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morgan
Advanced Member
United Kingdom
486 Posts |
 Posted - 23 Nov 2007 : 20:40:41
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We have all been told, and continue to be told that excess saturated fat clogs our arteries. This seems to include all types of saturated fat, from both animal and vegetable sources, whether processed or not. We know that saturated fat elevates cholesterol, but is this all types of saturated fats and in all people? We know that (age adjusted) analysis of people who have died reveals that there are fewer with cholesterol in the optimum range (The famous U-curve). But which studies undepin this belief in the deleterious effects of saturated fat and are those studies valid. Is there a demonstrable cast iron causal link? If not what is the best evidence we have?
Morgan |
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sportdiet
Advanced Member
United Kingdom
741 Posts |
Posted - 23 Nov 2007 : 21:16:01
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anecdotally i think that the problem lies in junk and trans fats. I have never felt that saturated fat from meat etc was the problem - unless eating ridiculous amounts and I have seen that too!
I think also we must not take chol in isolation - BP, smoking, lack of exercise, very overwt - they all play a part. It is just not that simple - oh and too much alcohol - says she with a glass of wine in her hand!
C.A.Cashin |
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 23 Nov 2007 : 22:38:34
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Hi Chris,
I very much agree with that.:) It is just people keep villifying saturated fat and I wanted to know what the evidence was. I often come across people who think they eat "healthily". You know - marg, not butter, skimmed milk, substutute cream, (processed) vegetable oil, no eggs, only lean meat, low fat this and low fat that. They look astounded when I tell them that is not "healthy", in fact they may be damaging their health.
I like to be sure of my ground when people tell me I don't know what I'm talking about, iykwim.
Morgan |
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sportdiet
Advanced Member
United Kingdom
741 Posts |
Posted - 24 Nov 2007 : 07:36:36
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tbh morgan as part of a healthy diet all those food should be eaten but i think the problem is that we don't teach people portion sizes - - in practice find if i get people to weigh meat for instance then they may be esting 10-12 oz and tons of butter over everything. that is the problem I feel with the low carb brigade they do not see the reality. I am going to get a book recently published by a journalist! gary taubes - he seems to push fat but I wonder if he has ever actualy worked with a real person.I have worked in this job for a long time and I can see what the problem is - junk, ready meals, biscuits, crisps, chocolate, oil!, too many snacks - i have hundreds of food diaries that confirm this.
i am tending these days to use a portfolio type plan which compares very well with the use of statins. the gps i work for are looking at this rather than doling out drugs.
C.A.Cashin |
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James Collier
Moderator
United Kingdom
849 Posts |
Posted - 24 Nov 2007 : 09:57:57
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Sat fats as 10% of total energy intake are not a problem. Sat fats do not clog the arteries, but they do contribute to a high total cholesterol level. A high cholesterol level means there is more chance some will oxidise and then become sticky (clog).
Worse fats are trans and oxidised junk fats - the problem is not the labelling of sat fats, its the lack of labelling of the others
JAMES COLLIER BSc (Hons) RNutr
Nutrition Consultant
Healthy Action
Professional Nutritional Advice |
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 24 Nov 2007 : 12:23:02
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Hi Chris,
"as part of a healthy diet all those food should be eaten" I guess I'll just agree to differ on that point: eg. I don't think any amount of trans or even processed veg oil is healthy. But I agree about the portion sizes.
It was doing Atkins (over 5 years ago now) that aroused my interest (some would say obsession) with food. I did it to the letter for 5 months and felt absolutely great. Some people tell you they feel strange or bad, but they will not be doing it properly. People seem to forget that it includes 1L of salad/day and loads of veg. Plus a range of nutritional supplements to ensure complete intake. For me, all my phys measures returned to the normal range. That is what made me curious about the diet and food in general. It curbed my hunger and my appetite and now I eat less and a lot smaller portions.
When I calculated my fat intake it was about 70% - but it has to be when the carbs are so low. I was not going out of my way to eat fat. I ended up eating the meals I'd always eaten without the bulk carbs. eg spagbol without the spag, fish-no chips and so on. I made up with eating more vegetables. Effectively I reduced my carbs without increasing protein and fat by much (most of the fat was olive oil). So I've always wondered about fat and saturated in particular.
I did loads of literature researching and concluded that it is trans fats and processed vegetable oil in particular that causes problems. Fats should come from natural sources and most importantly be in balance with each other in the overall diet. Our diets are poor at omega-3. Also excess SFA, MUFA and omega6 can block the pathway that converts Alpha-linolenic acid to EPA & DHA. So its not so much SFA that is pro inflammatory, but lack of omega-3.
