New thinking on heart disease: don’t blame the fats
October 30, 2013 | By:

Are cardiologists stuck in the 20th century? In a post adapted from his blog, our medical editor Jerome Burne asks if a low-fat diet could do you more harm than good

Heart disease and saturated fats. Cheese.

Cheese lovers rejoice! A cardiologist says it’s OK after all (maybe)

At first sight geology and nutrition have little in common, but a major shift in thinking about the surface of earth is a handy way of highlighting the size of the latest shift in ideas about how to cut the risk of heart disease with diet.

Back in the 1920s, a meteorologist called Alfred Wegener came up with the theory that the continents weren’t attached to the surface of the globe but drifted around (very slowly).

Geologists dismissed it as fantasy. But evidence for it built up, and by the 1960s a modified version of Wegener’s idea, by then called ‘plate tectonics’, became generally accepted.

My only (slightly exaggerated) claim is that conventional nutritionists are currently facing a comparable paradigm shift in their long-running assumption that the high carb/low fat diet should be the basis of their ‘healthy’ eating plate.

That paradigm is now being turned on its head. There is mounting evidence that a high fat/low carb diet not only makes more physiological sense but performs better clinically. It’s time that the ‘healthy’ plate was replaced by what could be called the paleo plate.

I recently wrote on my blog about a new strand of evidence for the shift; how eating 5,000 calories of mainly carbs every day for three weeks put on much more weight than 5,000 calories of mostly fat. To follow that up, I have now interviewed the latest critic of the low-fat plate, cardiologist Dr Aseem Malhotra of Croydon University Hospital in London.

Dr Malhotra has already written about growing evidence of the need for a change in several newspapers and his latest article in the British Medical Journal (BMJ) states, unequivocally: “Recent [studies] have not suggested any significant association between saturated fat intake and cardiovascular risk. Instead, saturated fat has been found to be protective.”

As an indicator of how long this debate has been running – and how the establishment has consistently ignored evidence against the low-fat view – Malhotra quotes a study published in the Lancet in 1956. It compared groups of people eating diets of 90 per cent carbohydrate, 90 per cent protein and 90 per cent fat. The greatest weight loss was in the group eating the fat.

Saturated fats: why the U-turn?

So I was intrigued to hear exactly why this mainstream cardiologist – who not so long ago was working at top heart transplant hospital Harefield and following standard procedures such as stenting and prescribing drugs – had made such a dramatic U-turn.

The trigger, it turned out, was something that is regularly recommended but rarely followed: listening to patients. “I was with one of my patients, who had just come round from an operation, when the lunch trolley came by. He said: ‘What I don’t understand, doc, is that the hospital has just spent a fortune saving my life but now you are feeding me crap food that is likely to put me back in here soon’.

“My first thought was that he was absolutely right. It didn’t make sense.

“The second was that it also didn’t make sense that, even though we cardiologists were really good at fixing up people, we paid very little attention to what they needed to cut their risk of falling ill in the first place.

“In fact, I knew that many cardiologists actively ignored prevention because of the damaging effect it might have on their income stream from private practice.”

Dr Malhotra then did something else unusual: he acted on these musings and began reading up on diet and heart attack prevention. Fairly soon he began to question the conventional low-fat view.

As a result, he changed his own diet in a low carb direction and increased his visits to the gym. The result was another event that prompted even more rethinking.

“I’d always had one of those sports drinks after a workout. It sounds silly now, but I believed in all that promotion about replacing energy and rehydrating. That all changed when a BMJ/Panorama joint investigation into [sugary] sports drinks demonstrated just how poor the evidence of any benefit was.

“I was furious that I’d fallen for the marketing hype. I figured I’d spent about £10,000 over ten years on a con.”

The hype over statins 

Exactly why added sugar was such a bad idea became clear when he read Dr Robert Lustig’s book, Fat Chance: The Bitter Truth About Sugar. This describes how it increases your appetite as well making your body more likely to store fat.

Meanwhile, the benefits he had felt from changing his diet and increasing his exercise time led to an increased focus on trying to persuade his patients to do the same, rather than relying on drugs, especially statins.

“I had been trained to regard statins as really valuable and virtually side effect-free weapons in the war against heart disease. But my patients kept telling me how dreadful they made them feel. That, combined with my own literature searches, convinced me that the sort of marketing hype that had driven sales of sports drinks had contributed more to use [of statins] than evidence of efficacy.”

Dr Malhotra ends his BMJ article with a call for a paradigm shift: “Doctors need to embrace prevention as well as treatment. The greatest improvements in morbidity and mortality have been due not to personal responsibility but rather to public health.”

It is an approach that chimes perfectly with a new blog I have helped to set up called HealthInsight, focusing on the need for sensible solutions to our ‘healthy’ eating crisis. You can look there at another article I’ve written, setting out why a low-carb diet could help with treating cancer.