Wow. This is mindblowing.
Have you heard about the French Paradox? French people traditionally eat a lot of saturated fat, like butter – yet they generally have less heart disease than other populations. A lot of brainpower has been wasted to explain this – do perhaps the red wine protect them?
It’s not a paradox.
Of course, modern science quite clearly shows no connection between saturated fat and heart disease. That’s no secret anymore. But now it gets even more interesting:
I was just shown the diagram above, recently published in the journal Nutrition. It’s based on WHO and FAO statistics over the average intake of saturated fat in 41 European countries in 1998 (the latest available data), and the age-adjusted risk of dying from heart disease. I added some explanations.
More saturated fat, less heart disease
It’s a stunner. The French paradox is actually a French-Swiss-Icelandic-Swedish-German-Austrian-etc.-paradox!
- France eats the most saturated fat and has the lowest rate of heart disease deaths in all of Europe.
- Switzerland eats second-most saturated fat and has the second-lowest mortality.
- The countries eating more saturated fat have less heart disease, period.
Less saturated fat, more heart disease
And the countries eating less saturated fat? Like Georgia, Moldavia, Azerbaijan etc.? Well, they seem to have the highest mortality from heart disease in Europe.
It’s a Pan-European paradox now.
No need to hold the butter?
What does it mean?
Correlations between populations, like these, are known as ecological data. It doesn’t really prove anything. In other words, the diagram above does not prove that saturated fat protects you from heart disease. There are obviously many other differences between these populations, not just the intake of saturated fat.
But a diagram like this can more or less disprove a theory. It’s hard to imagine how saturated fat could be a major cause of heart disease, when European populations stuffing themselves with it are so much healthier, without exception.
Can this possibly be a weird coincidence? Can saturated fat still possibly be bad? What do you say?
PS
When I recently interviewed professor Loren Cordain about our hunter-gatherer ancestors, his guess was that they on average got about 15 percent of their calories from saturated fat.
If that’s true it means that our genes should be well adapted to eating about 15 percent saturated fat. That’s more than twice as much as the maximum in the obsolete fat-phobic advice from the USDA and others. But about as much as the healthiest populations in Europe today. Coincidence?
More: The Paleo Diet Explained
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143 Comments
If this, however, is about the existence of heart disease in general in these populations, it does indeed show that there is no direct link between higher consumption of saturated fat and heart disease. I think it is important to mention as well that somewhat higher amounts of saturated fat is ok combined with low/very low carb intake. If one is eating 200+ gr carbs on a daily basis I don't think the saturated fats will be beneficial for them.
http://en.wikipedia.org/wiki/File:GDP_PPP_Per_Capita_IMF_2008.svg
No, it can't, Andreas.
Like I originally said in my blog post (http://scienceandnutrition.wordpress.com/2012/04/15/latest-ecological-data-inverse-sfa-chd/), this data is pretty much worthless alone. To make a serious case against the prevailing saturated fat-heart disease theory you need multidisciplinary evidence, with the greatest credence given to experimental studies.
I disagree. A correlation this strong is hardly "worthless".
Could sat fat still be a teeny weeny bit bad? Sure, ok, that might still be possible. But a main cause of heart disease? Sorry, no, that seems to be exceedingly improbable.
Just sayin'.
Just sayin'.
Interesting to see them at the top of the graph. Coincidence?
That being said, there *are* hard sciences that do rely purely on observation, astrophysics being a prime example. It would be nice to be able to do double blind studies with black holes but it isn't really feasible. So there is something to be said for epidemiological studies. Of course with people it is a lot more realistic to do double blind studies with SFAs and the great thing about those studies is that they eliminate a lot of the confounding variables that the epidemiological studies can't.
But do anyone here know exactly what they eat?
I agree with you altough the tendence is pretty stong to say the least.
It would be very interresting instead of CHD related deaths to see CHD alone in correlation to sat fat consumption.... that would be very interresting I think !
I think it would be quicker if we used pigs with human type gut flora.
We would have much better result than from rat/mouse models.
