Posted on Thu, 24 Oct 13
A cardiologist has made media waves with an essay in the British Medical Journal where he suggests guidelines to reduce saturated fat are doing more harm than good, and that we are over medicating people with statin drugs.
"The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades. Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks" says Aseem Malhotra a Cardiologist from Croydon University Hospital, London who goes on to suggest that our obsession with cholesterol "has led to the overmedication of millions of people with statins."
One of the problems, says Aseem, is that “when you take the fat out, the food tastes worse. The food industry compensated by replacing saturated fat with added sugar. The scientific evidence is mounting that sugar is a possible independent risk factor for the metabolic syndrome (the cluster of hypertension, dysglycaemia, raised triglycerides, low HDL cholesterol, and increased waist circumference).”
His essay also suggests our demonization of cholesterol has led to the over use of statin drugs, which have modest benefits at best and considerable side effects. “Adopting a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin” he points out.
Its good to see dialogue around the limitations of older approaches to cardiovascular risk reduction, namely low-fat diets and primary prevention with statins. It has been well established for some time that the supposed benefit of lowering dietary saturated fat is weak (2) and that, despite their ability to lower cholesterol, statins are essentially useless for primary prevention of cardiovascular disease when compared to “interventions” like dietary counselling and exercise (3).
The challenge now is to implement a personalised diet and lifestyle prevention program in a medical system that currently directs most of its funding at people who are lucky enough to survive a heart attack or stroke. An ounce of prevention is worth a pound of cure.
1. Malhotra A. Saturated fat is not the major issue. BMJ 2013;347:f6340
2. Astrup A, Dyerberg J, Elwood P, et al. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr. 2011 Apr;93(4):684-8
3. Ray KK, Seshasai SR, Erqou S, et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med. 2010 Jun 28;170(12):1024-31.