Mad, bad and dangerous to eat… What next?
Posted by Andrew Wadge on 19 January 2010 in General interest
As I sat eating my toast yesterday morning while listening to the radio and scanning the paper, I was somewhat concerned by the stories being thrown around on food and health – one calling for a ban on butter and the other for a ban on trans fats. My concern was less about the science being reported to justify such bans and more about what I would be able to spread on my toast in future if we banned all foods that were perceived by some to be ‘mad, bad and dangerous to eat’!
And if we banned butter and trans fats (which occur naturally in animal products), on the same grounds it follows that we would also have to ban cheese… And why stop there, what about chocolate, pastries, cakes and biscuits?
But the truth is, there are very little trans fats in any of our foods these days, including our spreads, and while butter should be eaten sparingly, because it contains high amounts of saturated fat, the world would be a poorer place if it ceased to exist.
It’s not that we don’t take these issues seriously, but a ban’s not a practical solution. In 2007 SACN (the Scientific Advisory Committee on Nutrition) conducted a full independent scientific review looking at the health impacts of trans fats and whether the UK should act to restrict their use. It concluded that levels of artificial trans fats in foods are now very low and the amounts we eat are below the limits set. This is because the food industry has voluntarily been reducing levels or removing them all together, including many fast-food restaurants changing cooking oils.
Consumer intakes of trans fat are now at very low levels – just 1% of food energy, which is half the recommended maximum intake. And, there’s currently no evidence to show that further reductions would result in a reduced risk of coronary heart disease in the UK.
And, although trans fats are talked about as evil chemicals lurking in our foods, it’s in fact sat fats that we should be taking more action on. As a nation we are all eating much more saturated fat than we need to, which is having a negative effect on our health – intakes are currently more than 13% of our food energy and above the current guidelines of less than 11%. This is precisely why the FSA is running campaigns to raise awareness of saturated fat and help people cut down – phase two launched yesterday promoting 1% fat milk.
So, rather than a ban, I’d encourage people to check out our campaign advice, take more responsibility for their choices and maybe cut back on the takeaways, cakes and biscuits.
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BA Festival of Science
Excellent advice
Posted by Jim on January 20, 2010 at 08:46 AM GMT #
No science in this one, just anecdote.
I love my butter, too.
Almost throughout 2008, we had banished marg from our household and used butter exclusively as a spread. In tandem, I selected my cooking oils carefully too, and progressively reduced exposure to vegetable oils.
I am not qualified to connect previous with next anecdote but during the course of the year I perceive some restoration of appetite control and I finished the year some 5 kilos lighter than I started. When I clasp my fingers they feel noticeably less 'puffy' than before and in common with this observation I observe sometimes the swelling (of fingers) does return temporarily and seemingly in response to dietary inputs. It fascinates me but I don't suppose there's anything in it.
Posted by John on January 20, 2010 at 01:32 PM GMT #
There's quite a lot of web based backlash, Andrew, that agrees with your sentiment. The paleo lot have reacted to Mr Kolvekars call and people are rallying on facebook.
It's looking a bit like an own goal because the web abounds with butter-is-best sentiment. Has the consultant fallen, or is about to fall, on his sword, err, scalpel!
Some good has emerged. You have revealed what you spread on your toast in common with Clarissa Dickson Wright.
Posted by Hot buttered toast on January 21, 2010 at 02:18 PM GMT #
Sadly another misguiided an erroneous repetition of the "saturated fat is bad" mantra. NO trial or study has EVER proven any link between dietary intake of saturated fat and either cardiovascular heart disease OR blood cholesterol.
Even the Framingham study concluded there was no link between cholesterol, dietary saturated fat and CVD! The real culprits are obesity, lack of exercise, smoking and high blood sugars together with oxidised fats e.g., highly processed and hydrogenated fats. Prior to organised agriculture, we had virtually no carbohydrates, defy initelno processed foods.
What has the low-fat mesage done over the last 50 years except see INCREASED heart disease, diabetes, and obesity.
Posted by Richard Painter on January 26, 2010 at 08:43 PM GMT #
Andrew, as a respectable scientist, I urge you to review the literature on saturated fat yourself. I believe you can come to a reasonable conclusion when looking at the totality of evidence.
A link discussing the trials concerning saturated fats.
Please, review it and give your comments. I am very interested in this, because the science presented in that link is very compelling. Are there some other studies you know about that he isn't mentioning, because if not, the obvious conclusion is that saturated fats don't cause heart disease?
Posted by George on January 27, 2010 at 04:24 PM GMT #
Bottom line: in the U.S., during the years that butter consumption went down and "vegetable" oil consumption went up, heart disease and many other disease rates went UP. Check your facts, butter is good for you.
Also, promotion of low-fat dairy foods seems to only be a boon to the food processing industry, as they can make more money on ice cream than whole milk.
Posted by Gina on January 27, 2010 at 07:14 PM GMT #
How do you react to the recent meta analysis by Kraus:
http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1
It says that
intake of [more] saturated fat was NOT associated with an increased risk of CHD [coronary heart disease], stroke, or CVD [cardiovascular disease].
