Dietary Villains Part I Fat Phobia It is

Dietary Villains Part I: Fat Phobia “It is now increasingly recognized that the lowfat campaign has been based on little scientific evidence and may have caused unintended health consequences” Frank Hu and W. Willett Harvard School of Public Health “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” AJCN Vol. 20, 1(5 -19) 2001

Hormonal Obesity Theory Vinegar Fibre High Protein Obesity High TG Low HDL Increased Insulin level Fattening Carbohydrates Hypertension Cortisol Wheat Super-carbohydrate Diseases Of Civilization Diabetes Fasting Fatty Liver Insulin Resistance Diabetes Heart Disease Cancer Periodontitis Metabolic Syndrome Fructose www. kidneylifescience. ca

Cholesterol Harmful alien substance? Daily Cholesterol needs 20% dietary (animal products) www. kidneylifescience. ca 80% manufactured by body

Ancel Keys Seven countries study - 1970 conclusions 1. Cholesterol levels predicted heart disease risk 2. Amount of saturated fat in the diet predicted cholesterol levels 3. Monounsaturated fat protected against heart disease www. kidneylifescience. ca

War on Cholesterol 1984 NIH Consensus Conference “there is no doubt that low fat diets will afford significant protection against coronary heart disease” www. kidneylifescience. ca

Diet-Heart Hypothesis Lipid Hypothesis Dietary Fat Cholesterol Cardiovascular Disease 1. Increased cholesterol associated with increased CV disease 2. Dietary saturated fat increases cholesterol 3. Therefore dietary fat increases cardiovascular disease www. kidneylifescience. ca

Cholesterol and Age Decreasing mortality with higher cholesterol Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data Arch Intern Med. 1993 May 10; 153(9): 1065 -73 Kronmal RA www. kidneylifescience. ca

Cholesterol in Women Long Term Mortality Framingham Heart Study Age <55 J Womens Health. 1997 Jun; 6(3): 295 -307, Zareba et al Prognostic value of cholesterol in women of different ages www. kidneylifescience. ca

Cholesterol and women Survey of 52 087 Norwegians from 1992 -1994 Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study J Eval Clin Pract. 2012 February; 18(1): 159– 168 www. kidneylifescience. ca

WHO study of 19 European nations www. kidneylifescience. ca

Pleiotropic Effects www. kidneylifescience. ca

Dietary Fat and Cholesterol Dietary Fat www. kidneylifescience. ca Increased serum cholesterol Cardiovascular Disease

Framingham Heart Study “There is considerable range of serum cholesterol levels within the Framingham Study Group. Something explains this inter-individual variation, but it is not diet” Tavia Gordon (NIH) www. kidneylifescience. ca

Framingham Diet Study “Unfortunately, these data were never incorporated into a definitive report“ Tavia Gordon www. kidneylifescience. ca

Framingham Diet Study No discernible relationship between reported diet intake and serum cholesterol levels Oct 30, 1970 www. kidneylifescience. ca

Framingham Diet Study 1977 Cholesterol Below Intake Median Above Median Mg/ day Mmol/ L Men 704 ± 220. 9 6. 16 Women 492 ± 170. 0 6. 37 6. 26 “There is no indication of a relationship between dietary cholesterol and serum cholesterol level” www. kidneylifescience. ca

Dietary Fat and Serum Lipids No influence of fat or cholesterol on serum cholesterol Daily nutritional intake and serum lipid levels. The Tecumseh study Am J Clin Nutr. 1976 Dec; 29(12): 1384 -92 www. kidneylifescience. ca

National Cholesterol Education Program “Dietary cholesterol causes marked hypercholesterolemia in many laboratory animals, including nonhuman primates. High intakes of cholesterol in humans, however, do not cause such a marked increase in serum cholesterol” Translation – “Non human primates should DEFINITELY avoid dietary cholesterol. Humans, though, not so much. ” www. kidneylifescience. ca

Dietary Fat and Cardiovascular Disease Dietary Fat www. kidneylifescience. ca Cardiovascular Disease

