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The Low-Fat Diet - The Trojan Horse of Heart Disease?

Cardiologists everywhere are thinking about swallowing their pride, or at least a nice sirloin steak.

For more than forty years, we have been recommending a relatively consistent dietary approach to prevent heart disease. We tell our patients to avoid saturated fat from animal products and to increase intake of fruits and vegetables. This recommendation is widespread and widely endorsed by the American Heart Association and other organizations.

And it makes sense, right? Eating cholesterol and saturated fat should translate into more cholesterol and plaque in your heart’s coronary arteries.

Except when it doesn’t.

Common wisdom was first put to the test when we began to learn more about how dietary cholesterol impacts blood cholesterol levels – many physicians then reconsidered prior recommendations to avoid eggs. Eggs are not very high in saturated fat, but are high in cholesterol. Eating cholesterol was believed to increase blood levels of cholesterol, thereby increasing the risk of heart disease.

But it turns out that dietary cholesterol plays a pretty small role in your own cholesterol profile. Many now recommend eggs as a high-protein breakfast food that may actually be preferable to refined carbohydrates and simple sugars found in many cereals and baked goods. More on those later.

So now that eggs were in, cardiologists united against saturated fat – a clear “no-no” that no one could argue with. But a growing number of journalists and scientists began to question the saturated fat-heart disease hypothesis with increasing justification.

In recent weeks, a study published in the American Journal of Clinical Nutrition tried to solve the controversy once and for all. Pooled data from twenty-plus studies and nearly 350,000 participants and found no difference in the risk of heart disease between people with the lowest and highest intake of saturated fat.

This is huge. It’s like telling people that bicycle helmets don’t protect them from head injuries or seatbelts don’t save lives. Sure, it’s not a perfect study. Some of the research relies on people’s recollections of what they ate, and it’s hard to draw any conclusions about whether there may be some benefit to a low-saturated fat diet in older or higher risk populations.

But we can’t ignore such a clear challenge to our way of thinking and hope that it just goes away. We need more research, more data and more open minds. Many are calling for a new approach to official dietary recommendations that takes the focus off of pyramids and nutrients like protein and fat, and more towards general dietary patterns.

Most people are now in agreement that highly processed foods and refined carbohydrates and sweets are not as good for us as a more plant-based diet enriched with whole grains, unsaturated fats and animal protein from fish. This seems like fact, but the cynic might just call it the next wave of conventional wisdom. Time will tell… but until it does, I’ll have mine cooked medium, please.

- James Beckerman, MD, FACC

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