So when I'm told SAT fat clogs arteries (not by you, I might add) it sort of wrankles. But I should not be surprised, because that is mainstream thinking.
I think you solved my query with your first word! "anecdotally". Dietetics is very much aligned to mainstream thinking (It's not a dig - it's just that way). Surrounding that, there is loads of material that attacks that thinking plus loads of doctor-patient experience that flies in the face on mainstream thinking.
Now I've come back to this suject, I find things have move on somewhat and more health professionals are asking questions.
If you are interested in Taubes, have you read his article: "What if It's All Been a Big Fat Lie? "
http://query.nytimes.com/gst/fullpage.html?res=9F04E2D61F3EF934A35754C0A9649C8B63
It's a good read if nothing else.
The books on fats that I found most useful were:
"Know your fats" Mary Enig
"Fats that heal, Fats that kill" Udo Erasmus
"The Cholesterol Myths" Ravnskov
Now there are 2 more recent ones - I've not read
"THE GREAT CHOLESTEROL CON" by Dr Malcolm Kendrick
"The Great Cholesterol Con" by Anthony Colpo
I found this extract from Kendricks book, which I found a useful summary.
Have we been conned about cholesterol?
http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=430682&in_page_id=1774
Anyway, I think it will be a long time before the truth comes out, because the drug companies have so much money resting on statins. Just look at the NHS bill! That money could be put to good use employing dietitians.
I've met so many people with bad reactions to statins, its untrue. Statins can never make up for a junk food diet, so I'm glad to learn there are people like you pushing for a more sensible approach.
Morgan |
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 24 Nov 2007 : 12:25:01
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Hi James,
Good summary, but I think it is the UPFAs that are prone to oxidation - omega6 in particular. Anti-oxidants (vit C & E) are need to protect them.
Morgan |
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sportdiet
Advanced Member
United Kingdom
741 Posts |
Posted - 24 Nov 2007 : 12:42:08
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Morgan - I didnt mean the trans fats and oils etc - i think they are time bomb waiting to happen.
Right I am now off to watch Wales thrash sOUTH aFRICA LOL
C.A.Cashin |
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 24 Nov 2007 : 13:06:01
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Right,
Enjoy the match!
Morgan |
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paulag
Advanced Member
United Kingdom
206 Posts |
Posted - 24 Nov 2007 : 18:48:54
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There are many things that the Daily Mail could be described as (most of which would get me banned here) but a quality scientific source is not one of them.
Probably the best source of evidence based scientific reviews are cochrane reviews. It's a few years old but their findings were suggestive of a small but potentially important reduction in cardiovascular risk in trials over two years involving reduction or modification of dietary fats.
http://www.cochrane.org/reviews/en/ab002137.html
Yes this is a complex area with both modifiable (e.g. diet, smoking and exercise) and non modifiable (e.g. genetics, gender) risk factors.
But a diet high in saturated fatty acids is also likely to be low in fruit and vegetables (and hence antioxidants), wholegrains and omega 3 fatty acids.
Mainstream thinking is not necessarily a conspiracy - in the medical profession it is the result of systematic analysis of the available quality research.
Taken alone the message to cut down animal fats to reduce heart disease may not be the whole story. But in the context of eat less fatty junk food and replace it with healthier alternatives it presents a more holistic approach to risk factors.
There are also links between high fat intake and other chronic diseases such as Metabolic Syndrome and Cancer. I notice that the World Cancer Research Fund had come out very strongly against red meat and particularly processed meat in its latest report: http://www.wcrf-uk.org/
Unfortunately despite any potential side effects statins are much more effective than diet. Metabolic studies have shown that dietary measures can lower blood levels by as much as 10-15% - but in free living people this tends to be more like 3-5% (From the Manual of Dietetic Practice which has the references). That doesn't mean that dietary and lifestyle advice is not beneficial, as it affects a range of cardiovascular and other risk factors. But if you are genetically predisposed to high cholesterol levels there is a limit to what you can achieve by lifestyle changes alone. This is where the informed us of statins comes in.
Paula |
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sportdiet
Advanced Member
United Kingdom
741 Posts |
Posted - 24 Nov 2007 : 20:02:41
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wales lost but i reckon played well!
Bring on england lol !!!!
paula it will depend which of the genetic hyperlipidaemias of course!
the porfolio approach i think is ideal as it adds all the things that will reduce chol together! Potentially it gives a 30% reduction. Ill dig out the ref - went to a review of it last week and I am feeling very posative about it.
Statins may be required for some but all the other things are worth a try first.
I also think that we must take a step back and look at all the pros and cons - i am sick of all these studies contradicting each other!!
