Cardiologist: time to stop demonising saturated fat

At first sight geology and nutrition have little in common but a major shift in thinking about the surface of earth is a handy way of highlighting a major change in ideas about how to cut the risk of heart disease with diet.

 Back in the 1920’s a meteorologist called Alfred Wegener came up with the theory that the continents weren’t attached to the surface of the globe but drifted around (very slowly).

 Geologists obviously dismissed it as fantasy but evidence for it built up and by the 1960’s a modified version of Wegener’s idea, by then called “plate tectonics”, became generally accepted.

My, only slightly exaggerated, claim is that conventional nutritionists are currently facing a comparable ‘paradigm shift’ in their long running assumption that the high carb/low fat diet should be the basis of their ‘healthy’ eating plate.

That paradigm is now being turned on its head with mounting evidence that a high fat/low carb diet not only makes more physiological sense but performs better clinically.  It’s time that the ‘healthy’ plate was replaced by what might be called the paleo plate.

Last week I wrote about a new strand of evidence for the shift – how eating 5000 calories of  mainly carbs a day for three weeks put on much more weight than 5000 calories of mostly fat. Today’s post is an interview with the latest critic of the low fat plate  -cardiologist Dr Aseem Malhotra of  Croydon University Hospital in London.

Saturated fat protective

Dr Malhotra has become an effective campaigner for this shift, having written about it in several newspapers. Today’s issue of the BMJ (British Medical Journal), carries his opinion piece which states unequivocally:  “recent (studies) have not suggested any significant association between saturate fat intake and cardiovascular risk. Instead saturated fat has been found to be protective.”

As an indicator of how long this debate has been running – and how the establishment has consistently ignored evidence against the low fat view – Malhotra quotes a study, published in the Lancet back in 1956, which compared groups of people eating diets of 90% carbohydrate, 90% protein and 90% fat. The greatest weight loss was in the group eating the fat.

So I was intrigued to exactly why a mainstream cardiologist, who not so long ago had been working at top heart transplant hospital Harefield and following standard procedures – stenting and prescribing drugs – had made such a dramatic U-turn.

The trigger, it turned out, was something that is regularly recommended but rarely followed – listening to patients. ‘I was with one of my patients who had just come round from an operation when the lunch trolley came by. “What I don’t understand, doc,” he said to me “is that the hospital has just spent a fortune saving my life but now you are feeding me crap food that he likely to put me back in here soon.”

 Cardiologists ignore prevention

‘My first thought was that he was absolutely right – it didn’t make sense. The second was that it also didn’t make sense that even though we cardiologists were really good at fixing up people, we paid very little attention to what they needed to cut their risk of falling ill in the first place. In fact I know that many cardiologists actively ignored prevention because of the damaging effect it might have on their income stream from private practice.’

Malhotra then did something else unusual: he acted on these musings and began reading up on diet and heart attack prevention and fairly soon began to question the conventional low fat view. As a result he changed his own diet in a low carb direction and increased his visits to the gym. The result was another event that prompted even more rethinking.

‘I’d always had one of those sports drinks after a workout- sounds silly now but I believed in all that promotion about replacing energy and rehydrating. That all changed when a BMJ/Panorama joint investigation into sports drinks demonstrated just how poor the evidence of any benefit was. I was furious that I’d fallen for the marketing hype. I figured I’d spent about 10,000 pounds over ten years on a con.’

 Sugar and hormone problems

Exactly why added sugar was such a bad idea became clear when he read Dr Robert Lustig’s book ‘Fat Chance: the bitter truth about sugar’ on the increased appetite and fat storage it causes. Meanwhile the benefits he had felt from changing his diet and increasing his exercise time led to an increased focus on trying to persuade his patients to do the same, rather than relying on drugs, especially statins.

‘I’d been trained up to regard statins as a really valuable and virtually side-effect free weapons in the war against heart disease, but my patients kept telling me how dreadful they made them feel, That, combined with my own literature searches, convinced me that the sort of marketing hype that had driven sales of sports drinks had contributed more to their use than evidence of efficacy.’

Dr Malhotra ends his BMJ article with a call to a paradigm shift: ‘Doctors need to embrace prevention as well as treatment. The greatest improvements in morbidity and mortality have been due not to personal responsibility but rather to public health.’

It’s an approach that chimes perfectly with a new blog I’ve helped to set up called HealthInsightUK, which focuses on the need for sensible solutions to our ‘healthy’ eating crisis. There’s more detail about a change in official advice on statins along with an article  I’ve writtensetting out why a low carb diet could help with treating cancer.

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