Cholesterol Myth and Truth


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  • The research and career of the physiologist, Dr. Ancel Keys had a profound effect on society's attitude to food and exercise. His work spanning from the 1930’s through the 1970’s, introduced many of the assumptions which we now take for granted about the relationship between diet, energy expenditure, metabolic rates and health. In 1937, Keys moved to the Universityof Minnesotawhere he organized the laboratory of physiological hygiene where he led the way in studying the effects of ageing and the body’s responses to heat, cold or starvation. He determined the relationships between height and weight, diet and blood fats, blood fats and the incidence of heart attacks. His study on the human body’s’ response to extreme conditions prompted the army to ask him to develop rations for army paratroopers. What resulted was the famous “K-rations” of World War II, the combat rations that sustained soldiers throughout the war. Dr. Keys died in 2004 at the age of 100. He is survived by his wife, Margaret Keys, a daughter, Carrie D’Andrea, and a son, Dr. Henry Keys; eight grandchildren; and six great-grandchildren
  • Slightly less convincing is when the choice of different countries from the same data bases suggests that dietary fat has nothing to do with heart disease and that heart disease is very rare anyway:
  • he link between cholesterol and saturated fat with cardiovascular disease has been a myth for over 50 years.Stephan Guyenet (Whole Health Source blog) nicely addresses the cholesterol-CVD myth, and lists the many unsupportive studies here. I also recommend the work of Drs. Malcom Kendrick and Uffe Ravnskov for more info on why elevated cholesterol is not the death sentence CW paints it to be. I believe that most (if not all) of the studies that correlated cholesterol with CVD, ignored significant confounding variables such as wheat and sugar consumption, or lumped saturated fat in with trans/hydrogenated fats.The Monica study (which assessed 21 countries over 10 years) found no meaningful correlation at all. The tiny correlation that does exist would point towards heart disease rates going down as cholesterol levels go up. People with high cholesterol actually tend to live longer.For more Paleo Diet hacks: Follow us: @PaleoHacks on Twitter | PaleoHacks on FacebookA Sampling of Unsupportive StudiesHere are references to ten high-impact prospective studies, spanning half a century, showing no association between saturated fat consumption and heart attack risk. Ignore the squirming about saturated-to-polyunsaturated ratios, Keys/Hegsted scores, etc. What we're concerned with is the straightforward question: do people who eat more saturated fat have more heart attacks? Many of these papers allow free access to the full text, so have a look for yourselves if you want:A Longitudinal Study of Coronary Heart Disease. Circulation. 1963.Diet and Heart: a Postscript. British Medical Journal. 1977. Saturated fat was unrelated to heart attack risk, but fiber was protective.Dietary Intake and the Risk of Coronary Heart Disease in Japanese Men Living in Hawaii. American Journal of Clinical Nutrition. 1978.Relationship of Dietary Intake to Subsequent Coronary Heart Disease Incidence: the Puerto Rico Heart Health Program. American Journal of Clinical Nutrition. 1980.Diet, Serum Cholesterol, and Death From Coronary Heart Disease: The Western Electric Study. New England Journal of Medicine. 1981.Diet and 20-year Mortality in Two Rural Population Groups of Middle-Aged Men in Italy. American Journal of Clinical Nutrition. 1989. Men who died of CHD ate significantly less saturated fat than men who didn't.Diet and Incident Ischaemic Heart Disease: the Caerphilly Study. British Journal of Nutrition. 1993.They measured animal fat intake rather than saturated fat in this study.Dietary Fat and Risk of Coronary Heart Disease in Men: Cohort Follow-up Study in the United States. British Medical Journal. 1996. This is the massive Physicians Health Study. Don't let the abstract fool you! Scroll down to table 2 and see for yourself that the association between saturated fat intake and heart attack risk disappears after adjustment for several factors including family history of heart attack, smoking and fiber intake. That's because, as in most modern studies, people who eat steak are also more likely to smoke, avoid vegetables, eat fast food, etc.Dietary Fat Intake and the Risk of Coronary Heart Disease in Women. New England Journal of Medicine. 1997. From the massive Nurse's Health study. This one fooled me for a long time because the abstract is misleading. It claims that saturated fat was associated with heart attack risk. However, the association disappeared without a trace when they adjusted for monounsaturated and polyunsaturated fat intake. Have a look at table 3. Dietary Fat Intake and Early Mortality Patterns-- Data from the Malmo Diet and Cancer Study. Journal of Internal Medicine. 2005.I just listed 10 prospective studies published in top peer-reviewed journals that found no association between saturated fat and heart disease risk. This is less than half of the prospective studies that have come to the same conclusion, representing by far the majority of studies to date. If saturated fat is anywhere near as harmful as we're told, why are its effects essentially undetectable in the best studies we can muster?
  • Cholesterol Myth and Truth

    1. 1. Cholesterol and Cardiac Mortality Myth & Truth Fayza Rayes MBBCh. Msc. MRCGP Consultant Family PhysicianJoint Program of Family & Community Medicine, Jeddah
    2. 2. The MythPeople consume high fat diet have high cardiac mortality
    3. 3. The Original Evidence Ancel Keys cheated. He selected data from 6 countries to create the linear relationship. Data were actually available from total of 22 countries!This is the graph of heart deaths Keys (1953). Journal of mount Sinai Hospital New York plotted against fat intake
    4. 4. Consumption of fat and cardiac mortalityWe can make it astraight line, itshows very clearpositivecorrelation:
    5. 5. Consumption of fat and cardiac mortalityChoosing a fewother countriesmight havegiven anegativecorrelation:
    6. 6. Consumption of fat and cardiac mortalityChoosing a fewother countriesthe negativecorrelationbecome moreclear(consumption of>40% ofcalories from fatassociated withlower cardiacmortality):
    7. 7. Consumption of fat and cardiac mortality So lets look at the whole database from which Keys carefully selected his six countries
    8. 8. Consumption of fat and cardiac mortalityCmpare to the originalline swept in by Keys.Things get worse ifyou add in the Masai,the Inuit, the Rendile,the Tokelau and a fewothers, shown as reddots:
    9. 9. Cholesterol and Cardiac Mortality Other Studies Do people who eat more saturated fat have more heart attacks? The following are high-impact prospective studies, showing noassociation between saturated fat consumption and heart attack risk.
