Saturated fat is very bad news. The energy content of one gram of fat at 9 Calories is twice that of a gram of carbohydrate at 4 Calories so limiting fat and sugar intake to avoid visceral obesity and dyslipidaemia is essential. Fat is more energy dense than carbohydrate.
There is an overwhelming amount of data showing that a high saturated fat diet raises the total serum cholesterol. It has also been clearly shown that following a reduced saturated fat diet can reduce the serum total cholesterol by about 10%.
If you plot a graph of coronary artery disease risk against total serum cholesterol it produces a curvilinear relationship and the bottom line is that the higher the serum total cholesterol, the higher the risk from coronary artery disease. There is no "normal" range for serum total cholesterol, the lower the better.
In my Lipid Clinic in the 1980s and 90s I saw many patients who had undergone coronary artery bypass surgery and even heart transplants with cholesterol levels up into double figures whose lives were transformed by the results of the landmark 4S study that reduced total cholesterol by some 20% and reduced all coronary end points and total mortality. Suddenly everybody was prescribing statins. Not only do they reduce the serum total cholesterol and raise the HDL by about 6% but they also stabilise unstable atherogenic plaques and have a very important anti-inflammatory role in the atherogenic process.
Prior to that study the British Cardiologists had ignored "the Lipid Hypothesis" and the importance of the total cholesterol. Indeed the father of modern British Cardiology had stated that cholesterol did not have any place in the pathogenesis of coronary artery disease. It is incredible to discover shades of that philosophy today.
Total cholesterol is a valid indicator of the LDL-cholesterol level. Yes small dense LDL is more atherogenic than the larger less dense LDL but all living in Westernised societies need lower LDL cholesterol levels large and small.
HDL is atheroprotective but must be regarded with LDL. The ideal lipid profile is a nice low LDL under 2.0mmol/L and an elevated HDL preferably the HDL2 sub-fraction.
Finally the ASCOT Study was a multicentre International Study that treated blood pressure in two similar groups of patients. In addition to anti-hypertensives one group was given a statin and the other half a placebo. There were significantly fewer coronary and cerebrovascular events in those on statins without dyslipidaemia requiring the study to be terminated early so everybody could benefit.
The statins have prevented millions of premature deaths and are one of the greatest pharmacological benefits of the 20th century.
Beware being led back to the past by members of the Flat Earth Society!
Rapid Response:
Re: Saturated fat is not the major issue
Saturated fat is very bad news. The energy content of one gram of fat at 9 Calories is twice that of a gram of carbohydrate at 4 Calories so limiting fat and sugar intake to avoid visceral obesity and dyslipidaemia is essential. Fat is more energy dense than carbohydrate.
There is an overwhelming amount of data showing that a high saturated fat diet raises the total serum cholesterol. It has also been clearly shown that following a reduced saturated fat diet can reduce the serum total cholesterol by about 10%.
If you plot a graph of coronary artery disease risk against total serum cholesterol it produces a curvilinear relationship and the bottom line is that the higher the serum total cholesterol, the higher the risk from coronary artery disease. There is no "normal" range for serum total cholesterol, the lower the better.
In my Lipid Clinic in the 1980s and 90s I saw many patients who had undergone coronary artery bypass surgery and even heart transplants with cholesterol levels up into double figures whose lives were transformed by the results of the landmark 4S study that reduced total cholesterol by some 20% and reduced all coronary end points and total mortality. Suddenly everybody was prescribing statins. Not only do they reduce the serum total cholesterol and raise the HDL by about 6% but they also stabilise unstable atherogenic plaques and have a very important anti-inflammatory role in the atherogenic process.
Prior to that study the British Cardiologists had ignored "the Lipid Hypothesis" and the importance of the total cholesterol. Indeed the father of modern British Cardiology had stated that cholesterol did not have any place in the pathogenesis of coronary artery disease. It is incredible to discover shades of that philosophy today.
Total cholesterol is a valid indicator of the LDL-cholesterol level. Yes small dense LDL is more atherogenic than the larger less dense LDL but all living in Westernised societies need lower LDL cholesterol levels large and small.
HDL is atheroprotective but must be regarded with LDL. The ideal lipid profile is a nice low LDL under 2.0mmol/L and an elevated HDL preferably the HDL2 sub-fraction.
Finally the ASCOT Study was a multicentre International Study that treated blood pressure in two similar groups of patients. In addition to anti-hypertensives one group was given a statin and the other half a placebo. There were significantly fewer coronary and cerebrovascular events in those on statins without dyslipidaemia requiring the study to be terminated early so everybody could benefit.
The statins have prevented millions of premature deaths and are one of the greatest pharmacological benefits of the 20th century.
Beware being led back to the past by members of the Flat Earth Society!
Competing interests: No competing interests