Still harping on about Cholesterol Malcolm?

I think that by now most of my friends have had 'the cholesterol chat' with me; in pubs, over dinner or even sometimes when out running. I am generally careful now to only harp on about this to people I have not met before. This blog is an exception.

I am not a medical person, nor a nutritionist (although I did follow a correspondence course last year), and I hope I know where to draw the line between my knowledge and that of others. I do happen to know a little about statistics, something that helps to understand the relationship between a health claim and the data that apparently supports it.

But cholesterol is one subject that I have taken a close interest in. The reason for this is that it lies at the crux of the health/diet debate; it has had a massive impact on public health and the practices and finance of the NHS.

When I first saw the FSA video that declared that saturated fat clogs up your arteries just like it could clog up a drain pipe, I was scared; clearly that was the intention. And for many years I lived in fear of my higher than normal cholesterol leading to an early peanut butter induced heart attack.

That said, the concept did seem a bit preposterous at the time.  Humans have always eaten saturated fats and as far as historians can say is seems that we have not always dropped dead of Coronary Heart Disease. Also, the fat in the video only clogged up when it got cold, and human arteries are well known to be warm places!

The fear of fat was created in the 1970s and 1980s when firstly US dietary advice and then the advice we received from the NHS was changed. Very few scientists agreed with this change at the time, but Kellogg's were pretty happy about it all. We all switched from eating real natural food to eating cheap cereals instead. And we started adding more and more sugar to everything in order to make it more palatable. And did we get healthier? No, we did not.

Then along came statins (or did they actually arrive earlier looking for something to cure?). A panacea, no longer even requiring full clinical trails as they meet the simple surrogate endpoint of lowering LDL cholesterol. The claims were that thousands of lives would be saved, and yet the data quoted at the time showed that only small numbers of lives (perhaps 1 in 200) of already ill people might be prolonged, for a short while. Lives were not saved. I get incensed by such things as this. Data like this is being used to support the notion that we should nearly all be taking a drug that has several known side-effects and has clearly ruined the lives of many many people.

And the more I've learned about cholesterol, "good or bad", the more I have become convinced that there is nothing in it. For every report that declares that high LDL will lead to high CHD there is another that shows that there is no causation. The most obvious data here describes whole populations with low LDL and high CHD, high LDL and low CHD. How could this be?  Malcolm Kendrick sums it up perfectly (again) in this article where he points out that Russian men are eighteen times more likely to get a heart attack than Japanese men, and yet their average cholesterol levels are the same. This whole series of Malcolm's articles makes very interesting reading if you have an interest in heart disease.

If we can remove statins, cholesterol and hence saturated fats from the whole heart disease debate then we can start looking at the relationship between health and food in a different way. Fats and carbohydrates both provide us with energy, but which are more healthy and which are making us fatter and unwell? And in my opinion a big clue lies in this simple question - which is the only macro-nutrient that in its natural form has no nutritional value?

Change4life or Change4fat?

The Change4life campaign has always got my goat. At first it was the way that they embraced partnerships from companies like Nestle who gaily abused the crusade for their own sugary profits (http://www.bbc.co.uk/news/health-11541433). Now it’s  their unquestioning support of the war on fat that winds me up.

I don’t mind so much that their whole message is pro-“healthy-balanced-diet”, after all there is not that much wrong with the diet that they recommend if that is indeed what you end up eating – the trouble is for a growing  percentage of people it is clearly not; and the patronising & blinkered NHS advice is not helping to change anything as far as I can see.

This is the mouthpiece of the NHS, the voice we rely on to TELL US THE TRUTH about our health.

People make such a song and dance about whole milk. But milk is not a high fat product, and whole milk is more nutritious than semi, the Daily Mail are good on health issues:

Source http://www.dailymail.co.uk/health/article-2114101/Whole-milk-healthier-skimmed-baked-potatoes-make-fat--Why-thought-knew-healthy-food-wrong.html

The low-fat message has become so pervasive. It is hard to get a coffee these days with full-fat milk in, despite the fact many of us think that it tastes so much better - Starbucks don't sell whole milk..  In a world where personal choice is everything we must clearly all have received the wisdom that fat is bad!

Anyway, what really gets my goat is the simplistic nonsense that change4life are peddling about fat being the root of all evil.  Here is some typical content from http://www.nhs.uk/Change4Life/Pages/facts-about-fat.aspx with some red appendages from me.

Where does the fat we eat go?

Ever wondered where the fat in foods goes? Here's more about what it does in our bodies....

Get ready to learn something…..

1. Brain

When arteries get clogged up this can stop blood getting to the right parts of our brain and can cause strokes.

This statement is true but it does not mention the word fat, so what is it doing here on a web page about fat?  Dietary fat does not ‘clog up’ arteries. This is misleading. No marks. Please try harder!

2. Heart

Arteries carry blood around our bodies. Over time, too much saturated fat can clog up our arteries and restrict the blood supply to our heart which can cause chest pain (angina) and if completely blocked heart attacks.

