Intended for healthcare professionals

Rapid response to:

Observations From the Heart

Saturated fat is not the major issue

BMJ 2013; 347 doi: (Published 22 October 2013) Cite this as: BMJ 2013;347:f6340

Rapid Response:

Re: Saturated fat is not the major issue

The debate on how nutrition relates to heart disease as well as other common chronic diseases has moved beyond isolated nutrients such as saturated fat and sugar in the USA. The emerging zeitgeist for chronic disease prevention and management is a diet based on whole plant foods. Large healthcare organisations such as Kaiser Permanente now support this approach:

Leading specialists such as Dr. William Roberts, a prominent cardiovascular pathologist and the editor of the American Journal of Cardiology, now recommend the same low-fat plant-based diet as that pioneered by Dr Caldwell Esselstyn in the prevention and management

Dr Garth Davis is a bariatric surgeon who has fully embraced whole foods plant based nutrition and has become very active in publicly promoting this approach. He is one of a growing number of doctors in North America who have incorporated plant based nutrition into their medical practice.

Here's an article Dr. Davis published on a social media site dated 27 May 2014:
"So I post a picture of a vessel loaded with fat and tell people to use common sense. I then get a bunch of responses trying to teach me physiology, even though that is my expertise. The fact that I actually go to the meetings where this is discussed and debated, the fact that I actually study the journal articles, the fact that I actually treat patients and have for 12 years, seems to not matter much to some people. So lets get scientific. And this is just the tip of the iceberg.

What matters when you eat is your post meal state. This is far more important than baseline fasting lipid values. A key study was done by Vogel who measured vessel response via duplex sonography after fatty and non fatty meals. AFter a fatty meal there is measurable vasoconstriction. The effect is like putting your finger over a hose. The velocity of the blood increases causes sheer force. He also showed that after a high fat meal the blood was loaded with fat, some of it is oxidized LDL which is exactly what you see in the picture from yesterday. Vogel, R. A., et al. (1997). "Effect of a single high-fat meal on endothelial function in healthy subjects." Am J Cardiol 79(3): 350-354.

Now I certainly don't think added sugar is good for you. Excess calories will create fat. Problem is that sugar itself, in a single meal, is not inflammatory at all, but fat is extremely inflammatory provoking. This study feed people juices vs cream and the difference in inflammation is dramatic. Deopurkar, R., et al. (2010). "Differential effects of cream, glucose, and orange juice on inflammation, endotoxin, and the expression of Toll-like receptor-4 and suppressor of cytokine signaling-3." Diabetes Care 33(5): 991-997.

So you have a state after a fatty meal where you are inducing flow changes and inflammation and increasing lipids!!!! Meanwhile, sugar does not create any of these issues. Sørensen, L. B., et al. (2005). "Effect of sucrose on inflammatory markers in overweight humans." Am J Clin Nutr 82(2): 421-427.

There has never been an animal model of atherosclerosis created with feeding carbs but many with feeding saturated fat. Population studies from EPIC, to ADVENTIST, to FRamingham, to so many others show definite relationship between high saturated fat and heart disease.

Chew on this. The National Geographic Blue Zone study found places where people had exceptional longevity. None of these places eat a high fat diet. They eat MAINLY CARBS. The Okinawans live long healthy lives eating yams and rice. If carbs ae so bad why are they so healthy. You may say processed carbs are different and they are in that they lack fiber. Otherwise though, sugar is sugar.

There are NO long living high fat consuming people. None. Please do not say the Inuits. They live to 50 at best and actually do have heart disease. GJ, f. and V. B (2014). for the origins of the Eskimos and heart disease, facts or wishful thinking? A review. Canadian Journal of Cardiology.
Of course people love to say the Masaii don't have heart disease. That is because they die at 45-50 before their 1 st heart attack, but autopsy studies show they do have atherosclerosis.

The bashing of sugar is backed by this belief that sugar causes insulin to rise and insulin is the real problem, so we should eat steak instead of bananas. Problem is that insulin rises higher after a steak than it does after a banana. A fatal flaw to the argument. Holt, S. H., et al. (1997). "An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods." Am J Clin Nutr 66(5): 1264-1276.

The fact is it is not as simple as fat or sugar. It is really a combination. You don't usually just eat plain sugar. A doughnut has more calories from fat than sugar. Most sugars are combined with fat, so the insulin release cause the fat to be stored. Eat a banana and there is sugar but no fat to react to the insulin.

The other absolute thing you have to understand is that active interventions aimed at reducing fat have actually reduced heart disease. THERE ARE NO STUDIES THAT SHOW INCREASING SATURATED FAT DECREASES HEART DISEASE. NONE!!! It is absolutely preposterous. Ornish showed that you can absolutely reverse heart disease with a low saturated fat diet. The North Karelia project showed that an organized government program to reduce saturated aft and cholesterol can work extremely well. Ornish, D., et al. (1998). "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 280(23): 2001-2007.

I sit across from patients everyday review their diet logs. I operate on them and see their insides. I cut open vessels and clear out cholesterol plaques. You can choose to believe a blogger or a journalist or you can trust in science that has been around for a long time. You choose."

Competing interests: No competing interests

31 May 2014
Colin Walsh
Cardiff, Wales