March 10

The lipid hypothesis starting to get negative press

18  comments

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A recent article on the popular online news site AlterNet delves into the bogus science underlying the lipid hypothesis. It’s nice to see the word starting to spread.
The entire piece is a great read, and I encourage you to read it through. I’ll give a few excerpts just to give you the flavor.
Quoting a famous Canadian report concerning the Framingham Study:

“Dietary saturated fats were not associated with heart disease even after adjusting for other risk factors. Buried deep in the massive number of reports produced from the study is a quote from the investigators saying ” … there is, in short, no suggestion of any relationship between diet and the subsequent development of coronary heart disease in the study group.”

You can find more info on the Framingham Study in earlier posts here and here.
Our friend Gary Taubes is quoted frequently. Here is his take on the firmly entrenched idea that LDL-cholesterol is harmful:

“So how did we come to believe strongly that LDL cholesterol is so bad for us?” he asks. “It was partly due to the observation that eating saturated fat raises LDL cholesterol, and we’ve assumed that saturated fat is bad for us. This logic is circular, though: saturated fat is bad because it raises LDL cholesterol, and LDL cholesterol is bad because it is the thing that saturated fat raises.” Yet, he points out, “in clinical trials, researchers have been unable to generate compelling evidence that saturated fat in the diet causes heart disease.

Don’t think that the American Heart Association (AHA) truly has your interests at heart in waging its misguided war on cholesterol. Just as with all wars, there are profits to be made by some. In the war on cholesterol it is the AHA that is both escalatating the war AND profiting from it.

You’ve probably seen the AHA’s “heart check” logo on numerous food products. No surprise, they don’t give them out for free. Food manufacturers pay a first-year fee of $7,500 per product, with subsequent renewals priced at $4,500 according to Steve Milloy, a biostatician, lawyer and adjunct scholar at the conservative Cato Institute, who posted about this on “junk science” in 2001.
“There’s gold in the AHA’s credibility,” Milloy observed. “Several hundred products now carry the heart-check logo. You do the math. Adding insult to injury, consumers pay up for the more expensive brands that can afford to dance with the AHA. Pricey Tropicana grapefruit juice is ‘heart healthy’ but supermarket bargain brand grapefruit juice isn’t?”

Anyone with good sense realizes, of course, that these “heart check” logos don’t do squat to help anyone reduce the risk of heart disease. There are other things the AHA could do that would doubtless have a bigger impact, but wouldn’t bring money into the AHA coffers.

“According to US research,” the report adds, “high cholesterol in women is not a statistically significant risk factor for sudden cardiac death. On the other hand, smoking is one of the most important predictors of sudden cardiac death in women.” Which makes one wonder: Why doesn’t the American Heart Association start a television campaign to try to persuade more women and girls to stop smoking?

Why indeed?
Let’s hope we see a lot more reporting like this AlterNet piece in the future. Constant chipping can wear away the biggest stone, but it will take a lot to wear this one down because of the money involved.

Despite widespread skepticism about statins and cholesterol, don’t expect the controversy to end anytime soon. There is just too much money and too much political muscle supporting the theory that 18 million Americans should be on statins.

World-wide sales of $33 billion is a very big rock indeed. But if we just keep chipping…
Hat tip to Elizabeth Miller for sending me the article.


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  1. The AHA could always change their logo promotion to foods that don’t contain hydrogenated oil. That would be a good thing for everyone.
    It would certainly be much better than what they’ve got now.

  2. Are you familiar with Linus Pauling’s Unified Theory of Heart Disease?
    I am familiar with it. I think it is probably a little more valid than the lipid hypothesis, but if I can paraphrase H.L. Mencken, for every complex problem there is a simple solution, and it’s almost always wrong. Heart disease is a complex problem that arises from multiple causes, and I don’t think there is a simple solution. I’m in favor of the inflammatory hypothesis of heart disease because it fits the facts the best and because it is a complex solution.

