My cousin died of a heart attack in his sleep. He was awaiting to have a quadruple bypass surgery and was only 46 when he died. Whilst we all knew he had a lot of excess weight and his diet wasn’t great, his cardiologist did not give him the standard mantra “skip butter, use vegetable oil”, “don’t eat skin on the chicken, better eat lean meat”. Instead his doctor said something like this: “For every piece of roast chicken, skin and fat, eat some raw carrots and cabbage. For every biscuit, follow it up with an apple”. I marvelled at the simplicity and wisdom of this advice.
A few weeks ago the journal Neurology published a study, which sent a ripple of disbelief to the nutrition world: having high levels of HDL cholesterol increases our risk of developing dementia. The study was done on over 180,000 subjects with the follow-up of 17 years. Even though this study was observational, which compared to randomised studies are often flawed, because they rely on what people report they ate and oftentimes this is not accurate, it had a significant result. This study challenged our long-term belief that having higher HDL was protective for one’s heart and overall cardiovascular health.
My surprise in reading this study was that the measures of HDL the researchers used were much lower than what we used to think ‘a healthy HDL’ should be. The average HDL level was 53mg/dL (British cholesterol measurements equivalent to 1.37 mmol/L). The high HDL was 65mg/dL - 1.68 mmol/L, the level found to have a 15% higher risk of developing dementia. And the low HDL (11 to 41 mg/dL equivalent to 0.28 and 1.06 mmol/L) were also found to give a 7% higher risk of dementia.
With the current study results, are we once again applying what Michael Pollan calls the act of “nutritionism”? Not only we are looking at foods from their macronutrient component differences and potential effects on health, but we are also taking substrates from foods and scrutinising them for their adverse outcomes on our longterm health and risks of developing disease. No longer we are looking at and eating foods, but reducing them to a sum of various parts.
Cholesterol plays a vital role in the body, and what a role it plays! If we continue partitioning it from the point of understanding how to lower, raise and tweak it this way or another, aren’t we missing the bigger picture? We are losing the main idea that we should be eating foods, getting energy and nutrients from foods and not parts of foods, or what’s become quite common nowadays, manufactured chemical concoctions that replace real foods?
Your cholesterol, or your cholesterol indicators, measured as part of your lipids blood test has been used by doctors since the 60s. The reasons medical professionals measure cholesterol is all down to the hypothesis proposed in the 50s that fat in the diet causes the fatty formations (atherosclerotic plaques) in our arteries and therefore increases our risk of cardiovascular disease - such as heart attacks, myocardial infractions and stroke. If we lower or cut down the fat from the diet, we lower cholesterol and thus we can decrease our risk of cardiovascular events. This hypothesis is known as the “diet-heart hypothesis”, and was first proposed by Ancel Keys, a physiologist at the University of Minnesota with an interest in nutrition. Presenting at the 1955 World Health Organisation meeting in Geneva, Keys made his proposition that he based on observational studies he had conducted prior. As the mortality rate from heart attacks in the US was on the increase at the time, Keys made his claim, with quite some confidence and even abrasiveness (as documented by his then colleagues). He had a challenge from Sir George Pickering, present at the meeting, who asked him “what he considered the single best piece of evidence to support his diet-heart idea”.
A few weeks ago the journal Neurology published a study, which sent a ripple of disbelief to the nutrition world: having high levels of HDL cholesterol increases our risk of developing dementia. The study was done on over 180,000 subjects with the follow-up of 17 years. Even though this study was observational, which compared to randomised studies are often flawed, because they rely on what people report they ate and oftentimes this is not accurate, it had a significant result. This study challenged our long-term belief that having higher HDL was protective for one’s heart and overall cardiovascular health.
My surprise in reading this study was that the measures of HDL the researchers used were much lower than what we used to think ‘a healthy HDL’ should be. The average HDL level was 53mg/dL (British cholesterol measurements equivalent to 1.37 mmol/L). The high HDL was 65mg/dL - 1.68 mmol/L, the level found to have a 15% higher risk of developing dementia. And the low HDL (11 to 41 mg/dL equivalent to 0.28 and 1.06 mmol/L) were also found to give a 7% higher risk of dementia.
With the current study results, are we once again applying what Michael Pollan calls the act of “nutritionism”? Not only we are looking at foods from their macronutrient component differences and potential effects on health, but we are also taking substrates from foods and scrutinising them for their adverse outcomes on our longterm health and risks of developing disease. No longer we are looking at and eating foods, but reducing them to a sum of various parts.
