Intended for healthcare professionals

CCBYNC Open access

Rapid response to:

Research

Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3978 (Published 12 August 2015) Cite this as: BMJ 2015;351:h3978

Rapid Response:

Re: Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies

Much work has already shown adverse outcomes from too much saturated fat in the diet, in addition to the development of diabetes, heart disease, and other cardiovascular events. As such, your work published here has gone too far in that anytime one over-adjusts for important variables, the real data and trends become hidden. it is analogous to over-smoothing an image — the granular image becomes so smooth it obscures some of the salient features.

As the authors indicate in their own work, a 5% increase in saturated fat increased mortality by nearly 5% — this is a highly important trend that was not included in the final conclusions.

Furthermore, recent work (1) reported experience eliminating saturated fats in 200 participants with significant cardiovascular disease. They were requested to eat whole food plant based nutrition and avoid oils, meat, fish, poultry, dairy products, eggs, and sugary drinks. After 3.75 years of follow up highlights of the 177 adherent participants included:

1 Program adherence 89.3%
2 Elimination of major cardiac events (heart attack, stroke, death) 99.4%
3 Resolution of angina 93%
4 Evidence of disease reversal via angiogram, carotid ultrasound, stress test, resolution of claudication and erectile dysfunction.
5 Twenty-seven participants successfully avoided previously recommended interventions of stents and bypass surgery.

This study, the pioneering work of Ornish and more recently others employing similar techniques, makes it inconceivable to embrace saturated fats and disagrees with the findings of De Souza, et al.

Caldwell B. Esselstyn, Jr., M.D.
Director Cardiovascular Disease Prevention and Reversal Program
Cleveland Clinic Wellness Institute
1950 Richmond Road
Lyndhurst, Ohio 44124

Andrew Freeman, MD, FACC
Co-chair, American College of Cardiology Nutrition Workgroup
Director of Clinical Cardiology, National Jewish Health, Denver, CO

1. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A Way to Reverse CAD. The Journal of Family Practice. July 2014 Vol 63, No 7 page 257

Competing interests: No competing interests

18 August 2015
Andrew M Freeman
MD
Caldwell B. Esselstyn, Jr. MD
National Jewish Health
1400 Jackson St. J307 Denver CO 80206