Saturated fats don't increase heart risk? Fat chance, say critics

By Will Chu

- Last updated on GMT

Saturated fat found in processed meats does not increase the risk of a heart attack said a research team in a challenge to current evidence-based messages. ©iStock/stevanovicigor.
Saturated fat found in processed meats does not increase the risk of a heart attack said a research team in a challenge to current evidence-based messages. ©iStock/stevanovicigor.
Saturated fat does not clog up arteries nor increase the chance of a heart attack, according to a team of doctors whose views have triggered a wave of criticism.

In an editorial, published in the British Journal of Sports Medicine​, the researchers described current thinking on the effect dietary saturated fat has on health as "just plain wrong​."

The paper also pointed an accusatory finger at research emphasising the need to lower cholesterol levels.

This market driver of ‘proven to lower cholesterol’ and ‘low-fat’ foods,’ the team said, had been "misguided​."

"Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 min a day and eating real food,"​ the review stated. "There is no business model or market to help spread this simple yet powerful intervention."

Key to their opinions was research​ that showed no link between saturated fat intake and death, coronary heart disease (CHD), CHD mortality, stroke or type 2 diabetes (T2D) in healthy adults.

Similarly in the prevention of CHD the team said there was no benefit from reducing fat, including saturated fat, on myocardial infarction, cardiovascular or all-cause mortality.

One solution put forward was the adoption of a Mediterranean-style diet coupled with 20 or so minutes of physical activity a day as sufficient enough reduce the risk of heart complications.

“In comparison with advice to follow a ‘low fat’ diet (37% fat), an energy-unrestricted Mediterranean diet (41% fat) supplemented with at least four tablespoons of extra virgin olive oil or a handful of nuts achieved a significant 30% reduction in cardiovascular events in over 7500 high-risk patients,”​ the team pointed out.

‘Muddled’ editorial adding ‘confusion’

elderly-people-happy
'Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 min a day and eating real food,' the editorial stated. ©iStock

The paper’s authors, Aseem Malhotra, a cardiologist at the Lister hospital in Stevenage, Pascal Meier, a cardiologist at University College London and editor of the journal BMJ Open Heart​ and Rita Redberg, the editor of the American journal JAMA Internal Medicine​, received a barrage of criticism from fellow cardiologists and experts.

Prof. Alun Hughes, professor of Cardiovascular Physiology and Pharmacology, described the editorial as "muddled​" adding to "confusion on a contentious topic​."

Others went further stating that the authors had reported evidence simplistically and selectively.

Dr Amitava Banerjee, senior clinical lecturer in Clinical Data Science and Honorary Consultant Cardiologist at University College London, was one such critic.

“The authors failed to cite a rigorous Cochrane systematic review​which concluded that cutting down dietary saturated fat was associated with a 17% reduction in cardiovascular events including coronary heart disease on the basis of 15 randomised trials.

“A lot of the evidence the authors quote about saturated fats, including the systematic review​, is based on observational data, making it harder to draw conclusions, due to confounding factors.”

Dr Christine Williams, professor of Human Nutrition at the University of Reading, questioned the reasons for publishing these findings.

“Snappy editorials recently published by a well-known cardiologist continue to argue the case for saturated fats as an innocent bystander in cardiovascular disease.

“The nature of their public health advice appears to be one of ‘Let them eat nuts and olive oil’ with no consideration of how this might be successfully achieved in the UK general population and in people of different ages, socio-economic backgrounds or dietary preferences. 

Dr Gavin Sandercock, reader in Clinical Physiology (Cardiology) and Director of Research at the University of Essex pointed out that the definition of real food was unclear in the piece adding that the editorial was not founded on good evidence.  

“There is no such thing as ‘real food’ – the authors don’t define what it is so it’s meaningless.”

Physical activity advice good

The editorial’s opinions were not entirely dismissed as their views on physical activity and choice of food were backed by some authors.

“An encouraging element of the editorial is repetition of the current consensus for healthy lifestyle interventions including physical activity and management of stress,”​ said Dr David Nunan, senior researcher at the Centre for Evidence Based Medicine, University of Oxford.

“Though the source and quality of evidence for the specific recommendation of 22 minutes of walking is not given.”

Dr Mary Hannon-Fletcher, head of School, Health Sciences, Ulster University, said it was the best dietary and exercise advice she had read in recent years.

“Walking 22 min a day and eating REAL food. This is an excellent public health message, the modern idea of a healthy diet where we eat low fat and low calorie foods is simply not a healthy option.”

“Eating reduced fat foods, will not have a positive impact on the body’s metabolism as a whole,

It may indeed, have a negative effect on important hormonal production. So eating real foods, in moderation and exercising daily is the answer to keeping fit and healthy.”

Source: British Journal of Sports Medicine

Published online ahead of print: doi.org/10.1136/bjsports-2016-097285

“Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions.”

Authors: Aseem Malhotra, Rita F Redberg, Pascal Meier

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5 comments

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17% RRR

Posted by Dr Guy-André Pelouze,

Firstly if we are rational we must consider the residual 83% RRR which are not dependent on dietary sat fat reduction. It is rather close to the Pareto's rule: look at the 20% of the causes which are involved in 80% of the cardiovascular risk.
I mean tobacco smoking, hypertension, and diabetes.
Secondly, when you eat whole foods, you can not eat a lot of saturated fats. Why? Because saturated fats are part of a tissue (meat, bone marrow) or fruit (coconut) and it is difficult to gorge.

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Critic Doth Protest Too Much

Posted by Hugo Cabret,

"Honorary Consultant Cardiologist" is hardly a credential to legitimize Dr. Banerjee or his editorial critique.

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Cochrane and relative risk

Posted by Stefhan Gordon,

Though even after looking at the data from the meta-analysis of the RCT’s in the study published by Cochrane, there was no consistent increase in relative risk for All-cause mortality, Cardiovascular mortality, stroke, CHD mortality, etc. What was shown was a relative risk increase risk of 17% on average for “combined cardiovascular events”. Though when you actually parse the data provided that on average per 10000 people there were 138 fewer incidents in the people who had reduced saturated fat intake. Now that reduces down to 1.38 fewer incidents per 100. Doing some algebra, that means 9.5 out of 100 per with “usual saturated fat intake” had combined cardiovascular events whereas 8.12 people with reduced saturated fat diets had cardiovascular events. So the absolute risk for eating usual saturated fats was only 1.38%. Relative risk makes for good headlines since 17% seems very scary. But, when you understand how that percentage was derived, the number is really insignificant. So more often than not, relative risk just is presented for the dramatic impact.

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