Where does the study go wrong in your view?
Posted by Chris Highcock on January 27, 2010 at 08:25 PM GMT #
In addition to Dr. Gyeynet's excellent post cited by George, here's one of my own that covers even a few more and recent studies.
Posted by Richard Nikoley on January 27, 2010 at 09:10 PM GMT #
For those who aren't aware of the reasons behind the argument here are a couple of links to recent research on the issue.
When significant figures in lipid research publish important article in significant publications the evidence presented has got to be taken seriously.
Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Patty W Siri-Tarino, Qi Sun, Frank B Hu, and Ronald M Krauss,
Dietary Fat and Coronary Heart Disease: Summary of Evidence from Prospective Cohort and Randomised Controlled TrialsC. Murray Skeaff Jody Miller
Department of Human Nutrition, University of Otago, Dunedin , New Zealand
"It is difficult to get a man to understand something when his livelihood depends on him not understanding it."
The FSA are going to have to reconsider there current opinion and practice and allow this issue to be discussed by health professionals in an open and honest manner.
Posted by Ted Hutchinson on January 28, 2010 at 10:40 AM GMT #
Its all very interesting, butter is better in my mind. When we look at the way palm oil and its derivatives have become an increasing component in our food in the past 15 years, it is more than an alarming co-incidence that CVD and obesity has increased under the guise that vegetable oil is better for you than say butter. Moderation is the key but few people are aware of how many products contain these extra unhealthy oils, even on their (Healthy)diets. Maybe the media should collaborate with the scientists and see how much palm oil is in our supposedly healthy foods, we did it with salt! People can only make an informed decision with their health if they have the correct information to hand, clearer labelling please.
Posted by Rachel Allardyce on January 28, 2010 at 03:05 PM GMT #
Andrew
In reference to Mr Kolkevar’s call to ban butter you say "My concern was less about the science being reported to justify such bans ..." yet no credible science was put forward by Mr Kolkevar to support this call. Despite being one of our ‘leading’ heart surgeons, when challenged by other medical professionals to provide evidence to support his claims, Mr Kolkevar cited one study from the 1970s and referred his peers to your web site.
This is deeply worrying on many levels, not least of which is the unquestioning coverage received by Mr Kolkevar in the international media (not one media outlet reported the fact that the press release originated from Unilever’s PR agency or challenged the statement’s scientific validity). Even more worrying is Mr Kolkevar’s reference to the FSA website given your relentless campaign against the consumption of saturated fats based on the flimsiest of evidence. You have repeatedly cited three studies in support of this policy despite the massive weight of evidence to the contrary (the fundamental tenet of science, challenging one’s own theories to destruction, is seemingly unimportant when one can simply select only that which supports one’s claims). The bad news is that you may have to strike one of these studies from your list as the most recent study from the WHO concluded "SFA intake was not significantly associated CHD events".
FSA advice has a huge impact opinion makers and food producers, but you continue to wage war on ‘sat fats’ (presumably so-called because the proles can’t understand words with more than one syllable) without any scientific basis or balance of opinion. Your recent campaign in favour of skimmed milk, for example, failed to mention that only a fraction of the calcium can be absorbed without the butter fat, or that skimmed milk has been associated with increased cancer risk and childhood obesity.
It is no longer good enough for public bodies to preach outmoded dogma to us in the hope that we’ll keep quiet and believe what they say, and it is morally unacceptable for the FSA to continue with a policy that is harming public health and having a profound effect on the way we eat. Thankfully the public is starting to question this policy and more and more medical professionals are willing to speak out – the FSA is in danger of losing credibility and may one day have to account for its actions.
Posted by Naomi on January 30, 2010 at 02:15 PM GMT #
There have been a number of comments on the blog questioning the evidence behind our advice on reducing saturated fat intakes. In particular, three studies, including one meta-analysis (i.e. bringing together the results of different research addressing similar questions), have combined the results of individual studies on the relationship between saturated fat and incidence of cardiovascular disease (CVD) or coronary heart disease (CHD) (Jakobsen et al., 2009; Skeaff and Miller, 2009; Siri-Tarino et al., 2010). The findings from these are not new. Earlier meta-analyses have looked at the same issue.
So is the FSA wasting public money campaigning to reduce saturated fat consumption? A detailed look at the papers and the evidence tells me we’re not. Why? Well first please accept my apologies for the slightly more technical tone in the following, but many of you who’ve posted comments on this subject obviously have a scientific background and I think it’s important to explain the science fully.
The majority of the analyses in these papers are based on combining data from prospective cohort studies. There are a number of problems with these types of data. For example, participants have their diets assessed at one time point and then they are followed up many years later (between 4 and 25 years) to collect health and death information. Of course, during this time, people’s diets may change a great deal. The quality of fat in the diet may also have changed, for example, the type of fats used in margarine production and for cooking oils, has changed over the years. Another issue is that the dietary information in these studies is often collected using a food frequency questionnaire – although these are relatively easy to use, they are less accurate than more detailed dietary assessment methodologies that are carried out over several days.
