
Saturated Fat is not the major issue  - hiroaki
http://www.bmj.com/press-releases/2013/10/22/observations-saturated-fat-not-major-issue
======
swombat
_Saturated fat has been demonised since the 1970s when a landmark study
concluded that there was a correlation between incidence of coronary heart
disease and total cholesterol, which then correlated with the percentage of
calories provided by saturated fat, explains Malhotra. “But correlation is not
causation,” he says. Nevertheless, we were advised to “reduce fat intake to
30% of total energy and a fall in saturated fat intake to 10%.”_

It is frightening to think that such a fundamental piece of public policy is
based on the "correlation is not causation" fallacious thinking.

Is there no one in power who is in the habit of actually thinking before
approving actions?

~~~
achileas
Most things in the biological sciences are correlations, to be as precise as
we are in the sciences, you have to point out that some relationship is
correlational unless you specifically test for causation (which is unfeasible
in most cases)...if you assume causation, even when there seems to be very
little doubt as to the causative agent, your paper is going to get sent back
to you by the reviewers (in most cases).

Add to that the fact that recommendations are based on erring on the side of
caution, and that tight correlations do become predictors of an outcome, then
you have a recipe for these recommendations. Nothing bad is going to happen by
reducing saturated fat intake, for the most part, but there is a chance of it
if intake is excessive, and in fact saturated fat intake is a fairly strong
predictor of future heart incidents.

~~~
wwweston
> Nothing bad is going to happen by reducing saturated fat intake

From what I've read, it depends on what you eat instead. For example, as the
article says:

"a JAMA study revealed that a 'low fat' diet showed the greatest decrease in
energy expenditure, an unhealthy lipid pattern, and increased insulin
resistance (a precursor to diabetes) compared with a low carbohydrate and low
glycaemic index (GI) diet."

~~~
Volpe
Insulin resistance is caused by sugar intake (completely unrelated to
cholesterol)... Arguing that in order to lower cholesterol you have to consume
more sugar seems rather strange.

~~~
tolmasky
Although individuals did not consciously decide to replace fat with sugar in
their diets, the reality is that this policy advisement lead food producers to
reduce fat in their products and replace that fat with sugar -- so the
practical result was indeed this. Most products that advertise low-fat have
accomplished this with sugar. Sure, it didn't _have_ to happen this way, but
thats irrelevant because it _did_ happen this way: their was public policy
that labeled fat as the bad guy, fat was reduced (sugar increased), and these
actions were applauded.

~~~
Volpe
But I've seen no evidence that, that is what happened. There doesn't seem to
be a logical reason as to why you'd need to increase sugar in order to lower
cholesterol, so why would companies do that?

Can you point to an example food(s) that had high fat, and low sugar, and then
after this policy, low fat, and high sugar... ?

~~~
malkia
Maybe to make the food still tasty. Go to your local store - check all low-
fat, 2%-enters, etc. and then full milk - check the sugar content percentage.
That's all... At least here in US, Los Angeles - usually it's the normal
yogurt/milk (e.g. hihg-fat) that has lower sugary content (percentage-wise)
than the rest. Sometimes it's quite significantly lower.

And I don't know how the whole craze about non-plain yogurt came. I'm
bulgarian native, and it's "foreign" to me that yogurt is mixed with any sugar
at all.

It's still yummy - you can mix it equal portions with water, shake it well -
and you get a very good drink. Or make this cold soup -
[http://en.wikipedia.org/wiki/Tarator](http://en.wikipedia.org/wiki/Tarator)

Or just eat it like this. No need for sugar...

~~~
Crake
I'm American and it took me until last year to learn that yogurt isn't sweet
by default. 95% of the grocery store offerings are the sugary kind, and that's
all I was ever exposed to as a kid, so I never noticed it. I spent years
thinking I hated yogurt only to eventually discover that the unsweetened kind
is really delicious. D:

------
scotch_drinker
There have been a lot of people saying this for quite awhile. Malcolm Kendrick
wrote an entire book about the poor science behind our current belief that
cholesterol causes heart disease. There are many others. But in the current
medical environment where doctors want to prescribe a pill to fix everything
and the biogen companies have enormous influence over public policy, dissent
never rises above the level of a whisper.

Smoking, cocaine, stress, these things cause heart disease. Saturated fat
probably isn't even a minor issue as it relates to heart disease. Every day,
millions of Americans take a pill to reduce cholesterol when it's not even an
issue. But don't expect that to ever change no matter how many doctors start
saying saturated fat isn't the major issue.