Cholesterol plays a vital role in the body, and what a role it plays! If we continue partitioning it from the point of understanding how to lower, raise and tweak it this way or another, aren’t we missing the bigger picture? We are losing the main idea that we should be eating foods, getting energy and nutrients from foods and not parts of foods, or what’s become quite common nowadays, manufactured chemical concoctions that replace real foods?
Your cholesterol, or your cholesterol indicators, measured as part of your lipids blood test has been used by doctors since the 60s. The reasons medical professionals measure cholesterol is all down to the hypothesis proposed in the 50s that fat in the diet causes the fatty formations (atherosclerotic plaques) in our arteries and therefore increases our risk of cardiovascular disease - such as heart attacks, myocardial infractions and stroke. If we lower or cut down the fat from the diet, we lower cholesterol and thus we can decrease our risk of cardiovascular events. This hypothesis is known as the “diet-heart hypothesis”, and was first proposed by Ancel Keys, a physiologist at the University of Minnesota with an interest in nutrition. Presenting at the 1955 World Health Organisation meeting in Geneva, Keys made his proposition that he based on observational studies he had conducted prior. As the mortality rate from heart attacks in the US was on the increase at the time, Keys made his claim, with quite some confidence and even abrasiveness (as documented by his then colleagues). He had a challenge from Sir George Pickering, present at the meeting, who asked him “what he considered the single best piece of evidence to support his diet-heart idea”.
Because of the rebuff from his peers was so strong, Keys reportedly went off in a huff to prove and demonstrate to all present that he was right. This is how the Seven Countries Study was born. When in 1970 Keys published the Seven Countries Study, it failed to show an association between total dietary fat and heart disease. His study instead found that populations with the greatest SFA intake (short-chain fatty acids) had the highest incidence of heart disease. This has lead to the shift in focus of dietary interventions to prevent heart disease by lowering the amount of saturated fat in the diets of populations.
We should not disregard old research as outdated, instead we should re-examine them with the understanding what their flaws and limitations may have been. One of the limitations of Key’s study was several countries, the results from which did not conform to Keys’s hypothesis: for example, Chile had one of the highest rates of heart attacks at the time, but their consumption of saturated fat was low; France had one of the lowest rates of heart attacks and yet they had had a long history of eating foods rich in saturated fat - butter, cheese, lard, meats.
The findings from “The Seven Countries Study” quickly gained acceptance among many doctors, leading to the American Heart Association (AHA) to officially make a dietary recommendation in 1961 to reduce total dietary fat and saturated fat and substitute saturated fat with polyunsaturated fat, such as vegetable oils and margarine.
Many countries adopted the same guidelines. Official recommendations of limiting saturated fat remained mainly unchanged until 2005, when in the sixth edition of the Dietary Guidelines for Americans, the dietary fat guidance was worded somewhat differently and more expansively, but the main concept remained. Here, cholesterol had a prominent place, as well as saturated fat: “Consume less than 10% of calories from saturated fatty acids and less than 300 mg/d of cholesterol, and keep trans fatty acid consumption as low as possible”. Further, total fat intake was recommended at 20 to 35% of total calories, with most fats coming from the sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
Reexamining and scrutinising the diet-heart hypothesis and re-evaluating Ancel Keys’s findings, to-date more than 20 peer review papers have largely concluded that saturated fats have no effect on cardiovascular disease. You may find completely different wordings, depending which source you are reading, and I find the most conservative tone is taken by the organisations that we trust our health most with - these are the ones considered the real experts in public health. Their interpretation of the recent data remains vague, ambiguous or often blatantly misleading - look at the following from Harvard Health, for example: “The American Heart Association advises to limit [fat] to a 5% or 6% of your daily calories, while the Dietary Guidelines for Americans say 10% is fine. Registered dietitian Kathy McManus, who directs the Department of Nutrition at Harvard- affiliated Brigham and Women’s Hospital, suggests a happy medium of 7%”. What? 7%? Where is the evidence for this number?
Christopher Ramsden of the National Institutes of Health, is a real Indiana Jones of research. In 2011 Ramsden, uncovered a study from 1989 by Dr. Ivan Frantz of the University of Minnesota, which had a most remarkable (from the scientific study-construction point) evidence: it concluded that replacing saturated fats with vegetable oils did not reduce the risk of coronary heart disease, what’s more it increased the risk. The study was of a great significance to Ramsden, because it had recorded the diets of people living in mental institutions, where all of their meals were prepared and recorded for the patients. And thus presented little margin for error of self-reporting, like majority of observational studies may have. One group of patients were allowed to eat saturated fats, such as butter and meat, and dairy products, the other group had half of the saturated fats replaced with vegetable oils. Ramsden attempted to look at the study and the data in the original, he reached to Frantz’s son (as the researcher himself had died two years prior).