Additionally, prospective cohort studies only allow the identification of associations – not a cause and effect – and are therefore difficult to interpret due to confounding factors and bias from other CHD risk factors that might not have been taken into account. For example, most studies have considered smoking (which is a major risk factor for CHD), but not all have taken into account the use of the cholesterol lowering drug statin, which reduces CHD, to some extent, independently of diet.
The Skeaff and Miller (2009) paper included a small number of randomised controlled trials (RCTs) as part of its analysis. These RCTs had some design problems. For example, only small numbers of participants were involved or they were of short duration. Larger and longer RCTs with robust design are required. However, they have not yet been done due to the huge cost and long timescales needed to conduct them.
Although the analyses reported in the paper suggest that reducing saturated fat is not significantly associated with CHD risk, all three analyses highlight that replacing saturated fat with unsaturated fat, particularly polyunsaturated fat, may help to reduce the risk of CHD, which is part of the Agency’s advice.
In common with the World Health Organization and other eminent public health bodies, the Agency recognises that there is evidence to support an indirect link between saturated fat intake and increased LDL cholesterol, which may lead to increased risk of CHD. The favourable effect of replacing saturated fat with unsaturated fat on blood cholesterol levels is well established (Mensink et al., 2003). The idea that lowering LDL cholesterol levels can lead to a reduction in the risk of developing CHD has firmly been recognised by RCTs of statins (Cholesterol Treatment Trialists’ Collaborators, 2005). It is therefore reasonable to conclude that reducing saturated fat will reduce LDL cholesterol and overtime will lead to a reduced risk in CHD.
So, given the weight of evidence, our message is simple – we should all be continuing to cut back on saturated fat, getting a balanced diet and moving more. You can find out more about eating healthily on our eatwell website.
References
Cholesterol Treatment Trialists’ (CTT) Collaborators (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet, 366, 1267-1278.
Jakobsen MU et al. (2009) Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. American Journal of Clinical Nutrition 89: 1425-1432.
Mensink RP et al. (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. American Journal of Clinical Nutrition, 77, 1146-1155.
Siri-Tarino PW et al. (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition doi: 10.3945/ajcn.2009.27725.
Skeaff CM & Miller J (2009) Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Annals of Nutrition and Metabolism 55: 173-201.
Posted by Andrew Wadge on February 11, 2010 at 04:08 PM GMT #
Why ascribe conditions such as ischaemic heart disease (IHD) to excess intakes of saturated fats? We have been eating 'saturated' animal fats and tropical oils for the whole of our existence as a species on this planet. Yet IHD was either non-existent or extremely rare until the 1920s. How can a traditional food suddenly become a killer?
There is also the fact that ALL mammals - perhaps all animals - eat a high saturated fat diet in their natural habitats (see the full paper at http://www.second-opinions.co.uk/should-all-animals-eat-a-high-fat-low-carb-diet.html). And none of them - animals or human - suffers the chronic degenerative diseases we do.
Although saturated fats are demonised by the FSA, the fact remains that it is only among populations and cultures that don't eat natural saturated fats that diseases such as heart disease, cancer, obesity and diabetes occur.
It is no coincidence that the incidences of these conditions have risen dramatically since 'healthy eating' was introduced by the COMA Report in 1984. These increases are classic examples of cause and effect.
The truth is that 'healthy eating' isn't healthy.
Posted by Barry Groves on February 15, 2010 at 09:40 AM GMT #
You wrote...
"The idea that lowering LDL cholesterol levels can lead to a reduction in the risk of developing CHD has firmly been recognised by RCTs of statins (Cholesterol Treatment Trialists’ Collaborators, 2005)."
Statins don't just lower LDL-c. They also have an anti-inflammatory effect. Association between LDL-c level & CHD risk factor does not prove causation. Instead of looking at cholesterol quantity, look at cholesterol quality i.e. LDL-c particle size, Lp(a) etc. There are other factors that greatly affect CHD risk factor which are ignored e.g. Vitamin D3 & K2 status & omega-3 status.
We in the UK are still in the dark ages compared to the USA where they can get lipoprotein profiling, also CAC & CIMT tests.
Cheers, Nige
Posted by Nigel Kinbrum on February 15, 2010 at 05:04 PM GMT #
Some scientific evidence that contradicts the dogma that saturated fats cause heart disease. The major problem is lipid oxidation and not acumulation.
Network of Cholesterol Skeptics (THINCS)
http://www.thincs.org
Cholesterol - You Can't Live Without It!
http://www.cholesterol-and-health.com
Lowest mortality observed when total cholesterol (t-C) is 200-240 mg/dl, low t-C linked to more infectious and parasitic diseases and also low t-C maybe associated with higher CHD (could atherosclerosis be an infectious disease?)
http://www.canibaisereis.com/2009/09/19/low-cholesterol-certainly-not-healthy/
LDL: bad cholesterol or bad science (Colpo)
http://www.thepaleodiet.com/pdf/badcholesterolcolpo.pdf
http://www.canibaisereis.com/download/ldl-doesnt-cause-chd-acolpo.pdf
Posted by O Primitivo on February 15, 2010 at 06:42 PM GMT #