  3. Hi Dr. Mike.
    I read your blog from time to time (whenever I have time), and I have one doubt regarding saturated fat and heart disease:
    What does the evidence say:
    That saturated fat doesn’t elevate LDL? or
    That saturated fat elevates LDL, but LDL doesn’t cause atherosclerosis?
    Maybe you already answered this one, so sorry in case you have, but I still have’nt understand this issue, and is something that troubles me.
    Best
    Miguel
    Hey Miguel–
    There is some evidence that saturated fat raises LDL-cholesterol levels. But no real evidence that LDL-cholesterol causes heart disease. And certainly no evidence that saturated fat causes heart disease.
    Best–
    MRE

  4. What really angers me about the whole cholesterol thing is that insurance companies arbitrarily set (and recently lowered!!) so-called “healthy” cholesterol levels to say you are a health risk, and thus bump you to a less desirable insurance tier based on your test results. My tests are 253 total, but my HDL is high (70) and that new VLDL that is included was also good, yet I’m penalized for the 253 and the LDL of 168, which is in the borderline category. And to think all this is based on junk science!!

  5. Below is part of one of the comments on the AlterNet piece. Is there any truth to this claim about the West of Scotland Study?
    “Actually, there’s good evidence that treating with statin drugs…..
    …..DOES lead to reduced incidence of heart disease, but for some reason the author of the article didn’t want to bring up these studies. One has to wonder why.
    In point of fact, the West of Scotland study (1995) DID find a significant decrease in the incidence of “primary” (i.e., “first-time”) fatal / non-fatal heart attacks in a large group of middle-aged men with elevated cholesterol levels who were treated with a statin drug (pravastatin) compared with a comparator group who were not.
    Of note, this study encompassed about 6,500 patients, as compared with the recent Enhance Trial quoted by the author, which dealt with only about 750 patients and which was NOT, in fact, designed to determine whether there was any difference in CLINICAL outcomes – i.e., rates of heart disease – between the two groups.”
    The West of Scotland study is an epidemiological study, which proves nothing. These patients were already taking a statin and were compared to other patients who weren’t. It wasn’t a prospective study; it was a retrospective study. And it certainly wasn’t a double blind, placebo-controlled study – the gold standard in drug testing. To prove a drug works one has to randomize similar subjects into two groups, give one group the statin (or whatever drug is being tested) and the other group a placebo. Neither the subjects nor the staff administering the drug and placebo can know who is taking what. This is the double blind, placebo-controlled process, and really the only process for showing a drug’s efficacy. When this has been done for statins, the only group showing and decrease in all-cause mortality was males under the age of 65 who had already had a heart attack. And even this wasn’t much of a decrease – probably not enough to put everyone in that category on a statin.

  6. Here’s some good press from Canadian TV. Probably belongs in another thread but i cant find a contact address at the blog . . .
    Canadian tv show on paleodiet research in a traditional community up thar’
    http://www.cbc.ca/thelens/bigfatdiet/
    See the side links about ouligan grease. This is where I got the idea
    to pour fish oil over blueberries some years ago — from the canadian
    indians.
    And also see the research summary. Average HbA1C went from 7 to below
    6. 4-6 is normal.
    http://www.cbc.ca/thelens/bigfatdiet/Poster.pdf

  7. Is it just me, or is this disturbing?
    0 out of 100 patients treated with statins will benefit by not dying.
    1 out of 100 patients treated with statins will benefit by not dying from a heart attack.
    3 out of 100 patients treated with statins will suffer side effects, some fatal.
    Did I miss something? I know I took some liberty with the numbers for simplicity, but isn’t this a fairly decent synposis using data provided by the drug manufacturers?
    How much Lipitor would Jarvik’s face sell if his pitch was “Well it won’t keep you from dying, and your 3 times as likely to have a potentially deadly side effect than it might help, but the good news is you have a 1 in 100 chance of not dying from a heart attack.”
    Agreed!

  8. I thought you might enjoy the following link to a piece about a CBC documentary: http://www.cbc.ca/thelens/bigfatdiet/index.html . Alert Bay, a native community in British Columbia, has gone on a low carb diet for the past year. The exciting part is that the study was funded by Health Canada. If you scroll down this page (http://www.cbc.ca/thelens/bigfatdiet/wortman.html), the second last paragraph has a link to a downloadable pdf showing the preliminary results.

  9. Dr Mike:
    “When this has been done for statins, the only group showing and decrease in all-cause mortality was males under the age of 65 who had already had a heart attack. And even this wasn’t much of a decrease – probably not enough to put everyone in that category on a statin.”
    What study are you referring to in your comment to Alex?
    Read this post.

