dietary villains part i: fat phobia “it is now increasingly recognized that the low- fat campaign...

Dietary Villains

Part I: Fat Phobia

“It is now increasingly recognized that the low-fat campaign has been based on little scientific evidence

and may have caused unintended health consequences”

Frank Hu and W. WillettHarvard School of Public Health

“Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” AJCN Vol. 20, 1(5-19) 2001

Hormonal Obesity Theory

FatteningCarbohydrates

Increased Insulin level

Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose

WheatSuper-carbohydrate Fasting

DiseasesOf Civilization

DiabetesHeart DiseaseCancerPeriodontitis

www.kidneylifescience.ca

CholesterolHarmful alien substance?

Daily Cholesterol needs 20% dietary (animal products)

80% manufactured by bodywww.kidneylifescience.ca

Ancel Keys

Seven countries study - 1970 conclusions1. Cholesterol levels predicted heart disease risk2. Amount of saturated fat in the diet predicted cholesterol levels3. Monounsaturated fat protected against heart disease


War on Cholesterol

1984 NIH Consensus Conference “there is no doubt that low fat diets will afford significant protection against coronary heart disease”


Diet-Heart Hypothesis

1. Increased cholesterol associated with increased CV disease2. Dietary saturated fat increases cholesterol3. Therefore dietary fat increases cardiovascular disease

Dietary FatCholesterol

Cholesterol CardiovascularDisease

Lipid Hypothesis


Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al

Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham dataArch Intern Med. 1993 May 10;153(9):1065-73 Kronmal RA

Cholesterol and Age

Decreasing mortality with higher cholesterol


http://www.ncbi.nlm.nih.gov/pubmed/8481074

Cholesterol in Women

Framingham Heart Study

Long Term Mortality

J Womens Health. 1997 Jun;6(3):295-307, Zareba et alPrognostic value of cholesterol in women of different ages

Age <55





Cholesterol and women

Survey of 52 087 Norwegians from 1992-1994

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study J Eval Clin Pract. 2012 February; 18(1): 159–168


WHO study of 19 European nations www.kidneylifescience.ca

Pleiotropic Effects


Dietary Fat and Cholesterol

Dietary Fat Increased serumcholesterol

CardiovascularDisease


Framingham Heart Study

“There is considerable range of serum cholesterol levels within the Framingham Study Group. Something explains this inter-individual variation, but it is not diet” Tavia Gordon (NIH)


Framingham Diet Study

“Unfortunately, these data were never incorporated into a definitive report“Tavia Gordon


Framingham Diet Study

No discernible relationship between reported diet intake and serum cholesterol levels

Oct 30, 1970


Framingham Diet Study 1977

Cholesterol Intake

Below Median

Above Median

Mg/ day Mmol/ L Mmol/ L

Men 704 ± 220.9 6.16 6.16

Women 492 ± 170.0 6.37 6.26

“There is no indication of a relationship between dietary cholesterol and serum cholesterol level”


Dietary Fat and Serum Lipids

Daily nutritional intake and serum lipid levels. The Tecumseh studyAm J Clin Nutr. 1976 Dec;29(12):1384-92

No influence of fat or cholesterol on serum cholesterol



National Cholesterol Education Program

“Dietary cholesterol causes marked hypercholesterolemia in many laboratory animals, including nonhuman primates. High intakes of cholesterol in humans, however, do not cause such a marked increase in serum cholesterol”Translation – “Non human primates should DEFINITELY avoid dietary cholesterol. Humans, though, not so much.”


