A study found that restrict­ing sat­u­rated fat in the diet does­n’t pro­tect against heart dis­ease, reignit­ing the debate among doc­tors over the issue. Instead of con­cen­trat­ing on a sin­gle nutri­ent, the authors rec­om­mended a more holis­tic approach to health, which includes fol­low­ing the Mediterranean diet sup­ple­mented with large quan­ti­ties of olive oil.

The belief that the sat­u­rated fat in foods like but­ter and cheese clogs the arter­ies is “just plain wrong,” accord­ing to car­di­ol­o­gists in the new report. This asser­tion is a direct chal­lenge to the tra­di­tional med­ical thought that for decades has prompted the admo­ni­tion to cut back on these foods.

In the edi­to­r­ial pub­lished in the British Journal of Sports Medicine, the authors said a key ear­lier study “showed no asso­ci­a­tion between sat­u­rated fat con­sump­tion and all-​cause mor­tal­ity, coro­nary heart dis­ease, CHD mor­tal­ity, ischemic stroke or type‑2 dia­betes in healthy adults.”

The car­di­ol­o­gists advised a dra­matic shift in the approach to the pre­ven­tion and treat­ment of heart dis­ease. “Decades of empha­sis on the pri­macy of low­er­ing plasma cho­les­terol, as if this was an end in itself and dri­ving a mar­ket of ‘proven to lower cho­les­terol’ and ‘low-​fat’ foods and med­ica­tions, has been mis­guided,” they said.

While doc­tors have long empha­sized low­er­ing LDL cho­les­terol, the report con­tended that a high total cho­les­terol to HDL cho­les­terol ratio is a more accu­rate pre­dic­tor of an ele­vated risk for heart attack and stroke. In addi­tion, they pointed out that car­dio­vas­cu­lar dis­ease is caused by inflam­ma­tion.

Therefore, they pro­moted an approach that gets to the root cause of the dis­ease. This involves plac­ing a focus on “eat­ing ‘real food,’ tak­ing a brisk daily walk, and min­i­miz­ing stress to stave off heart dis­ease,” they said. “Coronary artery heart dis­ease is a chronic inflam­ma­tory con­di­tion which responds to a Mediterranean-​style diet rich in the anti-​inflammatory com­pounds found in nuts, extra vir­gin olive oil, veg­eta­bles and oily fish.” They advo­cated the daily con­sump­tion of ample quan­ti­ties of health­ful fat; namely, “four table­spoons of extra vir­gin olive oil or a hand­ful of nuts.”

Why haven’t admo­ni­tions to cut sat­u­rated fat in the diet led to a reduc­tion in heart dis­ease? The answer lies in the fact that peo­ple have sub­sti­tuted refined and processed car­bo­hy­drates for sat­u­rated fat. Such foods pro­duce chron­i­cally high insulin lev­els, a prob­lem that trig­gers inflam­ma­tion, which in turn con­tributes to hard­en­ing of the arter­ies. Conversely, the health­ful car­bo­hy­drates that are part of the MedDiet, such as plenty of fibrous fruits and veg­eta­bles, actu­ally fight inflam­ma­tion.

Responses to the edi­to­r­ial exon­er­at­ing sat­u­rated fat con­sisted of sup­port from some quar­ters of the med­ical com­mu­nity, as well as sharp cen­sure from oth­ers. Those who expressed strong dis­agree­ment said the authors failed to take into con­sid­er­a­tion a 2015 Cochrane review that linked a reduc­tion in sat­u­rated fat intake to a 17-​percent decrease in car­dio­vas­cu­lar events.

How does lead author Aseem Malhotra address this crit­i­cism? “We didn’t use the Cochrane review because it is at best, fatally flawed, and at worst, unsci­en­tific non­sense,” he told Olive Oil Times. “The sat­u­rated fat ref­er­ences upon which we based our edi­to­r­ial are sys­tem­atic reviews for pri­mary and sec­ondary pre­ven­tion of heart dis­ease.”

So whom should we believe? Are the authors of the new edi­to­r­ial cor­rect, or should we give cre­dence to their crit­ics?

Olive Oil Times asked inte­gra­tive physi­cian Jacob Teitelbaum for his per­spec­tive. “It is impor­tant to look at the entire Cochrane review and not just selec­tively pick out a few of its data points. They key con­sid­er­a­tion is that the low sat­u­rated fat diet did not show any sig­nif­i­cant effect on over­all mor­tal­ity,” he said.

“As the review authors them­selves noted on dis­cussing even the one data point asso­ci­at­ing sat­u­rated fats with heart dis­ease, this evi­dence was lim­ited and cir­cum­stan­tial.”

“People are suf­fer­ing from the mis­im­pres­sion that they have to suf­fer to be healthy. This is sim­ply not so,” added Teitelbaum.

Common sense tells us that us that the best approach for the pre­ven­tion of a med­ical prob­lem is to attack the root cause, which in this case, is inflam­ma­tion. Since the MedDiet is known as the anti-​inflammatory diet, it offers the most effec­tive means of pro­mot­ing bet­ter car­dio­vas­cu­lar health.

• BMJ
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