It should be possible to raise germ free pigs and give them a human faecal transplant or give newborn piglets antibiotics followed by the human faecal transplant.
If you have nothing better to do this afternoon you could plot the data from exactly the same study used for the saturated fat graph.
This link will download a PDF to your computer with the data for smoking for the same countries.
European cardiovascular disease statistics 2008 edition
You've probably got a spreadsheet program on your PC that will turn those numbers into a graph.
It would be interesting to see if you are right or if there is some truth in that idea.
I disagree. A correlation this strong is hardly "worthless."
Andreas, I'm not sure why you disagree. What I'm saying is not contentious -- it's basic epidemiology. I explained in my blog post that the correlation is just a non-directional statistical relationship between two independent variables. When I say 'worthless', I mean purely in the scientific sense. And by itself, yes, that's all it is, worthless.
Ecological studies are the weakest of all observational evidence, therefore the interpretation of this data must be extremely nuanced. It may be "stunning" and "mindblowing" insofar as to provoke thought, but I really think some of your statements are sensationalistic and in the first instance when I quoted you, even misleading.
But do I ultimately agree with your overarching point that saturated fat does not cause heart disease? Yes.
A commonly used example is: Sleeping with one's shoes on strongly correlates with waking up with a headache.Therefore, sleeping with one's shoes on causes headache. Another example is: Since the 1950s, both the atmospheric CO2 level and obesity levels have increased sharply. Hence, atmospheric CO2 causes obesity.
We have seen a similar correlation, from epidemiological studies, between plasma cholesterol and the risk of cardiovascular death. However, I know that many readers of this blog do not believe that cholesterol causes cardiovascular disease.
Considering the above graph, there are so many other confounding factors, such as smoking, socioeconomic status, level of healthcare etc. This is where multivariate analysis comes in.
However, please don´t misunderstand me. I´m not saying that saturated fat is bad/good or anything between. I´m just commenting on the statistical information provided.
Hence, this graph proves absolutely nothing and shouldn’t ever be used by itself to prove anything.
Dr Eenfeldt, like most doctors, doesn't seem to have a firm grasp on what actual science is. He may be on the right team for the most part, but he's an accidental tourist. One has to be critical of *all* the data, not just the data that doesn't fit your paradigm. Otherwise you are no better than the vegans or all the other dogmatists.
I think you are forgetting Andreas is not presenting this information on it's own.
I'm sure most of us have read the previous post Saturated Fat: the Advice and the Science and the comments following in which I provided links to the earlier work Robert Hoenselaar has done.
Diet Doc has assumed we've all read and understood the previous paper on the same topic by the provider of the original graph.
I think it would be best if you went back on read the whole paper
Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice"
that Diet Doc kindly provided links to in a very recent post.
No, I don´t think I forgot. But, possibly, you may be misinterpreting my comment.
I have read the 2012 paper by Hoenselaar and his "letter to the editor" where he provides the diagram. I have been following your discussion from the beginning. I do respect your knowledge and I am not trying to challenge your concepts.
Here is what Andreas wrote: "But a diagram like this can more or less disprove a theory. It’s hard to imagine how saturated fat could be a major cause of heart disease, when European populations stuffing themselves with it are so much healthier, without exception. Can this possibly be a weird coincidence? Can saturated fat still possibly be bad? What do you say?
So, this is why I commented. I don´t think you can draw such a conclusion from the diagram. That would be improper use of statistics. That´s the only thing I am saying. The boundaries between our opinion and science have be very clear.