Dietary Fat and Cardiovascular Disease

Dietary FatCardiovascularDisease


Cherry Picking Data


Life Expectancy and Fat

Source: rawfoodsos.com


Industrialization

Increased Dietary FatIncreased Life ExpectancyIncreased Coronary Artery Disease

IncreasedIndustrialization


Exercise in FutilityStudy Journal/ Author Conclusions

A Longitudinal Study of Coronary Heart Disease

Circulation.1963; 28: 20-31Oglesby P

1,989 patients followed over 4 years. No relationship of dietary fat to CAD

Diet and Heart: A Post Script BMJ 1977; 2(6098): 1307-14 Morris JN

No relationship of CAD to dietary fat

Dietary intake and the risk of coronary heart disease in Japanese men living in Hawaii

Am J. Clin. Nutr. 31: 1270-1279, 1978. Yano K

7,705 men over 6 years.No relationship of CAD to dietary fat

Relationship of dietary intake to subsequentcoronary heart disease incidence: The PuertoRico Heart Health Program

Am. J. Clin. Nutr. 33: 18 18-1827, 1980 Garcia-Palmieri MR

10,000 patients over 6 years. No relationship of CAD to dietary fat. Protective effect of legumes

Diet, Serum Cholesterol, and Death from Coronary Disease: The Western Electric Study

NEJM 1981: 304; 65-70 Shekelle RB

1900 patients over 20 years. No relationship of CAD and saturated fats


Dietary Fat and Heart Disease

“Total fat intake was not significantly related to the risk of coronary disease”

Q1 Q2 Q3 Q4 Q50

0.20.40.60.8

11.2

Multivariate Adjusted for Trans fats

Risk of CAD

Dietary Fat Intake and the Risk of Coronary Heart Disease in Women N Engl J Med 1997; 337:1491-1499 Hu FB

Nurses Health Study


Dietary Cholesterol

Q1 Q2 Q3 Q4 Q50

0.2

0.4

0.6

0.8

1

1.2

1.4

11.16 1.09 1.08 1.12

CAD

DIETARY FAT INTAKE AND THE RISK OF CORONARY HEART DISEASE IN WOMENN Engl J Med 1997;337:1491-9 Hu FB

P=0.49

Dietary Cholesterol

McGee CT “Heart Frauds” HealthWise Publications 2001www.kidneylifescience.ca

Dietary Determinants

Arch Intern Med. 2009;169(7):659-669 Mente AA Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease


No correlation with total fat, saturated fat or PUFA

Dietary Determinants - Fats

A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart DiseaseArch Intern Med 2009;169(7):659-669 Mente A

“recent prospective studies (or meta-analysis of studies) have failed to detect a causative link between (percentage of dietary fat and obesity)”Translation - despite 40 years of trying to link dietary fat and obesity there is still no evidence

National Cholesterol Education Program


Saturated FatHidden Protection?


Animal vs. Vegetable Fats


Animal vs. Vegetable Fat


Animal Fat Consumption


Vegetable Oils

Poly-unsaturated Fatty Acid Consumption


Saturated Fats

Q1 Q2 Q3 Q4 Q50.7

0.75

0.8

0.85

0.9

0.95

1

1.05

Adj

uste

d re

lativ

e ri

sk

Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States

BMJ 1996;313:84 Ascherio A

Quintiles of Saturated FatIntake

Risk of Heart Attack


Dietary Fat and Stroke

7,895 Japanese-Hawaiian healthy men

Q1 Q2 Q3 Q4 Q50

5

10

15

20

25

30

35

40

45

FatProteinSodium

Dietary and Other Risk Factors for Stroke in Hawaiian Japanese MenStroke 1985 Vol 16; 3:390-96 Kagan A

10 year stroke incidence

Quintiles of Nutrient Intake


Inverse association of dietary fat with development of ischemic stroke in menJAMA. 1997 Dec 24-31;278(24):2145-50 Gillman MW

Dietary Fat and Stroke

Lowest intake of fatHighest risk of stroke

Highest intake of fatLowest risk of stroke

PUFA not protectiveP=0.33



Dietary fats, carbohydrate, and progression of coronaryatherosclerosis in postmenopausal womenAm J Clin Nutr 2004;80:1175–84 Herrington et al