The son - Dr. Robert Frantz, a physician at the Mayo Clinic, - obtained the records and let Ramsden analyse them. The study indeed seem to reveal that substituting saturated fats for vegetable oil lowered blood cholesterol levels. However, there was a surprise. Ramsden and his team found that lowering cholesterol did not help people live longer. As their cholesterol fell, the risk of dying increased. There was a 22 percent higher risk for every 30-point cholesterol fall. In other words, although diet could successfully lower blood cholesterol, this reduction did not appear to translate into long-term cardiovascular health protection.
In response to research by Ramsden and his team and others with similar results, in 2015 a panel of nutrition experts from the Academy of Nutrition and Dietetics (DGA) suggested to use a consistent language among expert organisations regarding their stance on fatty acids in the diet. They stated: “In the spirit of the 2015 DGAC’s commendable revision of previous DGAC recommendations to limit dietary cholesterol, the Academy suggests that HHS [the US Department of Health and Human Studies] and USDA [the US Department of Agriculture] support a similar revision de-emphasizing saturated fat as a nutrient of concern.
Did you spot the word “de-emphasising”? Why not clearly stating, the evidence is not there and we change our position on limiting saturated fats?
And so the diet-heart hypothesis lives on…
In the latest research published in Neurology, the authors and their peers who reviewed the study suggest that more research is warranted. Indeed it is. But would it mean that the layman, the person who is on the receiving end of dietary guidelines, may once again enter an era of ever-changing conflicting advice?
When it comes to analysing cholesterol, not only we have HDL and LDL (‘the good and the bad’ cholesterol guys), we also have triglycerides, VLDL, IDL and LP(a) and apo(a) - the stickier than other types of LDL does not mean we have managed to put an end to deaths from heart disease. Or even protect our cardiovascular health. But this is the point that seems to be missing from many research papers nowadays. Many studies dissect and partition foods, extracting some of their components (as as short-chain-fatty acids (SCFAs) and we, the public, rely on the media and public health organisations to interpret the findings and make sense of what those findings might mean for our individual long-term health benefits or detriments.
What would be much more useful if the officials behind public health guidelines agreed to have the patient’s health in mind: it is not the medicine lowering your LDL, (or maybe now in light of the new study, would also be lowering HDL?) that will protect you, but eating real foods, the foods that your gut can recognise as its own, the foods that come from nature, the foods that our evolution made us to be able to break down, absorb and utilise and not the foods that have come out of a food manufacturer’s chemical lab.
If your doctor told you you have high cholesterol, you have high cholesterol in your family, or you are confused which foods cause your cholesterol to rise and which foods you should be eating to have healthy cholesterol levels, I have created a Healthy Eating for Cholesterol Plan for you. You can buy it and download from here.
It is a comprehensive guide on which foods cause your liver to accumulate excess fat and increase your cholesterol and the best foods to regulate your liver function and have a healthy cholesterol levels again.
We should not disregard old research as outdated, instead we should re-examine them with the understanding what their flaws and limitations may have been. One of the limitations of Key’s study was several countries, the results from which did not conform to Keys’s hypothesis: for example, Chile had one of the highest rates of heart attacks at the time, but their consumption of saturated fat was low; France had one of the lowest rates of heart attacks and yet they had had a long history of eating foods rich in saturated fat - butter, cheese, lard, meats.
The findings from “The Seven Countries Study” quickly gained acceptance among many doctors, leading to the American Heart Association (AHA) to officially make a dietary recommendation in 1961 to reduce total dietary fat and saturated fat and substitute saturated fat with polyunsaturated fat, such as vegetable oils and margarine.