There's not a single lipitodologist in the world who would take these new meta-analysis seriously. They are all from very homogenously eating high risk Western cohorts, where practically everyone eats an athrogenic diet. One cannot establish a link between, let say, lugn cancer and smoking in a cohort where 95 people smokes 3 packs per day and 5 person two packs a day, eventhough lung cancer was the most common cause for mortality in this hypthetical cohort. We need always variability in the critical variables. Something we don't see in cohorts where the most common way to die is sudden cardiadic death. Harvards epidemiologist Frank Hu, the co-author of Siri-Tarini meta-analysis knows this, and this is what he says in february 2012:
“Why is red meat harmful? “Saturated fat, which can lead to cardiovascular disease, is really just the beginning of the story,” explains Hu”
http://harvardmagazine.com/2012/01/a-diabetes-link-to-meat
Moreover, I recommend Jenkins review article for everyone, (I repeat there's no one the field of science who would take these meta-analysis seriously, the biological mechanism of how saturated fat causes heart-disease is very well known and well understood)
Dietary cholesterol increases the susceptibility of LDL-C to oxidation, vascular inflammation, oxidative stress, and postprandial hyperlipemia and potentiates the harmful effects of saturated fat, impairs endothelial function, and increases cardiovascular events.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989358/
Jeremiah Stamler showed 12 methodological flaws in Siri-Tarinos meta-analysis, among other things. I think the cholesterol-confusionist are essentially on par with creationists, it's all about religion.
“…To neglect this fact in a review about humans is to imply that the Darwinian foundation of biomedical research is invalid and/or that there is a body of substantial contrary evidence in humans. Neither is the case. Dietary cholesterol (as well as SFA) adversely influences human serum lipid concentrations, per cited equations”
Jeremiah Stamler, http://www.ajcn.org/content/91/3/497.full
I love these studies where the correct co-founders are corrected.
Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity.
“These results demonstrate a continuous, graded relationship of serum cholesterol level to long-term risk of CHD, CVD, and all-cause mortality, substantial absolute risk and absolute excess risk of CHD and CVD death for younger men with elevated serum cholesterol levels, and longer estimated life expectancy for younger men with favorable serum cholesterol levels”.
http://www.ncbi.nlm.nih.gov/pubmed/10891962
“Why is red meat harmful? “Saturated fat, which can lead to cardiovascular disease, is really just the beginning of the story,” explains Hu”
The paper you refer to was debunked by most bloggers with half a brain.
It's studies like this the team at Harvard are churning out at great speed but no regard to quality, accuracy, let alone common sense that are bringing nutritional research into such disrepute.
Here are a couple of examples of replies, there are many more in the same vein.
Red meat & mortality & the usual bad science
Denise Minger's comment on same paper
Thank you for the fresh wind.
I do prefer a good debate on key issues rather than the constant Hallelujah choir.
You might find help in staying away from sugar here: gapsdiet.com/uploads/FAQS_Listing.pdf.
It's written by Dr. Natasha Campbell-McBride. Her advice is to consume butter with a little raw honey to take cravings away. I've found this works and it lets a person concentrate on eating the healthy stuff. Hang in!
I am sure there's not a single study on the face of this planet which would not have been already "debunked" by the bloggers. The most notorious example is the Ancel Keys story which is being portrayed in every low-carb book and which is factually 100% flawed in every low-carb book.
Anyways,I am not sure what Frank HU had particularly in his mind, but I am thinking of something along these:
How eating red meat can spur cancer progression
“Researchers at the University of California, San Diego School of Medicine, led by Ajit Varki, M.D., have shown a new mechanism for how human consumption of red meat and milk products could contribute to the increased risk of cancerous tumors. Their findings, which suggest that inflammation resulting from a molecule introduced through consumption of these foods could promote tumor growth, are published online this week in advance of print publication in the Proceedings of the National Academy of Sciences (PNAS)”.
http://www.eurekalert.org/pub_releases/2008-11/uoc–her111308.php
A tightly controlled metabolic ward study with human participants found NOC arising from heme iron in meat forms DNA adducts in the colon, a risk factor for cancer.
http://cancerres.aacrjournals.org/content/66/3/1859.full.pdf
Numerous tightly controlled metabolic ward studies with human participants have confirmed that heme iron from meat significantly increases the production of cancerous N-nitroso compounds (NOC) in the digestive tract.
http://cancerpreventionresearch.aacrjournals.org/content/4/2/177.full...
But hey, as Andreas has told us, low-carb diet doesn't have to high in red meat, we have the Eco-Atkins
@Axel,
Thanks
I strongly doubt that. But please share a reference if you have it.