Cherry Picking Data www. kidneylifescience. ca

Life Expectancy and Fat Source: rawfoodsos. com www. kidneylifescience. ca

Industrialization Increased Industrialization www. kidneylifescience. ca Increased Dietary Fat Increased Life Expectancy Increased Coronary Artery Disease

Exercise in Futility Study Journal/ Author Conclusions A Longitudinal Study of Coronary Heart Disease Circulation. 1963; 28: 20 -31 Oglesby P 1, 989 patients followed over 4 years. No relationship of dietary fat to CAD Diet and Heart: A Post Script BMJ 1977; 2(6098): 1307 -14 Morris JN No relationship of CAD to dietary fat Dietary intake and the risk of coronary heart disease in Japanese men living in Hawaii Am J. Clin. Nutr. 31: 12701279, 1978. Yano K 7, 705 men over 6 years. No relationship of CAD to dietary fat Relationship of dietary intake to subsequent coronary heart disease incidence: The Puerto Rico Heart Health Program Am. J. Clin. Nutr. 33: 18 181827, 1980 Garcia-Palmieri MR 10, 000 patients over 6 years. No relationship of CAD to dietary fat. Protective effect of legumes Diet, Serum Cholesterol, and Death from Coronary Disease: The Western Electric Study NEJM 1981: 304; 65 -70 Shekelle RB 1900 patients over 20 years. No relationship of CAD and saturated fats www. kidneylifescience. ca

Dietary Fat and Heart Disease Multivariate Adjusted for Trans fats 1. 5 1 Nurses Health Study 0. 5 0 Q 1 Q 2 Q 3 Q 4 Q 5 Risk of CAD “Total fat intake was not significantly related to the risk of coronary disease” Dietary Fat Intake and the Risk of Coronary Heart Disease in Women N Engl J Med 1997; 337: 1491 -1499 Hu FB www. kidneylifescience. ca

Dietary Cholesterol CAD 1. 4 1. 2 1 1. 16 1. 09 1. 08 1. 12 Q 3 Q 4 Q 5 1 0. 8 0. 6 0. 4 0. 2 0 Q 1 DIETARY FAT INTAKE AND THE RISK OF CORONARY HEART DISEASE IN WOMEN N Engl J Med 1997; 337: 1491 -9 Hu FB P=0. 49

Dietary Cholesterol www. kidneylifescience. ca Mc. Gee CT “Heart Frauds” Health. Wise Publications 2001

Dietary Determinants Arch Intern Med. 2009; 169(7): 659 -669 Mente A A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease www. kidneylifescience. ca

Dietary Determinants - Fats No correlation with total fat, saturated fat or PUFA A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease Arch Intern Med 2009; 169(7): 659 -669 Mente A

National Cholesterol Education Program “recent prospective studies (or meta-analysis of studies) have failed to detect a causative link between (percentage of dietary fat and obesity)” Translation - despite 40 years of trying to link dietary fat and obesity there is still no evidence www. kidneylifescience. ca

Saturated Fat Hidden Protection? www. kidneylifescience. ca

Animal vs. Vegetable Fats www. kidneylifescience. ca

Animal vs. Vegetable Fat www. kidneylifescience. ca

Animal Fat Consumption www. kidneylifescience. ca

Vegetable Oils Poly-unsaturated Fatty Acid Consumption www. kidneylifescience. ca

Saturated Fats Adjusted relative risk 1. 2 1. 1 1 Quintiles of Saturated Fat Intake 0. 9 0. 8 0. 7 Q 1 Q 2 Q 3 Q 4 Q 5 Risk of Heart Attack Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States BMJ 1996; 313: 84 Ascherio A www. kidneylifescience. ca

Dietary Fat and Stroke 45 40 10 year stroke incidence 35 30 25 Fat 20 Protein 15 Sodium 7, 895 Japanese. Hawaiian healthy men 10 5 0 Q 1 Q 2 Q 3 Q 4 Q 5 Quintiles of Nutrient Intake Dietary and Other Risk Factors for Stroke in Hawaiian Japanese Men Stroke 1985 Vol 16; 3: 390 -96 Kagan A www. kidneylifescience. ca