Many countries adopted the same guidelines. Official recommendations of limiting saturated fat remained mainly unchanged until 2005, when in the sixth edition of the Dietary Guidelines for Americans, the dietary fat guidance was worded somewhat differently and more expansively, but the main concept remained. Here, cholesterol had a prominent place, as well as saturated fat: “Consume less than 10% of calories from saturated fatty acids and less than 300 mg/d of cholesterol, and keep trans fatty acid consumption as low as possible”. Further, total fat intake was recommended at 20 to 35% of total calories, with most fats coming from the sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
Reexamining and scrutinising the diet-heart hypothesis and re-evaluating Ancel Keys’s findings, to-date more than 20 peer review papers have largely concluded that saturated fats have no effect on cardiovascular disease. You may find completely different wordings, depending which source you are reading, and I find the most conservative tone is taken by the organisations that we trust our health most with - these are the ones considered the real experts in public health. Their interpretation of the recent data remains vague, ambiguous or often blatantly misleading - look at the following from Harvard Health, for example: “The American Heart Association advises to limit [fat] to a 5% or 6% of your daily calories, while the Dietary Guidelines for Americans say 10% is fine. Registered dietitian Kathy McManus, who directs the Department of Nutrition at Harvard- affiliated Brigham and Women’s Hospital, suggests a happy medium of 7%”. What? 7%? Where is the evidence for this number?
Christopher Ramsden of the National Institutes of Health, is a real Indiana Jones of research. In 2011 Ramsden, uncovered a study from 1989 by Dr. Ivan Frantz of the University of Minnesota, which had a most remarkable (from the scientific study-construction point) evidence: it concluded that replacing saturated fats with vegetable oils did not reduce the risk of coronary heart disease, what’s more it increased the risk. The study was of a great significance to Ramsden, because it had recorded the diets of people living in mental institutions, where all of their meals were prepared and recorded for the patients. And thus presented little margin for error of self-reporting, like majority of observational studies may have. One group of patients were allowed to eat saturated fats, such as butter and meat, and dairy products, the other group had half of the saturated fats replaced with vegetable oils. Ramsden attempted to look at the study and the data in the original, he reached to Frantz’s son (as the researcher himself had died two years prior).
The son - Dr. Robert Frantz, a physician at the Mayo Clinic, - obtained the records and let Ramsden analyse them. The study indeed seem to reveal that substituting saturated fats for vegetable oil lowered blood cholesterol levels. However, there was a surprise. Ramsden and his team found that lowering cholesterol did not help people live longer. As their cholesterol fell, the risk of dying increased. There was a 22 percent higher risk for every 30-point cholesterol fall. In other words, although diet could successfully lower blood cholesterol, this reduction did not appear to translate into long-term cardiovascular health protection.
In response to research by Ramsden and his team and others with similar results, in 2015 a panel of nutrition experts from the Academy of Nutrition and Dietetics (DGA) suggested to use a consistent language among expert organisations regarding their stance on fatty acids in the diet. They stated: “In the spirit of the 2015 DGAC’s commendable revision of previous DGAC recommendations to limit dietary cholesterol, the Academy suggests that HHS [the US Department of Health and Human Studies] and USDA [the US Department of Agriculture] support a similar revision de-emphasizing saturated fat as a nutrient of concern.
Did you spot the word “de-emphasising”? Why not clearly stating, the evidence is not there and we change our position on limiting saturated fats?
And so the diet-heart hypothesis lives on…
In the latest research published in Neurology, the authors and their peers who reviewed the study suggest that more research is warranted. Indeed it is. But would it mean that the layman, the person who is on the receiving end of dietary guidelines, may once again enter an era of ever-changing conflicting advice?
When it comes to analysing cholesterol, not only we have HDL and LDL (‘the good and the bad’ cholesterol guys), we also have triglycerides, VLDL, IDL and LP(a) and apo(a) - the stickier than other types of LDL does not mean we have managed to put an end to deaths from heart disease. Or even protect our cardiovascular health. But this is the point that seems to be missing from many research papers nowadays. Many studies dissect and partition foods, extracting some of their components (as as short-chain-fatty acids (SCFAs) and we, the public, rely on the media and public health organisations to interpret the findings and make sense of what those findings might mean for our individual long-term health benefits or detriments.
What would be much more useful if the officials behind public health guidelines agreed to have the patient’s health in mind: it is not the medicine lowering your LDL, (or maybe now in light of the new study, would also be lowering HDL?) that will protect you, but eating real foods, the foods that your gut can recognise as its own, the foods that come from nature, the foods that our evolution made us to be able to break down, absorb and utilise and not the foods that have come out of a food manufacturer’s chemical lab.
If your doctor told you you have high cholesterol, you have high cholesterol in your family, or you are confused which foods cause your cholesterol to rise and which foods you should be eating to have healthy cholesterol levels, I have created a Healthy Eating for Cholesterol Plan for you. You can buy it and download from here.
It is a comprehensive guide on which foods cause your liver to accumulate excess fat and increase your cholesterol and the best foods to regulate your liver function and have a healthy cholesterol levels again.