No it can’t.  Firstly, you would probably die long before your arteries were completely blocked. Heart attacks and stroke happen when arterial plaques break off and block up somewhere important like the heart or brain.  Secondly saturated fat is no worse than any other fat in this context (http://online.wsj.com/news/articles/SB10001424052702303678404579533760760481486).

Atherosclerosis (the blocking of arteries) is caused by inflammation, and the role of fats (or rather cholesterol) in the inflammation process has recently been discovered to be improved by a high fat diet (http://www.dietdoctor.com/dr-oz-changes-his-mind-on-cholesterol).  Sorry NHS, this 'clogging-up' message is out of date and wrong. No marks! 

3. Pancreas

Eating too much fat can make us put on weight. Being overweight or obese can stop our pancreas from producing enough insulin and cause type 2 diabetes.

Poor quality again. Eating too much of anything can make us put on weight. Eating fat does not make us put on more weight when compared to eating a similar amount of carbohydrate. Yes there are slightly more calories in a gram of fat but in practice eating fat normally helps us lose weight as we feel full sooner and end up eating less than we tend to on a carbohydrate-based diet.  The second sentence is correct but not correctly implied by the first, so 3 out of 10 for trying!

4. Bowel

Being overweight increases our risk of getting bowel cancer - but a diet high in fibre and low in saturated fat keeps our bowel healthy and reduces the risk.

This may be true, but the jury is currently out on this one. It is quite possible that the problem here lies with processed meat, rather than saturated fat per se. A 2011 meta analysis showed no link between dietary fat intake and bowel cancer (http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/risks/food-types-and-bowel-cancer). Besides, who said that you should stop eating all fibre?  There is plenty in the veg that you should be eating anyway; just don’t feel that you have to go as far as All Bran (or even cardboard) to get your daily fix. No more that 5 marks out of 10; please try harder.

5. Body

If we eat too much fat we store the fat in our bodies which can lead us to put on weight.

Don't be silly; exactly the same is true of carbohydrates! I might as well say that if we ate too many donuts we would store the excess glucose as fat in our bodies which can lead us to put on weight! We all know this but the statement is simply not relevant unless you put it in some context which change4life have not done.

0 out of 10.

Total marks 8 out of 50. 10%, D-.  Not good enough!

So, a whole lot of spurious “advice” and misinformation. And this is what the NHS believes we should all know about fat.

Now when you consider that change4life is a top programme in implementing Government policy. https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet then I would say we have a big fat problem on our hands.

Now let me show you where the fat that I eat goes. And let’s be clear about this, I eat a lot of fat, but then I burn more energy than most with my running and cycling.

Source: http://www.ketogenic-diet-resource.com/metabolic-pathways.html

Now this diagram is slightly complicated but if you see my smiley red face it is there because the fat that I eat is being oxidized for energy. If I was also eating more than a small amount of carbs it might be stored as triglycerides in fat cells, but I am not, so it is not (or not much of it).

Like many LCHF dieters my triglicerides (the amount of actual fat being transported about my body looking for a nice home) are very low. So I can control my weight by eating more or less fat, depending on how much energy I am using.

On the left-hand side of the diagram (crossed out as I don't eat very much of them) is what we should be learning about carbohydrates. If we don’t burn them now we will store them as fat - we really can’t store very much as glycogen. This is the obesity epidemic at work.  And protein? Eat more than you can quickly turn into new things (like muscles) and the excess will be stored as fat. 

Unsurprisingly we see than anything we don't use we store as fat. But there is nothing special here about dkietary fat, is there? So why do we make out that fat is the devil's food? 

Read the article and you will also see how saturated fat is not making my cholesterol levels dangerous; in fact it is making them safer. My post at http://lchf4runners.blogspot.co.uk/2014/04/time-to-help-bust-that-cholesterol-myth.html explains this key point in detail.

So given the choice of carbs that can do nothing but help you move or make you fat, or fats that are highly nutritious and can make you more healthy, I have chosen fats.

Come on NHS, it's time to change4fat!

TIME Gentlemen Please! Butter is back!

Remeber this? Time magazine March 1984. The start of the low-fat revolution.The start of what went wrong with public health advice and the reason why crappy cereals now have pride of place at our breakfast tables.

 

Well TIME may not be recommending humble pie just yet but this month's cover goes a long way in that direction.

 

Eat butter. It's natural, it's tasty and it makes a whole lot of other things taste much, much better.

And it doesn't make you fall over and die of a heart attack.

 

 

Time to Help Bust that Cholesterol Myth

So, the elephants in my room at night are Fats, and in particular Saturated Fats.  I am eating lots of them for breakfast, lunch and dinner. The received wisdom suggests that I will die of a heart attack, perhaps as early as next week.  