C.A.Cashin |
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James Collier
Moderator
United Kingdom
849 Posts |
Posted - 24 Nov 2007 : 21:42:13
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quote:
Originally posted by morgan
Hi James,
Good summary, but I think it is the UPFAs that are prone to oxidation - omega6 in particular. Anti-oxidants (vit C & E) are need to protect them.
Morgan
Yes I only gave a 1min reply above
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 25 Nov 2007 : 01:53:43
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Hi Paula, Your reply got me a bit fired up! So apologies for a rather long response.
quote:
There are many things that the Daily Mail could be described as (most of which would get me banned here) but a quality scientific source is not one of them.
Yes agreed. But it is just an extract from a book. Any paper could have published it. Just because it’s in the Daily Mail does not mean it is not worth reading. I thought it a useful summary of some current non-mainstream thinking.
quote:
Probably the best source of evidence based scientific reviews are cochrane reviews. It's a few years old but their findings were suggestive of a small but potentially important reduction in cardiovascular risk in trials over two years involving reduction or modification of dietary fats.
http://www.cochrane.org/reviews/en/ab002137.html
I found the full paper is at http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002137/pdf_fs.html
The language is a little convoluted for me. I think the analysis states that in the 4S study that statins demonstrated reduced CHD and reduced cholesterol. Therefore dietary interventions that reduced cholesterol reduced CHD. One therefore only had to monitor reduced cholesterol to see if dietary interventions reduced CHD. To my mind there are some pretty big assumptions here that need to be justified.
That aside, we have the
Authors’ conclusions (in the body of the document)
“Dietary change to reduce or modify dietary fat intake appears to reduce the incidence of combined cardiovascular events. This trend is statistically significant for all trials, but when a trial which also increased omega-3 fat intake in the intervention group is excluded the results are no longer statistically significant. “
I kept reading this and I think this means that reduced incidences of CV events only happens when subjects increased omega3 intake, and are not linked to reduction reductions in saturated fat. That to me seems like there is a problem with low omega3. When omega3 intake is corrected, saturated fats have no significance.
There is more…
“The protective effect is seen almost exclusively in those who continue to modify their diet over at least two years. The extent of this protection appears similar in both high and low risk populations, although the relationship does not achieve statistical significance in low risk participants. Dietary advice to those at high risk of cardiovascular disease (particularly where statins may not be available), and probably also to lower risk population groups, should continue to include dietary fat modification and it should be stressed that this is a permanent pattern of eating. There is a suggestion that dietary fat modification has protective effects on total mortality and on cardiovascular mortality when the dietary modification is followed for at least two years, however this trend is not statistically significant [emphasis added]. It may be that not enough people were involved in long term trials to show the protective effect of a change in dietary fat, or it may be that there is no such effect.”
I think this is saying that there is a trend, but not statistically significant. How significant is not mentioned and the pictorial representation (table2) is not available. Is a non-statistically significant trend of any value? Evidence based medicine demands evidence that is statistically significant.
I don’t believe the authors’ comments are reflected in the “authors’ conclusions” in the abstract. But the abstract is all that people read. I read this paper to mean that there is no evidence for increased CV events with increased sat fat intake unless omega3 intake is deficient. (when they says increase unsaturates, they really means omega3)
Authors’ conclusions
The findings are suggestive of a small but potentially important reduction in cardiovascular risk in trials longer than two years. Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates
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Yes this is a complex area with both modifiable (e.g. diet, smoking and exercise) and non modifiable (e.g. genetics, gender) risk factors.
Quite so.
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But a diet high in saturated fatty acids is also likely to be low in fruit and vegetables (and hence antioxidants), wholegrains and omega 3 fatty acids.
Agreed, but it is not germane to the main thrust that “saturated fat clogs arteries”
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Mainstream thinking is not necessarily a conspiracy - in the medical profession it is the result of systematic analysis of the available quality research.
I used to think this once, but now I have doubts. There are many vested interests and huge revenues to protect. The first argument is who funds the research? Usually those with enough money to do the funding – they will only fund projects that will endorse their business, and will cherry pick results. I am afraid it is naive to believe otherwise.
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Taken alone the message to cut down animal fats to reduce heart disease may not be the whole story. But in the context of eat less fatty junk food and replace it with healthier alternatives it presents a more holistic approach to risk factors.
Why have you switched to talking about animal fats? Most studies have used saturated fats from vegetable sources eg NHANES II.
It definitely not the whole story. The main risk factors relating to lifestyle are accepted as cigarette smoking, alcohol, raised blood pressure, elevated serum cholesterol, inappropriate dietary intake, physical inactivity and obesity (Shaper et al, 1981 and Gandhi, 1997).
