distinctly maladaptive and therefore potentially harmful.

    Much as I like trying to make the truth as plain as my abilities allow, the desire to simply tell Dr Ruxton and Unilever to **** ***!! is a strong one in the face of their intransigence.

    On Radio 2 last week Steve Wright and Janey Lee Grace had a brief exchange on the topic of Earthing and cast it in a positive light, so truth does get an outing sometimes, but so rarely do we humans credit the truth with the respect it deserves, and when so easily and often a bank account can be credited from the promotion of a lie.

  52. SueG 28 July 2013 at 8:29 pm #

    “Anyone can make an honest mistake, of course, but I think Dr Ruxton compounds her error by refusing to accept the facts even when they were put in front of her face.”

    I wonder if this is where most of the community GPs also sit? They slavishly dish out what was the conventional wisdom about diets, treatments, diseases etc. because they fear to step out of line. As a sole voice in a multi-partnered practice, which GP would consider speaking out?

    In our practice there are at least 8 GPs, even if one were enlightened enough to advise that eating saturated fats was fine, when you next visit the chances of seeing the same GP are minimal and the next one along is likely to tell you that saturated fats are the Devil’s spawn and to be avoided. You can of course make your own decision based on sites like Dr. Briffa’s but first you have to realise that not all the advice given by a GP is sensible or accurate and be prepared to go off and do your own research.

    I fear many people still consider the GP to be the fount of all medical knowledge and wouldn’t think to question what they are told. As these days the media are also fighting each other over such issues as saturated fat, carb intake, fad diets etc. I think most of the population finds it easier to stick with what their GP advises.

    The Daily Mail does a wonderful line in reporting a medical truism, followed some days or weeks later by an article that completely contradicts the first. Off hand I can think of sun causing melanoma v. sun not thought to be responsible for melanoma, salt being bad for you, salt not being bad for you. Confused? Well, I’m not surprised!

  53. fionab 28 July 2013 at 9:52 pm #

    Christopher Palmer referenced “The lately departed Barry Groves”. As a great supporter of all Barry’s writings and books I was shocked and saddened to hear this news. Barry has done so much to help educate us all. Trick and Treat should be a text book for current generations of trainee medical and nutritional professionals. The main contents of his chapter on PUFAs is also available on his web site, that fortunately remains active.

  54. SueG 29 July 2013 at 8:54 am #

    Oh my goodness, I have visited the Fat Information Service, it’s like a propaganda service for Unilever! How have they persuaded such high profile people to lend their name to it. This page had my jaw dropped, should we really include something in our diet because it spreads easily???

    http://www.fatinformationservice.org/news/growing-trend-for-butter-over-margarine

  55. Robert Park 29 July 2013 at 12:40 pm #

    I had not realised that Dr Barry Groves had passed away at the end of last April aged 77 (cause of death, as far as I can determine, is unknown). Seemingly his brother Richard passed away just 6 days prior aged 75; both apparently maintained good health until the end. Like Dr Groves, I too became interested in the benefits of saturated fats during the 60s era and followed his interest in dietetics when he started his Web page http://www.second-opinions.co.uk but where we differed was that although I attempted the high fat low carb diet on a few occasions I was not fully committed having the suspicion that our bodies need some carbohydrates. I do not like vegetables nor fruits and while I have them they amount to very little. My experience is that if I consume a diet that is high in saturated fats (which I do) that I have no problem with eating other foods but in moderation. I am convinced that high amounts of saturated fats in the diet is our saviour. Today, at 82, I am in good health and still believe that I have a future. There is clearly insufficient research done on the merits of different fats in the diet. Meantime, I feel saddened learning of the passing of Dr Barry Groves.

  56. Jennifer Gait 3 August 2013 at 12:05 am #

    I recently read the book The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease – And the Statin-Free Plan That Will by Stephen Sinatra MD and Jonny Bowden PhD ( a cardiologist and nutritionist respectively) In it they write that several studies have shown that saturated fat is not associated with a greater incidene of heart disease, and, according to a Harvard study, is associated with less progression of coronary athersclerosis. Other studies showed that saturated fat raises HDL and increases LD-A (a subtype type that does no damage) while unsaturated fat raises LDL-B (a subtype tha tis the damaging sub-type.) In fact they found that the most harmful dietry component worsening heart disease, was refined carbohydrates.

    They also noted that studies did not lower the heart-related death rates in those subjects who lowered cholesterol, and some showed a higher all-cause mortality rate for these subjects than for those in the control group.

    So for me, saturated and mon0saturated fats are in, and unsaturated fats are out.

  57. SueG 16 August 2013 at 9:48 am #

    I am also part way through a Dr. Sinatra book, Reverse Heart Disease now. I love his approach, he evaluates carefully and thoroughly and doesn’t dismiss anything out of hand. He explains well so that even a lay person should be able to understand the interactions of the body and it’s functions. He calls what he does, New Cardiology and is willing to use any proven branch of medicine to treat his patients. I find this very refreshing. Interestingly he even seems to believe that statins have a use though not not necessarily for just reducing cholesterol. Worth a read if you have heart disease.

    Despite the now overwhelming research results indicating that saturated fats aren’t the baddies, there are still TV programmes doling out the same outdated advice. The latest was Food Ripoff introduced by that well known good health guru Gloria Hunniford. As for Dr. Christian Jessel and his team, they should be shot! It saddens me watching them repeat the same old mantra about saturated fats whilst advising obese participants in their programmes.

  58. Valerie McKen 29 August 2013 at 12:30 pm #

    If they can prove the fat you eat causes heart disease…oh sorry, cardiovascular events…then I’ll continue with what I’ve been doing thanks.

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