Dietary Fat and Stroke Lowest intake of fat Highest risk of stroke PUFA not protective P=0. 33 Highest intake of fat Lowest risk of stroke Inverse association of dietary fat with development of ischemic stroke in men JAMA. 1997 Dec 24 -31; 278(24): 2145 -50 Gillman MW www. kidneylifescience. ca

Dietary Fat and CV disease PUFA Lower Saturated fat = More progression CAD Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women Am J Clin Nutr 2004; 80: 1175– 84 Herrington et al www. kidneylifescience. ca

Dietary Fat and Heart Disease 29, 098 men and women Dietary fat intake and early mortality patterns – data from The Malmo Diet and Cancer Study J Intern Med August 2005; 258(2): 153 -65 Leosdottir M www. kidneylifescience. ca

French Paradox 216 CV Death per 100, 000 250 200 171 157 150 108 72 100 82 French American 50 0 Total Fat (g/day) Animal Fat CV Death Males age 35– 74 www. kidneylifescience. ca WHO 2000

Saturated Fat – Hidden protection www. kidneylifescience. ca British Journal of Nutrition 1 Mar 2012

Saturated Fat Phobia Saturated fat Completely irrelevant Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Krause et al AJCN 2009 www. kidneylifescience. ca Saturated fat protective for stoke!

Adjusted Odds Ratio Saturated Fat 1. 1 1. 05 1 0. 95 0. 9 0. 85 0. 8 0. 75 0. 7 0. 65 0. 6 Saturated Fat Intake Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Stroke MI Total CVD Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese Am J Clin Nutr doi: 10. 3945/ajcn. 2009. 29146, Yamagishi K Cohort study of 58, 453 Japanese www. kidneylifescience. ca

Dairy Fat and Diabetes Prospective cohort study of 3, 736 pts Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults Ann Intern Med. 2010 December 21; 153(12) Mozaffarian D www. kidneylifescience. ca

Adjusted Odds Ratio Diabetes and Inflammation 3. 1 3 2. 9 2. 8 2. 7 2. 6 2. 5 2. 4 2. 3 2. 2 CRP (mg/l) HOMA Quintile Quintile 1 2 3 4 5 Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults Ann Intern Med. 2010 December 21; 153(12) Mozaffarian D www. kidneylifescience. ca

Eggs A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women JAMA April 21, 1999 www. kidneylifescience. ca

Eggs Egg consumption and risk of coronary heart disease and stroke BMJ 7 Jan 2013 www. kidneylifescience. ca

Eggs and Diabetes Pooled Hazard Ratio Low vs. High Egg consumption 1. 6 1. 4 1. 2 1 0. 8 0. 6 0. 4 0. 2 0 1. 42 0. 96 0. 97 Overall CVD IHD 0. 93 Stroke 0. 98 0. 92 IHD Stroke Diabetes mortality Egg consumption in relation to risk of cardiovascular disease and diabetes Am J Clin Nutr July 2013, Jang Yel Shin et al www. kidneylifescience. ca

Nuts and Heart Disease Nut Consumption Adjusted Relative Risk 1. 2 1 0. 8 0. 6 0. 4 0. 2 www. kidneylifescience. ca ee k /w >5 2 - 4/ w ee th 1 - 4/ m on er ev os t n Al m k 0 86, 016 women from Nurse’s Health Study Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study BMJ 1998; 317: 1341– 5 Hu FB

Omega 3 Fats www. kidneylifescience. ca

Omega 3 supplements 18, 645 hypercholesterolemic Japanese patients Effects of eicosapentaenoic acid on major coronary events in hypercholesterolemic patients (JELIS) Lancet March 31, 2007 1090 -98 Yokoyama et al www. kidneylifescience. ca

Low Fat Diets after Heart Attack not effective Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART) Lancet. 1989 Sep 30; 2(8666): 757 -6 Burr ML www. kidneylifescience. ca

Increased Fish intake after Heart attack Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART) Lancet. 1989 Sep 30; 2(8666): 757 -6 Burr ML www. kidneylifescience. ca

Trans Fats 20 year follow up from Framingham study 1966 Margarine intake and subsequent coronary heart disease in men Epidemiology. 1997 Mar; 8(2): 144 -9 Gillman MW www. kidneylifescience. ca