Dietary Fat and CV disease

Lower Saturated fat =More progression CAD

PUFA


Dietary Fat and Heart Disease

29,098 men and women

Dietary fat intake and early mortality patterns – data from The Malmo Diet and Cancer Study J Intern Med August 2005; 258(2): 153-65 Leosdottir M


French Paradox

Total Fat (g/day)

Animal Fat CV Death0

50

100

150

200

250

171

108

82

157

72

216

FrenchAmerican

CV D

eath

per

100

,000

WHO 2000

Males age 35–74www.kidneylifescience.ca

Saturated Fat – Hidden protection

British Journal of Nutrition 1Mar 2012 www.kidneylifescience.ca

Saturated Fat Phobia

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular diseaseKrause et al AJCN 2009

Saturated fat protective for stoke!

Saturated fatCompletely irrelevant


Saturated Fat

Dietary intake of saturated fatty acids and mortality from cardiovasculardisease in Japanese Am J Clin Nutr doi: 10.3945/ajcn.2009.29146, Yamagishi K

Cohort study of 58,453 Japanese

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 50.6

0.650.7

0.750.8

0.850.9

0.951

1.051.1

Stroke MI Total CVD

Adj

uste

d O

dds

Ratio

Saturated Fat Intake


Dairy Fat and Diabetes

Prospective cohort study of 3,736 pts Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US AdultsAnn Intern Med. 2010 December 21; 153(12) Mozaffarian D


Diabetes and Inflammation

2.22.32.42.52.62.72.82.9

33.1

CRP (mg/l)HOMA

Adj

uste

d O

dds

Ratio

Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US AdultsAnn Intern Med. 2010 December 21; 153(12) Mozaffarian D


Eggs

A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women JAMA April 21, 1999


Eggs

Egg consumption and risk of coronary heart disease and stroke BMJ 7 Jan 2013


Eggs and Diabetes

Overal

l CVD

IHD

Stroke

IHD m

ortality

Stroke

morta

lity

Diabetes

0

0.4

0.8

1.2

1.6

0.96 0.97 0.93 0.98 0.92

1.42

Low vs. High Egg consumption

Pool

ed H

azar

d Ra

tio

Egg consumption in relation to risk of cardiovascular disease and diabetes Am J Clin Nutr July 2013, Jang Yel Shin et al


Nuts and Heart Disease

Almost never

1-4/month

2-4/ week

>5/week

0

0.2

0.4

0.6

0.8

1

1.2

Nut Consumption

Adj

uste

d Re

lativ

e Ri

sk

Frequent nut consumption and risk of coronary heartdisease in women: prospective cohort study BMJ 1998;317:1341–5 Hu FB

86,016 women from Nurse’s Health Study


Omega 3 Fats


Omega 3 supplements

18,645 hypercholesterolemic Japanese patients Effects of eicosapentaenoic acid on major coronary events in hypercholesterolemic patients (JELIS) Lancet March 31, 2007 1090-98 Yokoyama et al


Low Fat Diets after Heart Attack not effective

Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART) Lancet. 1989 Sep 30;2(8666):757-6 Burr ML


Increased Fish intake after Heart attack

Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART) Lancet. 1989 Sep 30;2(8666):757-6 Burr ML


Trans Fats

Margarine intake and subsequent coronary heart disease in menEpidemiology. 1997 Mar;8(2):144-9 Gillman MW

20 year follow up from Framingham study 1966




Poly-unsaturated FatsHidden Dangers


Added Fats


Butter


Poly-unsaturated Fats

Source: wholehealthsource.blogspot.cawww.kidneylifescience.ca

Industrial Vegetable Oils1. Seeds de-hulled, de-skinned and ground into meal and heated2. Pressing - Meal fed into a screw press, under pressures up to 20,6850 kilopascals3-. Solvent extraction - Hexane used to dissolve oil, which is then recovered by distilling4. Solvent Removal – Oil is boiled by steam, and the lighter hexane floats upward5. Refining - Heat oil to 85C and mix sodium hydroxide. Soap forms and is removed by centrifuge.6. Degumming - Treating them with 95C water, steam, or water with acid. The gums (phosphatides), precipitate out, and the dregs are removed by centrifuge.7. Bleaching - filtered through fuller's earth, activated carbon, or activated clays8. Deodorization - steam is passed over hot oil in a vacuum at 250C. Citric acid at. 01 percent is also added to oil after deodorization to inactivate trace metals9. Enjoy “all-natural, healthy” vegetable oil!