  10. Saw this interesting clip this morning from Good Morning America
    http://cosmos.bcst.yahoo.com/up/player/popup/?rn=3906861&cl=6960848&ch=4226723&src=news
    Two college guys decide to find out about corn from seed to end products and how much of a role it plays in diet and disease. Some of what they found out surprised me and I thought I knew about most corn based products having been a label reader for more than 20 years. Even though they don’t talk about corn oil in the video piece what they do say couples nicely with what Mary Enig has to say.
    Maybe with more pieces like this more people will seriously look at low carb. Although it is interesting to note how two college guys deciding to research something and finding out that corn is bad for us get such good press but when a doctor or research scientist actually says the same thing, and has sound research and experience to back it up, he or she gets dissed.
    Great video clip. Thanks for sending.

  11. Here is the link to the site for the documentary these to guys made. It looks like it will be in theaters starting in October.
    http://www.kingcorn.net/
    And a link to GMA printed version with viewer comments. The comments are interesting to read as they run the gamut from corn growers defending their livelihood to doctors agreeing with the film and promoting Gary Taubes book to people who don’t have a clue.
    http://abcnews.go.com/GMA/OnCall/story?id=4439943&page=1

  12. I would not count the lipid hypothesis down and out by a long shot. Judged by the following article which was splashed all over every media today the low fat, high carb camp is determined to defend their turf by continuing to cite the Western diet as high fat, blaming it for the current epidemic of obesity while in the same breath advocating the low fat, high carb diet as the cure.
    http://www.abc.net.au/science/articles/2008/03/17/2191471.htm
    Overeating disrupts web of genes
    Monday, 17 March 2008 Maggie Fox
    Reuters
    obese woman
    Networks of genes are disrupted in people who are obese, some that can’t be detected using simple blood tests (Source: iStockphoto)
    Overeating disrupts entire networks of genes in the body, causing not only obesity, but diabetes and heart disease, in ways that may be possible to predict, researchers report.
    The researchers developed a new method of analysing DNA and used it to discover that obesity is not only complex, something already known, but complex in ways that had not been previously understood.
    “Obesity is not a disease that is the result of a single change to a single gene. It changes entire networks,” says Dr Eric Schadt, executive director of genetics at Merck Research Laboratories.
    His team identified networks of hundreds of genes that appear to be thrown out of kilter when mice are fed a high-fat diet.
    “This network is completely rocked by exposure to a high-fat, Western-type diet,” Schadt says.
    Problem is that mice aren’t simply little furry humans. They are rodents – we are primates. There is a big difference. Mice react differently to high-fat diets than do humans – a fact that researchers and others spreading this kind of nonsense would do well to keep in mind.
    I don’t think the lipophobes are preparing to surrender any time soon, but they’re going to have to do better than this study.

  13. Good article. Good post. But it is disappointing that at the top of the page is a Google ad titled Statins Lower Cholesterol. The page to which it links (http://About-Lowering-Cholesterol.info) gives the same old establishment advice about avoiding saturated fats.
    No need to publish my comment, but I would have thought you would not need the Google ad revenue so much as to allow this kind of junk to clutter you otherwise excellent website.
    Donna M. Byrne
    Professor of Law (and fan of good science and sound advice)
    William Mitchell College of Law
    Food Law Prof Blog: http://lawprofessors.typepad.com/foodlaw/
    I’m in the process of getting rid of the ads. I just found out that I can control what appears in the ads in the sense that I can refuse to put up certain groups of ads. I hate ads that are counter to my own purposes, but somehow there is a sort of justice, though, when I get paid for ads for statins while I’m in the process of bashing those very drugs.
    Took a look around your blog. Interesting. I’ll be back.

  14. Here’s a link to a great presentation by Dr. Malcolm Kendrick to the British Medical Association on the lack of correlation between saturated fat consumption and heart disease that I got from Donna’s great blog site:
    http://www.youtube.com/watch?v=XPPYaVcXo1I
    You might want to embed it on your main blog page – it’s right up your readers’ alley!
    I already posted on this. Here is the post.
    Cheers

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