RE Dietary cholesterol increases the susceptibility of LDL-C to oxidation, vascular inflammation, oxidative stress, and postprandial hyperlipemia and potentiates the harmful effects of saturated fat, impairs endothelial function, and increases cardiovascular events.
R Hoenselaar has also had a close look that the evidence about
Consumption of dietary cholesterol and cardiovascular disease.
and I think it's also worth pointing you to
Dietary cholesterol and coronary artery disease: a systematic review.
by Luc Djoussé, J Michael Gaziano
May I also recommend everyone study Peter Attia series "The Straight Dope on Cholesterol" series and bear in mind this is not part of a cholesterol-confusionist plot but a serious attempt to explain the work of eminent lipidologists to the general public. The more people who actually understand where the problem lays the fewer will be subject to mindless, pointless medications that for the majority will lead only to a lower quality of life.
Junk Science Week: Lipophobia and the bad science diet
This is, I believe, too black-or-white, too simplistic. Obviously observational correlations are very weak science (as emphasized in the post) but that does not make it completely worthless.
Well, I don't claim to be the smartest scientist on the internet. Far from it. I'm surely not completely unbiased either.
I do however aspire to improve my understanding and be as unbiased as I can. My guess is that I've read a few more books on the philosophy of science than most doctors (although that may not say too much). Also having been a professional poker player and having read dozens of books on it leaves you with some grasp of statistical probabilities – which is what the post above is really about.
"I strongly doubt that. But please share a reference if you have it"
A new meta-analysis is fresh from the print. Dealing with Western lacto-ovo-vegeterians, whether they eat healthy or not is competely different story, though. What we know for sure is that they take their calories from non-flesh sources,which can be almost anything, even saturated fat laden icecreams to cholesterol bomb eggs.
Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians: A Meta-Analysis and Systematic Review
http://www.ncbi.nlm.nih.gov/pubmed/22677895
@Ted
Dietary cholesterol is prime example of how looking blindly at high risk Western cohorts can lead us to false conclusion. Much of this confusion has been public knowledge among lipitodologists for decades, though.
A famous Swedish low-carb author covered the Tarahumara indians in his book, I don't know why since they live on a quasi-vegan diet and take 80% calories from carbs. The Tarahumaras cannot get atherosclerosis since it's impossible, unless you some kind of vascular anomalities, to get atherosclerosis when your TC cholesterol is under 150mg/dl (3,88mmol/l) consistently much of your life, as the Framinghan study and plethora of epidemiologic studies strongly indicates. Anyway, the Tarahumara provide a nice case:
"The lack of relationship between dietary cholesterol and plasma cholesterol concentration in Americans with these relatively high intakes....Under conditions of similar high dietary intake the wide range of plasma cholesterol levels in Iowa children indicates the impact of genetic-metabolic factors in setting homeostatic level of the plasma cholesterol level and not the cholesterol in the diet as it is. When populations consuming low-cholesterol, low-fat diet are looked at the same perspective, a completely different pattern emerges".
"Apparently the level dietary cholesterol intake in the Tarahumaras is below the so-called treshold level above which differences in intake do not affect plasma-cholesterol concentrations. We suggest from various metabolic-studies that this treshold may well be in between 100-300mg/day of dietary cholesterol"
and million dollar money-line comes here:
"Since in the experimental dietary cholesterol is sine qua non for the development for the experimental atherosclerosis, especially among the sub-human primates, the finding of linear association of dietary cholesterol intake and plasma cholesterol concentrations in man further undergirds the evidence relating dietary factors to hypercholesterolemia and atherosclerotic coronary heart disease".
the plasma lipids lipoproteins and diet of the tarahumara indians of mexico
http://www.ajcn.org/content/31/7/1131.full.pdf
Summa summarum, cholesterol does not have a linear, dose-dependent association in your blood-lipids only when you are at the high risk for sudden cardiadic death already, eating cholesterol rich Western diet, that is. I am afraid that Attia nor Hoenselaar do not have much to say about the issue, so instead listen guys like Jenkins who actually is aknowledged in his area of expertise.
