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Vindicating Saturated Fat WON'T Reduce Heart Disease, But Here's What Will

An observational piece in last week's British Medical Journal had the media buzzing when cardiologist Aseem Malhotra lashed out at governments and the food industry as being culpable in wrongly demonising saturated fat consumption as a leading cause of cardiovascular disease

"Break out the chips! Top doc claims saturated fats are GOOD for you", decreed The Star.

"Saturated fat is GOOD for you", reported The Mirror and The Express.

An observational piece in last week's British Medical Journal had the media buzzing when cardiologist Aseem Malhotra lashed out at governments and the food industry as being culpable in wrongly demonising saturated fat consumption as a leading cause of cardiovascular disease [1].

Malhotra cites

"The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades. Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks...... It is time to bust the myth of the role of saturated fat in heart disease"

To many, it may sound like heresey - so unrelentingly has the fat is bad mantra being drummed in. But the reality is that the evidence never supported saturated fat's bad rap in the first place.

It was all based on the simplified notion that saturated fat raised your bad LDL cholesterol, which appeared indisputable as a cast iron cause of heart disease. Replace saturated fat with any nutrient - protein, carbohydrate, or unsaturated fat - and our LDL cholesterol levels reduce. And with it goes our risk of heart disease.....or so we were told. But here's the rub, when we took all the studies that looked at saturated fat consumption in populations (a 2010 meta analysis of 347,747 individuals) we found the highest consumers of saturated fat had absolutely no increased occurrence in heart disease [2]. What was going on?

Evidence now shows that the notion that LDL cholesterol levels is the primary driver of coronary heart disease is naively oversimplified. Instead, the plaque in our arteries is the consequence of a cacophony of factors involving inflammation, dysfunction of blood flow and damage to the artery wall. And, whilst LDL cholesterol indubitably has a role, what is truly important is what is known as LDL's atherogenicity (the LDL particle size and whether it is oxidised). The amount of the LDL cholesterol per se is pretty irrelevant, and this explains why saturated fat consumption is an innocuous event.

So saturated fat is welcomed back on the menu, and with this big fat mess behind us can we now look forward to a drop in the 4million European deaths each year that are attributable to heart disease? The answer is: not at all.

Saturated fat does not cause heart disease, but it does not stop it either. It's best described as an 'inert' substance, and eating more or less of it is pretty much an irrelevant care. Whilst we were totally wrong to castigate it in the first place, we should not fall into the trap of allowing the pendulum to swing in the opposite direction and promote its consumption as heart healthy eating advice, when, again, not an iota of evidence exists to support it. Especially, if it heralds excuses to 'break out the chips' or increase our consumption of biscuits and baked goods, and chocolate - both appearing in the top five dietary sources of saturated fat in the UK diet.

What this news does, is allow you to simply forget about fat altogether, and focus on what does matter when it comes to thwarting heart disease. For example;

  • Our risk of coronary heart disease is decreased 4% for every additional portion of fruit and veg we consume daily [3]. Yet, only 31% of adults and 10% of children meet the "5-a-day" fruit and veg recommendation (we average about three servings a day).
  • Fish consumption is associated with a 14% lower risk of coronary heart disease [4]. Yet, our average consumption of oily fish is half a serving a week (nowhere near the 1-2 servings recommended).
  • Every additional 10 grams of dietary fiber intake per day reduces coronary heart disease mortality by 17% [5]. Yet, average daily intakes of dietary fibre for adults is a miserly 13-14g per day (well short of the minimum target of 18g per day).
  • The risk of heart disease reduces 8% for each weekly serving of nuts (up to four servings a week) [6]. Yet, we average not much more than one serving (handful) of nuts per week.
  • We don't even manage to consume a measly single serving (16 grams) of wholegrains a day, even though the evidence shows that a two serving per day increase in whole grain consumption is associated with a 26% reduction in coronary heart disease [7].
  • And despite the gargantuan of evidence supporting the benefits of being active, 80% of us fail to meet the government target of taking moderate exercise at least 12 times in a four-week period.

Saturated fat has been vindicated, and rightly so. Now with that done, let's move on, and focus on promoting those changes that will actually reduce the burden of cardiovascular disease that engulfs the population.

1. Malhotra A. Saturated fat is not the major issue. BMJ (Clinical research ed) 2013;347 doi: 10.1136/bmj.f6340.

2. Siri-Tarino PW, Sun Q, Hu FB, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition 2010;91(3):535-46 doi: 10.3945/ajcn.2009.27725.

3. Dauchet L, Amouyel P, Hercberg S, et al. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. The Journal of nutrition 2006;136(10):2588-93

4. Whelton SP, He J, Whelton PK, et al. Meta-analysis of observational studies on fish intake and coronary heart disease. The American journal of cardiology 2004;93(9):1119-23 doi: 10.1016/j.amjcard.2004.01.038.

5. Streppel MT, Ocke MC, Boshuizen HC, et al. Dietary fiber intake in relation to coronary heart disease and all-cause mortality over 40 y: the Zutphen Study. The American journal of clinical nutrition 2008;88(4):1119-25

6. Kelly JH, Jr., Sabate J. Nuts and coronary heart disease: an epidemiological perspective. The British journal of nutrition 2006;96 Suppl 2:S61-7

7. Anderson JW. Whole grains protect against atherosclerotic cardiovascular disease. The Proceedings of the Nutrition Society 2003;62(1):135-42 doi: 10.1079/pns2002222.