I hope that you can join our next exciting discussion of functional medicine on Tues Sept 29 at 6 pm with some healthy food sponsored by Metagenics. Please let me know via email or phone if you will be able to attend.

The topic for the next Functional Medicine Discussion Group is: Does dietary cholesterol and saturated fat intake contribute to cardiovascular disease?

For many years we advised our patients to avoid saturated fat and cholesterol in their diet, since they were linked with increased LDL cholesterol, which would increase cardiovascular disease risk. This would mean avoiding butter, cheese, egg yolks, red meat, poultry skin, whole fat dairy, etc.  In recent years, studies have not found as clear a link between dietary cholesterol or saturated fat intake with heart disease.  For example, the study by Mozaffarian in 2004 (1)  found no relation between saturated fat intake and heart disease in postmenopausal women. Similarly, a meta-analysis published in 2010 by Siri-Tarino found that the intake of saturated fat was not associated with an increased risk of heard CHD, stroke, or CVD.(2)

Jonny Bowden and Stephen Sinatra in The Great Cholesterol Myth (2012) pointed out the problems with the Diet-Heart Hypothesis first p8ut forth by Ancel Keys back in the 1950s, who claimed to have found a clear link between dietary fat intake and heart disease after examining epidemiological data from various countries around the world. Looking at the chart below, it’s hard to see how you could draw a straight line connecting the dots:

Inline image
http://rawfoodsos.files.wordpress.com/2011/12/yerushalmy_hilleboe_22_countries.jpg

Nina Teicholz in The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet published in 2014 made this case in even more exhausting detail that saturated fat intake was not the cause of heart disease.  The problem she argued is the carbohydrate and trans fat intake.  Teicholz and other practitioners who promote the Paleo or Primal nutrition approaches often argue that saturated fats do not contribute to cardiovascular disease and it is fine to eat plenty of eggs, butter, cheese, red meat, bacon, coconut oil, etc., though it is often recommended that we choose meat that has been grass fed and not farmed and butter that is from grass fed cows.  They recommend avoiding commercial seed oils (vegetable oils) other than olive oil.

Is this position correct?  Do we simply tell our patients to consume as much saturated fat and cholesterol as they like and not worry about it, even those with elevated LDL or coronary artery disease?  Recently, several papers have been published that review the evidence linking dietary cholesterol and saturated fat with cardiovascular disease risk.  Dr. Mozaffarian concludes that a review of the evidence demonstrates that consuming polyunsaturated fatty acids (vegetable oils) in place of saturated fats significantly reduces coronary heart disease. (paper attached)  The review by Berger et al. on dietary cholesterol concludes that intervention studies did show a relationship between dietary cholesterol and increased total cholesterol, LDL, and HDL levels, but only when high levels of dietary cholesterol were used (500-1400 mg/day).  Dr. Eckel in his accompanying editorial suggests “when ordering an omelet, why not order an egg white omelet with plenty of vegetables, lean meat, and spices, rather than one with 600 mg cholesterol?”

Please look at the attached papers before the next discussion group on September 29

References:
1. Mozaffarian D, et al. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal wome. Am J Clin Nutr 2004; 80: 1175-1184
2. Siri-Taurino PW, Sun Qi, Hu FB, et al. Meta-anlysis of propective cohort studies evaluating the association of saturated fat with cdardiovascular disease. Am J Clin Nutr 2010; 91:535-46.