~~~
Volpe
Those with higher cholesterol have a higher percentage of heart attacks.

Doctors (in Australia at least) prescribe when your risk (calculated on your
cholesterol, smoking, stress, exercise, etc) is lowered by reducing your
cholesterol, and dietary restriction hasn't worked (i.e. your liver just isn't
as good as it used to be). Is that not how its done in the U.S?

~~~
vixen99
It's the HDL/Cholesterol and triglyceride/HDL ratios that predict risk. Check
it out.

------
wwweston
A related pet peeve:

It's becoming difficult to find products with "all" the fat (vs "low/reduced"
fat). Prime example for me: chocolate milk. It's pretty rare nowadays that I
ever see anything over 1% milk used in it -- and of course the label touts the
low fat formulation, but doesn't mention there's more sugar pumped in it than
a can of soda.

Even if this was healthier than full-fat/less sugar chocolate milk, I'd still
resent it. Chocolate milk is a treat, not a dietary staple. People should know
that. Make it that way, market it that way.

But it's starting to look like it isn't healthier. Which makes the marketing
more misleading and the formulation pretty ironic.

~~~
mirsadm
I think the biggest issue is that high (saturated) fat is often combined with
high carb (refined sugars, starchy foods etc). My diet consists of high fat /
low carb foods and it simply works (for me...). I've lost weight (without
trying) and my energy levels are much more predictable and stable. I never
watch how much I eat because my body will naturally stop be from overeating.

~~~
dools
I found that "mentally" what worked for me was focusing on increasing fibre
intake, rather than reducing sugar intake.

The effect is basically the same but I find it easier from a discipline
perspective to focus on including more high fibre foods (even in "treats" and
dessert foods) thank I do to "cut out" things that I enjoy.

~~~
eniacpx
I agree, I lost a load of weight doing this. I still eat treats but I make
them with whole wheat flour and I typically reduce the sugar content as well.

------
JunkDNA
About 10 years ago the journal "Science" ran a cover story called "The soft
Science of Dietary fat". If you have access to back issues through a library
(sadly it's paywalled), go pull it and read it. Your mind will be blown at how
thin the evidence is for many dietary recommendations. We know shockingly
little about how our bodies actually work.

~~~
droopyEyelids
Is this what you're talking about?

[http://garytaubes.com/wp-content/uploads/2011/08/Science-
The...](http://garytaubes.com/wp-content/uploads/2011/08/Science-The-soft-
science-of-dietary-fat.pdf)

~~~
JunkDNA
Yes, that's it. If I recall there were multiple pieces in that issue about
various aspects, but this was the primary one.

------
gabemart
I'm confused by the reference towards the Mediterranean diet being protective
against heart disease, because it seems tangential to the argument presented
in the rest of the article.

The clinical Mediterranean diet _is_ low in saturated fat. In one of the
landmark papers measuring the effects of the Mediterranean diet on CVD risk,
the "prudent" Western-style diet used as a control has 11.7% of calories from
saturated fat, while the experimental Mediterranean diet has 8.0% of calories
from saturated fat [1]. This diet is actually within the 10% limit the article
references as out-of-date advice from the 1970s.

Another large intervention study has the calories from saturated fat on a
Mediterranean-style diet falling from 13.7% before intervention to 8.0% after
intervention [2], again below the 10% limit.

I am not at all suggesting that the Mediterranean lowers the risk of CVD
because it is low in saturated fat. It just seems odd to use it as an example
of saturated fat not being linked with CVD risk without addressing the fact
that the Mediterranean diet is relatively low in saturated fat, and that
intervention studies using the Mediterranean diet typically reduce the %
calories from saturated fat in the intervention group.

It also seems odd to use the Mediterranean diet as an example in an article
that paints refined carbohydrates as a major CVD risk factor. While the
Mediterranean diet is relatively higher in whole-grain carbohydrates [2], it
still includes lots of refined-carbohydrate foods (think pasta), and it
introduces so many other dietary changes, particularly a vast increase in
consumption of fruits and vegetables [2], that one can't assume that the
increase in whole grains particularly is the source of the diet's protective
effects against CVD risk.

[1]
[http://www.drhirani.com/Assets/lyonfinalreport.pdf](http://www.drhirani.com/Assets/lyonfinalreport.pdf)

[2]
[http://jama.jamanetwork.com/article.aspx?articleid=199488](http://jama.jamanetwork.com/article.aspx?articleid=199488)

------
cam_l
Good response to this article with, like, facts and that..

