By MELISSA
HEALY — Los Angeles Times Published:
October 22, 2013
The British Medical Journal has issued a clarion call to all
who want to ward off heart disease: Forget the statins and bring back the bacon
(or at least the full-fat yogurt). Saturated fat is not the widow-maker it's
been made out to be, writes British cardiologist Aseem Lahotra in a stinging
"Observations" column in the BMJ; the more likely culprits are empty
carbs and added sugar.
Virtually all the truths about preventing heart attacks that
physicians and patients have held dear for more than a generation are wrong and
need to be abandoned, Lahotra writes. He musters a passel of recent research
that suggests that the "obsession" with lowering a patients' total
cholesterol with statins, and a public health message that has made all sources
of saturated fat verboten to the health-conscious, have failed to reduce heart
disease.
Indeed, he writes, they have set off market forces that have
put people at greater risk. After the Framingham Heart Study showed a
correlation between total cholesterol and risk for coronary artery disease in
the early 1970s, patients at risk for heart disease were urged to swear off red
meat, school lunchrooms shifted to fat-free and low-fat milk, and a food
industry eager to please consumers cutting their fat intake rushed to boost the
flavor of their new fat-free offerings with added sugar (and, of course, with
trans-fats).
The result is a rate of obesity that has
"rocketed" upward, writes Lahotra. And, despite a generation of
patients taking statins (and enduring their common side effects), the trends in
cardiovascular disease have not demonstrably budged.
Lahotra cites a 2009 UCLA study showing that three-quarters
of patients admitted to the hospital with acute myocardial infarction do not
have high total cholesterol; what they do have, at a rate of 66 percent, is
metabolic syndrome - a cluster of worrying signs including hypertension, high
fasting blood sugar, abdominal obesity, high triglycerides and low HDL
("good" cholesterol).
Meanwhile, research has shown that when people with high LDL
cholesterol (the "bad" kind) purge their diet of saturated fats, they
lower one kind of LDL (the large, buoyant particles called "Type A"
LDL), but not the small, dense particles ("Type B" LDL) that are
linked to high carbohydrate intake and are implicated in heart disease.
Recent research has also shown that Mediterranean diets -
admittedly skimpy on red meat but hardly light on saturated fats - have
outpaced both statins and low-fat diets as a means of preventing repeat heart
attacks. Other research suggests that the saturated fat in dairy foods may
protect against hypertension, inflammation and a host of other dysfunctions
increasingly linked to heart attacks.
"It is time to bust the myth of the role of saturated
fat in heart disease and wind back the harms of dietary advice that has
contributed to obesity," writes Lahotra.
Whether physicians at the front lines of health have gotten
the message, a change in thinking is evident, at least, among some of
medicine's leaders. But it's not easy to tune out years of what Lahotra calls
"the mantra that saturated fat must be removed to reduce the risk of
cardiovascular disease."
"When saturated fat got mixed up with the high sugar
added to processed food in the second half of the 20th century, it got a bad
name," noted University of California, San Francisco, pediatric endocrinologist
Robert Lustig. On the question of which is worse - saturated fat or added
sugar, Lustig added, "The American Heart Association has weighed in - the
sugar many times over."