My wife Jane started using a LCHF diet last year and it was her growing prowess on a bike that really impressed me. As she trained more she bacame less and less reliant on extra energy to power her through the long training runs leading up to the RideLondon-Surrey 100 bike event last August. This made me start thinking about the effect this could have on long distance running.

Up until about a year ago I was definitely in the low-fat camp. I ate lots of good and some not-so-good carbs and I avoided fatty foods. I have never liked margarine and so there was always butter in the fridge. I disliked low-fat food as it is often very sweet (got to make it taste nice after removing the good stuff!) . We ate healthily but it was easy to put on weight, even when running a fair bit.

Opinions have been changing fast in recent years.  

The belief that saturated fats and their association with Cholesterol have a direct relationship with heart disease has led to a demonization of natural foods like meat and butter, and the growth of huge industries for low-fat food and cholesterol-lowering foods and drugs. One of the first studies to refute this belief came from the American Journal of Clinical Nutrition in 2010. (http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract).

Here are a couple of  recent findings – you may have heard about them recently on the news:

• A highly-regarded recent study suggested that there is no difference between saturated fats and any other kind of fats in terms of their relationship with heart disease. (http://annals.org/article.aspx?articleid=1846638 )
• Recent research suggests that the actual relationship between cholesterol and heart disease is not as simple as having too much ‘bad‘ LDL cholesterol in our blood.
  (http://www.bmj.com/content/347/bmj.f6340)

When Jane and I started looking at LCHF diets this seemed like a giant leap of faith. What if the research is wrong? What if it is just a fad? But our interest in this subject has coincided with a wave of new research. Almost every week there is a new study published or another scientist or doctor ‘coming out’.  The mainstream is starting to shift, like all rivers do over the years.

What I particularly like about the latest research is that far from being bad for your heart health, a high-fat diet is quite likely to be better for it. This is not so suprising; as Jane put it the other day, "If a high fat diet is bad for you then how did our species ever evolve in a world governed by the survival of the fitest?".

 

There is compelling evidence that the relationship between cholesterol and heart disease lies not simply in your level of ‘bad’ LDL cholesterol, but in the size and number of the LDL particles themselves http://www.internationaljournalofcardiology.com/article/S0167-5273%2899%2900107-2/abstract. The lower the size, and hence greater the number of LDL particles, the higher the risk. This particle size is known as LDL-p (or alternatively LDL patterns A and B as shown below) . 

This LDP-p value is not reported in the standard UK cholesterol test and is not mentioned on the NHS web sites or that of HEARTUK “The Cholesterol Charity”.   Perhaps because this ‘charity’ like several other charities are sponsored by companies that make cholesterol-lowering foods. 

Research also suggests that the high-carb diet recommended by most dieticians, doctors and the NHS promotes a higher LDL-p (pattern B) value, whereas the high-fat diet that most humans have followed for the last million years promotes a lower (healthier) LDL-p value.

Now this is relatively new science, but the drugs industry and health authorities have yet to seriously challenge any of the data being produced. This may be because a debate might draw more attention to the facts. Or it may be because the research that they produce in support of their own views is generally so weak that most A level students studying research methods and statistics would be tempted to tear it apart (read this and see what I mean http://en.wikipedia.org/wiki/Seven_Countries_Study). This study formed the basis of the ‘cholesterol myth’. 

While you are at it, watch the Cerealkillers movie (http://www.cerealkillersmovie.com/) for a description of LDL-p and how it relates to your diet. This documentary also discusses the success being achieved by Tim Noakes and others in treating Type 2 Diabetes with a controlled LCHF diet. It’s a fascinating programme.

Take a look at the graphs below. The left hand side of the first graph below has a lot of scatter, but then there are lots of other causes of heart disease. The right hand side is more interesting as the dots are mostly closer to the line (less deviation implies a stronger trend).  So while the graph does not necessarily prove that less saturated fat will always lead to more heart disease than average it does suggest that more saturated fat will normally lead to less heart disease than average.

So if the countries that eat the most saturated fats appear to have the lowest levels of heart disease then why would we want to lower our cholesterol?

Can you spot France and the UK in the graphs?

This is known as the French paradox - the French eat the most saturated fat, their cholesterol is not that high and they have the least death from heart disease. They also have the lowest levels of obesity. This may be because the French are very resistant to anything that changes their national character, particularly their food; they are still eating the same way they have for decades. So why aren’t they having so many heart attacks as us? Perhaps because their higher saturated fat diet is actually protecting them. I’d be very interested to know if they have a lower LDL-p value than we do in the UK. 

The graphs above were taken from the following web sites. Well worth a read.

http://authoritynutrition.com/6-graphs-the-war-on-fat-was-a-mistake 

http://bebrainfit.com/lifestyle/drains/exposed-why-cholesterol-doesnt-cause-heart-disease

http://karenlebillon.com/2012/09/17/french-kids-dont-get-fat-why

The bible on this subject is here: http://drmalcolmkendrick.org/the-great-cholesterol-con/