As for the Siri Torino/Hu/Knauss paper, it's dead and been killed for months. Like the insulin hypothesis itself, there are only about 5 people left who believe it - and I'm not sure the authors of the paper are still believers either. Their defense of it appears to have ceased - unless someone can provide a newer URL?
They didnt wright perticaly about it (of unknown reasons) but its in there data!
As I wrote above, there are hard sciences that actually do exist on pure observation, such as astrophysics (although the physics part can often be tested terrestrially). What I have a problem with is when you write:
"But a diagram like this can more or less disprove a theory."
No it can't. There are simply too many confounding variables for this to prove or disprove anything. In the above comment you write:
"Obviously observational correlations are very weak science (as emphasized in the post) but that does not make it completely worthless."
What was "emphasized" in the post?
"Correlations between populations, like these, are known as ecological data. It doesn’t really prove anything. In other words, the diagram above does not prove that saturated fat protects you from heart disease. There are obviously many other differences between these populations, not just the intake of saturated fat."
Yes, I agree. But it seems like you are just trotting this out because it is immediately followed by, (sorry for the redundancy):
"But a diagram like this can more or less disprove a theory."
No it can't. First of all, the lipid hypothesis was never theory, But I think Koala makes a much stronger case than I ever could for why this correlation can't be taken seriously as science, even though I happen to think it is correct. As Feynman said, "The first principle is that you must not fool yourself, and you are the easiest person to fool."
"Research dating back to the 1950s reported an association between the consumption of saturated fatty acids (SFAs) and risk of coronary heart disease. Recent epidemiological evidence, however, challenges these findings. It is well accepted that the consumption of SFAs increases low-density lipoprotein cholesterol (LDL-C), whereas carbohydrates, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) do not. High-density lipoprotein (HDL)-C increases with SFA intake. Among individuals who are insulin resistant, a low-fat, high-carbohydrate diet typically has an adverse effect on lipid profiles (in addition to decreasing HDL-C, it also increases triglyceride and LDL particle concentrations). Consequently, a moderate fat diet in which unsaturated fatty acids replace SFAs and carbohydrates are not augmented is advised to lower LDL-C; compared with a low-fat diet, a moderate-fat diet will lower triglycerides and increase HDL-C. Now, there is some new evidence that is questioning the health benefits of even MUFAs and PUFAs. In addition, in a few recent studies investigators have also failed to demonstrate expected cardiovascular benefits of marine-derived omega-3 fatty acids. To clarify the clinical pros and cons of dietary fats, the National Lipid Association held a fatty acid symposium at the 2011 National Lipid Association Scientific Sessions. During these sessions, the science regarding the effects of different fatty acid classes on coronary heart disease risk was reviewed."
http://www.ncbi.nlm.nih.gov/pubmed/22658146
The individual can now find every bit of data in the world that backs up the theory they have chosen to believe. Not only that, but they can join up with all the others who share their conviction.
I believe it is genetic. That human desire to narrow the options down to what the tribe agrees is best. A genetic ability to see things in a certain way that excludes contradictory information.
Allows the tribe's to stay cohesive and for the DNA to be passed on intact. (in the pre-internet world)
A very powerful force as the world re-tribes into ideological subsets via the digital connection..
I wonder where the folks in Okinawa would fit on the chart?
"The present paper examines the relationship of nutritional status to further life expectancy and health status in the Japanese elderly based on 3 epidemiological studies. 1. Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese. 2. High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years. 3. Nutrient intakes were compared, based on 24-hour dietary records, between a sample from Okinawa Prefecture where life expectancies at birth and 65 were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. Intakes of Ca, Fe, vitamins A, B1, B2, C, and the proportion of energy from proteins and fats were significantly higher in the former than in the latter. Intakes of carbohydrates and NaCl were lower."