[http://theconversation.com/its-not-even-debatable-
saturated-...](http://theconversation.com/its-not-even-debatable-saturated-
fat-is-bad-for-you-19386)

~~~
artichokeheart
Such a shame that the author apparently didn't read all of the linked "facts".

eg. "This cause and effect is now beyond reasonable doubt; science shows
([http://www.ncbi.nlm.nih.gov/pubmed/8043072](http://www.ncbi.nlm.nih.gov/pubmed/8043072))
that high levels of cholesterol cause arterial damage and this, in turn,
causes coronary heart disease."

The linked paper and the comments to that paper disputing the findings
completely contradicts the author's "beyond reasonable doubt" argument.

I don't have a "team" in this debate, personally I wish scientists would put
their pride aside, stop the furious debating and find a definitive answer. I'm
just pointing out an obvious flaw in this response.

~~~
mistermann
Excellent point. It sounds like a conspiracy theory, but I find the anti-fat
crowd to be chronically intellectually dishonest.

------
r0h1n
The current post links to the BMJ press release on this topic. These links are
to the full article:

[http://www.bmj.com/content/347/bmj.f6340](http://www.bmj.com/content/347/bmj.f6340)

[https://news.ycombinator.com/item?id=6599460](https://news.ycombinator.com/item?id=6599460)

------
femto
"Catalyst", the ABC's weekly science show, had an interesting investigation
into this last Thursday [1]. Last week was Part I, which presumably means this
week will be Part II.

[1]
[http://www.abc.net.au/catalyst/stories/3876219.htm](http://www.abc.net.au/catalyst/stories/3876219.htm)

\---

Edit: Wed->Thu

~~~
femto
Followup: Last week's program is generating some heat, with calls for the next
installment not to be shown. The ABC plans on showing it.

[http://www.abc.net.au/news/2013-10-28/professor-says-abc-
cat...](http://www.abc.net.au/news/2013-10-28/professor-says-abc-catalyst-
episode-could-result-in-deaths/5050866)

------
auctiontheory
They had me right until the end, with the quote from Timothy Noakes, who is
not a cardiologist, and makes plenty of data-unsupported mistakes in his own
writing, e.g. about barefoot running. It's like having Malcolm Gladwell back
up your research findings.

Was this piece supposed to be science or it is entertainment-journalism? The
latter, I think. (I.e. it is not the abstract of any particular research
study.)

I'm not saying the anti-anti-saturated fat recommendation is wrong. I'm saying
this piece is just another opinion, which adds nothing to my understanding.
Obviously the vast majority of educated and well-intentioned physicians
disagree with their recommendation.

~~~
adamconroy
Here is a transcript from a show that has cardiologists on the panel
:[http://www.abc.net.au/catalyst/stories/3876219.htm](http://www.abc.net.au/catalyst/stories/3876219.htm)

------
arunc
Am I the only one to see a trend in the increasing number of articles like
these?

Traditionally for centuries people in India have been consuming coconut oil,
ghee, etc which are supposed to be high in saturated fats and never had
problems. After globalization (1992), the food industry in here changed a lot
as well. The business promotion and the usage of refined oils increased which
is good for business, nevertheless not for health. These days, diabetes, heart
attacks and other such illness are very common even among 20+ and 30+. The
Indian food industry is one in which India (as a society) failed to nurture
and preserve its rich, diverse and healthy food culture.

~~~
auctiontheory
Diabetes and heart disease were widespread in India long before 1992. A
simpler explanation, over the last century, is that Indians are eating more,
and exercising less (i.e. not in the fields).

Aloo curry over white rice - nothing healthy about that, whatever oil you use
to cook it in.

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chrismealy
For what it's worth, my GP told me that old studies didn't distinguish regular
fats from trans fats, so saturated fats got the blame for what's wrong with
trans fats (which do mess up your cholesterol badly).

------
adamconroy
Trusting nutritionists is like having surgery in the 19th century. Deadly.

This show was quite interesting. Makes a very similar case:
[http://www.abc.net.au/catalyst/stories/3876219.htm](http://www.abc.net.au/catalyst/stories/3876219.htm)

------
tzm
_...refined carbohydrates and sugar in particular are actually the culprits_

 _Adopting a Mediterranean diet after a heart attack is almost three times as
powerful in reducing mortality as taking a statin, writes Malhotra._

------
anuraj
Coconut oil is perhaps the best with its anti oxidant and microbicide
properties. More often than not, it is the lifestyle that causes health
issues.

------
loourr
or better yet, "saturated fat is not an issue"

------
s_baby
carbs + saturated fat = cholesterol

choose one