    10. 10. Cholesterol and cardiac mortality Between nation studies this figure, credited to Dr. Kendrick, shows the rates of death from CHD plotted against the percent of a given population who are frankly hypercholesterola- -emic. He extracted the data from MONICA study
    11. 11. NegativeCorrelationWHO-MONICA Study- Multinational MONItoring of Trends anddetermination in CArdiovascular Disease; a 10 year study, 7million people,14 European countries plus the AustralianAborigines (Aborigines are the leftmost country-lowestcholesterol & highest death rate).
    12. 12. BMJ. 1996 Jul 13;313(7049):84-90.Dietary fat and risk of coronary heart disease in men: cohort follow up study in the USAAscherio A, Rimm EB, Giovannucci EL, Spiegelman D, Stampfer M, Willett WC.Source: Harvard School of Public Health, Boston, MA 02115, USA.OBJECTIVE: To examine the association between fat intake and the incidence of coronary heart disease in men of middle age and older.DESIGN: Cohort questionnaire study of men followed up for six years from 1986.SETTING: The health professionals follow up study in the United States.SUBJECTS: 43 757 health professionals aged 40 to 75 years free of diagnosed cardiovascular disease or diabetes in 1986.MAIN OUTCOME MEASURE: Incidence of acute myocardial infarction or coronary death.
    13. 13. RESULTS: During follow up 734 coronary events were documented, including 505 non-fatal myocardial infarctions and 229 deaths. After age and several coronary risk factors were controlled for significant positive associations were observed between intake of saturated fat and risk of coronary disease. For men in the top versus the lowest fifth of saturated fat intake (median = 14.8% v 5.7% of energy) the multivariate relative risk for myocardial infarction was 1.22 (95% confidence interval 0.96 to 1.56) and for fatal coronary heart disease was 2.21 (1.38 to 3.54). After adjustment for intake of fibre the risks were 0.96 (0.73 to 1.27) and 1.72 (1.01 to 2.90), respectively. Positive associations between intake of cholesterol and risk of coronary heart disease were similarly attenuated after adjustment for fibre intake. Intake of linolenic acid was inversely associated with risk of myocardial infarction; this association became significant only after adjustment for non-dietary risk factors and was strengthened after adjustment for total fat intake (relative risk 0.41 for a 1% increase in energy, P for trend < 0.01).
    14. 14. CONCLUSIONS: These data do not support the strong association between intake of saturated fat and risk of coronary heart disease suggested by international comparisons. They are compatible, however, with the hypotheses that saturated fat and cholesterol intakes affect the risk of coronary heart disease as predicted by their effects on blood cholesterol concentration. They also support a specific preventive effect of linolenic acid intake.
    15. 15. J Intern Med. 2005 Aug;258(2):153-65.Dietary fat intake and early mortality patterns--data from The Malmö Diet and Cancer Study.Leosdottir M, Nilsson PM, Nilsson JA, Månsson H, Berglund G.Source : Department of Medicine, Lund University, University Hospital (UMAS), Malmö, Sweden. Most current dietary guidelines encourage limiting relative fat intake to <30% of total daily energy, with saturated and trans fatty acids contributing no more than 10%. We examined whether total fat intake, saturated fat, monounsaturated, or polyunsaturated fat intake are independent risk factors for prospective all-cause, cardiovascular and cancer mortality.DESIGN: Population-based, prospective cohort study.SETTING AND SUBJECTS: The Malmö Diet and Cancer Study was set in the city of Malmö, southern Sweden. A total of 28,098 middle-aged individuals participated in the study 1991-1996.MAIN OUTCOME MEASURES: Subjects were categorized by quartiles of relative fat intake, with the first quartile used as a reference point in estimating multivariate relative risks (RR; 95% CI, Coxs regression model). Adjustments were made for confounding by age and various lifestyle factors.
    16. 16. RESULTS: Women in the fourth quartile of total fat intake had a significantly higher RR of cancer mortality (RR 1.46; CI 1.04-2.04). A significant downwards trend was observed for cardiovascular mortality amongst men from the first to the fourth quartile (P=0.028). No deteriorating effects of high saturated fat intake were observed for either sex for any cause of death. Beneficial effects of a relatively high intake of unsaturated fats were not uniform.CONCLUSIONS: With the exception of cancer mortality for women, individuals receiving more than 30% of their total daily energy from fat and more than 10% from saturated fat, did not have increased Current dietary guidelines mortality. concerning fat intake are thus generally not supported by our observational results.
    17. 17. The TruthPeople consume high fat diet and people with high serum cholesterol have low cardiac mortality
    18. 18. But Why ??!! Why cholesterol has received plenty of this negative media over the last decade? Several studies have shown that cholesterol is not the cause behind problems of the heart. The reason is crystal clear: The pharmaceutical companies who manufacture cholesterol- lowering drugs have protected their billions of dollars by twisting the information.
    19. 19. The Bitter Truth$ billion Year During the past decade Pfizers Lipitor generated $115 billion in cumulative global revenue
    20. 20. For More Information Go to: Or go to YouTube Fat Fiasco pt. 1-5