http://www.ncbi.nlm.nih.gov/pubmed/1407826
I read the paper. I think their choice of vocabulary is just silly and reflect their own cultural paradigm. Although, as they concluded caution against MUFAs should be in order. The "low-fat" diet in WHI-trial was a diet in which 3/4 of the protein came from animal sources, it contained 18grams of fiber (one big pear-fruit contains 8 grams) and was laden with dietary cholesterol. The Western "low-fat" has absolutely nothing in common with the diet pattern that was consumed by let say Okinawa-folk, whole-plant based, no oil, quasi-vegan diet, naturally low in fat and protein. Esselstyn is coming recently with a new study with hundred of patients, ultra-high carb diet, atherosclerosis reversed, the results should be equally good if not better than in his first study. The mediterranians had high intake of olive-oil, yes, however, their overall diet pattern was traditionally almost vegetarian, animals very consumed very modestly, In crete during the 1940s animal products made up max. 10% calories.
It's all very simple,you just the in way which allows you to have your serum cholesterol under 3,88mmol/l consistently. Most people cannot include much animal products to aim this targets, hunter gathers do it with the help of parasites.
“Only populations that maintain very low levels of serum cholesterol, eg. total cholesterol below 150mg/dl throughout the life do we see a near-absence of clinical CHD”.
National cholesterol education program, third expert panel
Mayby this has someting to do wy Okinawa is cald Island of pigs?
There's always fresh new material on the diet patterns of Korean centenerians, carbohydrate input was above 70% on every study subject. Currently the longest lived community is the seventh day adventists from California, who are on vegetarian diet.
http://www.nytimes.com/2011/12/19/us/loma-linda-calif-frets-about-fir...
http://en.wikipedia.org/wiki/Battle_of_Okinawa
BTW, no one said Okinawan's were vegetarians or trying to be "low fat" or "low carb".
Obviously those reaching age 100 were eating a somewhat different diet than is currently found today.
Any idea of the amount of meat they eat daily? By year 2000, their levels had risen to 100 grams per day, or about 3.5 ounces.
In 1990, they were at 90 grams or about 3 ounces.
In earlier decades it was even a bit lower, and of course it was in earlier decades when the longer living individuals were laying the ground work for their longevity.
So, can we assume you'd be in favor of limiting meat intake to about a single 3 ounce serving per day? How do those levels compare with the countries we see in the chart above?
Also, given that their main staple was sweet potatoes, is that something you'd agree is also healthy? Fairly carb laden, or do they eat a separate variety?
Frankly, I think the older folks on Okinawa would have a good laugh at both the current "low-fat" and "low-carb" crowd. They just ate the food, never preached about it.
BTW, they didn't eat their portions of meat and fish in isolation. They had a rather complexed array of foods not seen in most Western diets.
"Results. Smoking rates varied among men, from 43.3% to 65.3% among the countries examined. Results showed that smoking among women remains uncommon in Armenia, Georgia, Kyrgyzstan, and Moldova (rates of 2.4%–6.3%). In Belarus, Ukraine, Kazakhstan, and Russia, rates were higher (9.3%–15.5%). Men start smoking at significantly younger ages than women, smoke more cigarettes per day, and are more likely to be nicotine dependent."
"Conclusions. Smoking rates among men in these countries have been high for some time and remain among the highest in the world"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448609/
Like I said, true believers in anything, can and will, find data to support their theories.
BTW, I visited a ultra low fat site, (McDougall) where they were discussing the Okinawan diet and their problem in knowing that the Okinawans eat pork.
Their answer, from their expert, that while it was true, was as follows...
"Yes, Okinawans ate pork.
However it was a small part of their diet (< 1%)and not a key ingredient in their longevity"
And this from another thread by their expert....
"The total animal products including fish was less than 4% of calories which is less then 70 calories a day. That is the equivalent of around 2 oz of animal products or less a day"
Of course he fails to mention this was in circa 1950 when they were recovering from the war and totally poor.
Less than 1% from Pork.... LOL . I'm sure it was right up their with a few sprinkles of pepper...
So you see, both sides pull out the most absurd facts to bolster their claims and theories.
I tell you, its like religion.
They simply cannot accept any facts that contradict the purity of their theory.
Othewise followers will begin to question everything.
Thank God for the internet, now every theory can have an abundance of proof to rely upon.