A paper entitled:
“Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis” by Zoe Harcombe and colleagues has been picked up by the press in a big way (1). Here are some examples of the headlines:
• Daily Express:
“FAT is the key to living longer: Previous diet advice was WRONG, say experts” (2)
• The Times:
“Saturated fat diet advice not backed by evidence” (3)
• Guardian:
“Fat guidelines lacked any solid scientific evidence, study concludes” (4)
• Irish Times:
“Advice to cut intake of fat and saturated fat ‘wrong’” (5).
The research paper has taken the data from those reliable trials which were available prior to the development of the dietary recommendations to reduce saturated fat (SFA). There were only 6 studies which looked at the relationship between dietary fat, serum cholesterol, and the development of coronary heart disease that were considered to be satisfactory. And all but one focused on secondary rather than primary prevention. The pooled data revealed a total of 740 deaths from all causes, and 423 from coronary heart disease. There was no difference in deaths from all causes between the ‘treatment’ and comparison groups, with 370 deaths in both. And there was no significant difference in deaths from coronary heart disease, with 207 in the ‘treatment’ groups and 216 in the comparison groups. Although there was a reduction in the levels of blood cholesterol (TC) in the treatments groups with reduced intake of SFA this not associated with corresponding reduction in deaths. As all the participants were men, it follows that there was absolutely no information for women.
So the reality is that there was absolutely no justification in 1984 for the official Committee on Medical Aspects of Food Policy (COMA) to recommend that the SFA intake should be reduced from 20% of food energy to 15% as part of a strategy to reduce cardiovascular disease (6). As it happens this target was reached by 2000 (7). Currently the amount of SFA in the British diet is 12.7% of energy. Over this period the incidence of obesity has continued to increase. In men it has doubled since 1993, which is when detailed information was first collected (8). What is especially disturbing is that since 1994 the incidence of diabetes has more than doubled for both men and women (9). It is quite obvious that the expected results have not materialised and that the standard of public health have deteriorated.
These results will come as no surprise to anyone who has taken the trouble to review the evidence or to read any of the books written by independent researchers/journalists such as Gary Taubes, Barry Groves, John Briffa, Zoe Harcombe, Malcolm Kendrick or Nina Teicholz.
Publishing this report in a prestigious journal which has open access may prove to be a master stroke as it has clearly been picked up by the press and is certainly having an impact. But what is disturbing, but not surprising, is the response from the establishment. Here are a few examples:
• Dr Rahul Bahl in an editorial in the same issue of BMJ Openheart claims that:
“Epidemiological and ecological evidence suggests a link between fat consumption and heart disease. The seven countries cohort study by Keys referred to by the authors did find that higher serum cholesterol tended to be related to coronary heart disease incidence and that higher saturated fat consumption tended to be related coronary heart disease incidence. These findings were consistent in long-term follow-up” (10).
Nutritional policy has had numerous failures due to the reliance on epidemiological evidence which by itself cannot provide sound evidence on the relationship between diet and health/illness. It is outrageous that anyone can rely on this study by Keys which has been totally discredited (11).
• Dr Alison Tedstone, chief nutritionist at Public Health England, said:
“This paper is not critical of current advice on saturated fats but suggests the advice was introduced prematurely in the 1980s.” (12).
This really is being disingenuous. We just cannot get away from the facts that there was no reliable basis for the introduction of the recommendation to reduce SFA in the first place, that it has not worked and that no studies have provided any justification in the meantime.
• Victoria Taylor, senior dietician at the British Heart Foundation (BHF), said
“Understanding the true relationship between diet and our health is not simple. It would be all but impossible to carry out a research trial where you controlled the diets of thousands of people over many years. We continue to recommend switching saturated fat for unsaturated fat.” (13).
This position is simply untenable. There is very convincing evidence that many of the individual SFAs are actually important nutrients in their own right (14). Furthermore there is simply no case for increasing the intake of the polyunsaturated fats (PUFA) because this will increase the requirements for the omega-3 fatty acids and will probably also have deleterious effects such as increasing the risks of inflammation (15). It is rather ironic that the BHF commissioned research on SFA which concluded that there is not enough evidence to support the current dietary recommendations to reduce SFA and increase PUFA in order to reduce the risk of heart disease (16). Despite this the organisation could not resist putting their own spin on the research by making this statement on their website:
“We know there are good biological reasons for encouraging a Mediterranean-style diet, where we eat more unsaturated than saturated fat, that lower our levels of ‘bad’ LDL cholesterol” (17).
Surely the position adopted by the BHF has nothing to do with the support it receives from the manufacturers of Flora which is promoted on the grounds that it will “reduce cholesterol”? (18).
The fundamental problem is that when the dietary guidelines were first devised, the decision to recommend that the fat and the SFA in particular should be reduced was wrong! The focus of attention should have been on sugar and the refined carbohydrates. As a consequence the SFA intake has fallen and there has been a corresponding increase in the intake of sugar and carbohydrates. This is primarily why public health is deteriorating as shown by the rise in obesity and diabetes. The only way to address the issue is to reverse the current trends. Although there is growing recognition of the dangers of sugar, there will be little progress until it is accepted that SFA is a crucial nutrient and that it is actually beneficial to increase it.
Hence it is absolutely appalling that so many of the “great and the good” in the medical and public health professions continue to try to put forward rather pathetic justifications to support the official advice even though it cannot be substantiated. To persist in the light of the evidence is completely irresponsible because it is condemning a huge number of people to a life of misery and early death. It is about time these “deniers” faced up to reality and have the intellectual honesty to admit that they have been wrong. Surely that is the least we can expect?
Finally, congratulations to Zoe and her colleagues for a wonderful initiative. Let’s hope this triggers the breakthrough many of us have been anticipating!
REFERENCES
1. http://openheart.bmj.com/content/2/1/e000196.full.pdf+html
2. http://www.express.co.uk/life-style/health/557220/Avoid-low-fat-products-packed-sugar-eat-natural-fat-instead
3. http://www.thetimes.co.uk/tto/health/news/article4349211.ece
4. http://www.theguardian.com/lifeandstyle/2015/feb/10/fat-guidelines-lacked-any-solid-scientific-evidence-study-concludes
5. http://www.irishtimes.com/news/health/advice-to-cut-intake-of-fat-and-saturated-fat-wrong-1.2096666
6. Department of Health and Social Security (1984) “Diet and Cardiovascular Disease” London: HMSO
7. http://webarchive.nationalarchives.gov.uk/20130103014432/http://www.defra.gov.uk
8. Health Survey of England 2010 Adult Trend Tables
9. Health Survey for England 2009
10. http://openheart.bmj.com/content/2/1/e000229.full
11. https://vernerwheelock.com/?p=554
12. http://www.express.co.uk/life-style/health/557220/Avoid-low-fat-products-packed-sugar-eat-natural-fat-instead
13. http://www.independent.co.uk/life-style/health-and-families/health-news/dietary-advice-from-the-1970s-found-to-be-a-big-fat-mistake-10034786.html
14. https://vernerwheelock.com/?p=155
15. https://vernerwheelock.com/?p=370
16. https://vernerwheelock.com/?p=381
17. https://www.bhf.org.uk/media/news-from-the-bhf/fats-in-your-diet.aspx
18. http://www.zoeharcombe.com/2013/01/the-british-heart-foundation-flora-pro-activ-an-unhealthy-relationship/