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There are also links between high fat intake and other chronic diseases such as Metabolic Syndrome and Cancer. I notice that the World Cancer Research Fund had come out very strongly against red meat and particularly processed meat in its latest report: http://www.wcrf-uk.org/
Yes, I accept the risk from processed meats because I know they create nitrosamines – carcinogenic agents, from sodium nitrite used to prevent botulism. I’m not convinced about red meat per se. The problem may be linked to hormones, antibiotics, POPs or other toxins accumulated in fat stores. Quality and type of meat then comes into question. Also cooking methods: Smoked/Charred/Burnt meat contains carcinogens and also oxidised cholesterol (which may be a significant factor in CHD). Also the public has been led to believe that all animal fat is saturated, when it contains less than 50% as SFA.
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Unfortunately despite any potential side effects statins are much more effective than diet. Metabolic studies have shown that dietary measures can lower blood levels by as much as 10-15% - but in free living people this tends to be more like 3-5% (From the Manual of Dietetic Practice which has the references).
Reduction by diet must depend on the dietary measures. How do you know these studies used the best ones?
There is no doubt that statins significantly reduce cholesterol. They also reduce CV events in males who have suffered a major CV event and extend their lives. They have never been shown to be any benefit in females or people who have not had a CV event. Also no one has yet proved that lowering cholesterol is the method by which statins work. According to my doctor they reduce arterial inflammation (and therefore only work when inflammation is present). Statins are HMG-CoA reductase inhibitors. That means they also limit the production of CoenzymeQ10 needed for muscle function and energy (That is why muscle pain & fatigue are common side-effects). Statins also inhibit cholesterol manufacture in the brain. Since cholesterol cannot pass the blood brain barrier, statins can impair cognitive function.
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That doesn't mean that dietary and lifestyle advice is not beneficial, as it affects a range of cardiovascular and other risk factors.
You bet. It is essential, especially if you have elevated risk factors.
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But if you are genetically predisposed to high cholesterol levels there is a limit to what you can achieve by lifestyle changes alone. This is where the informed us of statins comes in.
There are always cases where medical intervention (at least in the short term) may be necessary. But it is the prophylactic use of statins I’m against, especially in people with only marginally elevated cholesterol. Look at the graphs, risk does not significantly increase until about 6.2 – 7, yet people are treated when their cholesterol is over 5.
I have a friend who was put on statins with a level of 4.7 simply because he was over 65. He said after 9 days he experienced every single side-effect possible and thought he would die. The wife of a friend was elated because she had reduced her level to 1.5. 6 months later she was in hospital in distraught state. The solution : stop the statins. Informed use of statins is one thing, but what is going on seems to me to be totally barmy and costing the taxpayer a fortune, and if my personal experience is anything to go by, a lot of people great distress.
Morgan |
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morgan
Advanced Member
United Kingdom
486 Posts |
Posted - 25 Nov 2007 : 02:02:36
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Btw, Did anyone see Trevor McDonald last Mon 19th Nov? I thought the pregram raised some very important questions about statins. There was a retired airline pilot who had been virtually crippled by them. I felt very sorry for him. You know pilots have to be fit as fleas to be allowed to work.
Morgan |
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paulag
Advanced Member
United Kingdom
206 Posts |
Posted - 26 Nov 2007 : 17:49:28
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Morgan,
There's very little that I can do with your long reply because I simply don't have the time to go through it section by section.
I appreciate that you have concerns about vested interests in drug companies. Cochrane reviews are not funded by drug companies and are independant. Their research methodology is systematic and looks at all available research in an area with very strict quality inclusion criteria.
It's worth mentioning that it is not just drug companies that might have vested interests. There are a lot of 'nutritionists' out there flogging books that have a very strong vested interest in convincing people that the consensus is wrong, drugs are dangerous and the only way forward is to follow their miraculous diet. They usually wrap this in pseudoscience and cherry picked research studies. They want to spread confusion about official advice and make healthy eating seem complicated so that they look like they are providing something worth paying for. But it just isn't that complicated.
The real issue is how we can support people can make healthy changes to their lifestyle and diet within the context of the challenges that they face in their everyday lives in the current obesogenic environment. |
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sportdiet
Advanced Member
United Kingdom
741 Posts |
Posted - 26 Nov 2007 : 19:48:50
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morgan - Amanda Ursell a dietitian presented that program and she used the portfolio approach - it worked and was shown only on 3 patients that u get a 30% reduction. I am using it and getting good results.
C.A.Cashin |
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Topic |
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Does Saturated Fat Clog arteries?