Omega 6 Fats

Source: wholehealthsource.blogspot.ca

Increased Deaths with PUFA

Sydney Diet-Heart StudyReplaced saturated fats with PUFA

Use of dietary linoleic acid for secondary prevention of coronary heart disease and deathBMJ 2013;346:e8707 doi: 10.1136


No Cardiac Benefits to PUFA

Test of Effect of Lipid Lowering by Diet on Cardiovascular RiskArterioscler Thromb Vasc Biol. 1989;9:129-135 Frantz ID

39% fat diet – replaced saturated fats with PUFA

CV Event rate


Increased Deaths with PUFA

Treatment

Control

All Cause Mortality

Test of Effect of Lipid Lowering by Diet on Cardiovascular RiskArterioscler Thromb Vasc Biol. 1989;9:129-135 Frantz I


Increased deaths with PUFA

Use of dietary linoleic acid for secondary prevention of coronary heart disease and deathBMJ 2013;346:e8707 doi: 10.1136/bmj.e8707 (Published 5 February 2013) Ramsden CE

Increased deaths with Omega 6

Protection with Omega 3


Homicide

Each point represents 1 country and 1 year

Increasing homicide rates and linoleic acid consumption among five Western countries, 1961-2000 Lipids. 2004 Dec;39(12):1207-13 Hibbeln J




Depression

Increasing homicide rates and linoleic acid consumption among five Western countries, 1961-2000Lipids. 2004 Dec;39(12):1207-13 Hibbeln J



Source: wholehealthsource.blogspot.ca

Low Fat Diets

Multiple Risk Factor Intervention Trial

Quit smoking, lower BP, eat a low fat dietDr. Jeremiah Stamler JAMA. 1982 Sep 24;248(12):1465-77




No Benefit to Low Fat Diet

Dr. Jeremiah Stamler JAMA. 1982 Sep 24;248(12):1465-77

40.4/ 1000

41.2/ 1000


Copyright restrictions may apply.

Beresford, S. A. A. et al. JAMA 2006;295:643-654.

Women’s Health Initiative


Howard, B. V. et al. JAMA 2006;295:655-666.

No Benefits for CHD or Stroke


Prentice, R. L. et al. JAMA 2006;295:629-642.

Invasive Breast Cancer

Beresford, S. A. A. et al. JAMA 2006;295:643-654.

Invasive Colorectal Cancer


Fats are ProtectiveThe Effect of Co-ingestion of Fat on the Glucose, Insulin and gastric inhibitory polypeptide responses to carbohydrate and protein Am J Clin Nutr 1983; 37:941-4 Collier G


Fats are Protective

AUC Glucose Response 1 hr

Eating fat reduces glucose response


The Lyons Diet Heart Study

75% Risk Reduction


Mediterranean Diet

Primary Prevention of Cardiovascular Disease with a Mediterranean DietN Engl J Med 2013;368:1279-90 PREDIMED study

MI, Stroke, or CV Death


Hormonal Obesity Theory

FatteningCarbohydrates

Increased Insulin level

Insulin Resistance

Fibre

Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose

WheatSuper-carbohydrate Fasting

DiseasesOf Civilization

DiabetesHeart DiseaseCancerPeriodontitis

Fat


dietary villains part i: fat phobia “it is now increasingly recognized that the low- fat campaign...

Documents

increased cholesterol

higher cholesterol

daily cholesterol

heart disease risk

risk of coronary heart

kronmal ra cholesterol

fat phobia

monounsaturated fat