Poly-unsaturated Fats Hidden Dangers www. kidneylifescience. ca

Added Fats www. kidneylifescience. ca

Butter www. kidneylifescience. ca

Poly-unsaturated Fats www. kidneylifescience. ca Source: wholehealthsource. blogspot. ca

Industrial Vegetable Oils 1. Seeds de-hulled, de-skinned and ground into meal and heated 2. Pressing - Meal fed into a screw press, under pressures up to 20, 6850 kilopascals 3 -. Solvent extraction - Hexane used to dissolve oil, which is then recovered by distilling 4. Solvent Removal – Oil is boiled by steam, and the lighter hexane floats upward 5. Refining - Heat oil to 85 C and mix sodium hydroxide. Soap forms and is removed by centrifuge. 6. Degumming - Treating them with 95 C water, steam, or water with acid. The gums (phosphatides), precipitate out, and the dregs are removed by centrifuge. 7. Bleaching - filtered through fuller's earth, activated carbon, or activated clays 8. Deodorization - steam is passed over hot oil in a vacuum at 250 C. Citric acid at. 01 percent is also added to oil after deodorization to inactivate trace metals 9. Enjoy “all-natural, healthy” vegetable oil! www. kidneylifescience. ca

Omega 6 Fats Source: wholehealthsource. blogspot. ca

Increased Deaths with PUFA Sydney Diet-Heart Study Replaced saturated fats with PUFA Use of dietary linoleic acid for secondary prevention of coronary heart disease and death BMJ 2013; 346: e 8707 doi: 10. 1136 www. kidneylifescience. ca

No Cardiac Benefits to PUFA CV Event rate Test of Effect of Lipid Lowering by Diet on Cardiovascular Risk Arterioscler Thromb Vasc Biol. 1989; 9: 129 -135 Frantz ID 39% fat diet – replaced saturated fats with PUFA www. kidneylifescience. ca

Increased Deaths with PUFA All Cause Mortality Control Treatment Test of Effect of Lipid Lowering by Diet on Cardiovascular Risk Arterioscler Thromb Vasc Biol. 1989; 9: 129 -135 Frantz I www. kidneylifescience. ca

Increased deaths with PUFA Increased deaths with Omega 6 Protection with Omega 3 Use of dietary linoleic acid for secondary prevention of coronary heart disease and death BMJ 2013; 346: e 8707 doi: 10. 1136/bmj. e 8707 (Published 5 February 2013) Ramsden CE www. kidneylifescience. ca

Homicide Each point represents 1 country and 1 year Increasing homicide rates and linoleic acid consumption among five Western countries, 1961 -2000 Lipids. 2004 Dec; 39(12): 1207 -13 Hibbeln J www. kidneylifescience. ca

Depression Increasing homicide rates and linoleic acid consumption among five Western countries, 1961 -2000 Lipids. 2004 Dec; 39(12): 1207 -13 Hibbeln J www. kidneylifescience. ca

Source: wholehealthsource. blogspot. ca

Low Fat Diets

Multiple Risk Factor Intervention Trial Quit smoking, lower BP, eat a low fat diet Dr. Jeremiah Stamler JAMA. 1982 Sep 24; 248(12): 1465 -77 www. kidneylifescience. ca

No Benefit to Low Fat Diet 40. 4/ 1000 41. 2/ 1000 Dr. Jeremiah Stamler JAMA. 1982 Sep 24; 248(12): 1465 -77 www. kidneylifescience. ca

Women’s Health Initiative Beresford, S. A. A. et al. JAMA 2006; 295: 643 -654. www. kidneylifescience. ca Copyright restrictions may apply.

No Benefits for CHD or Stroke Howard, B. V. et al. JAMA 2006; 295: 655 -666. www. kidneylifescience. ca

Invasive Breast Cancer Prentice, R. L. et al. JAMA 2006; 295: 629642. www. kidneylifescience. ca Invasive Colorectal Cancer Beresford, S. A. A. et al. JAMA 2006; 295: 643 -654.

Fats are Protective The Effect of Coingestion of Fat on the Glucose, Insulin and gastric inhibitory polypeptide responses to carbohydrate and protein Am J Clin Nutr 1983; 37: 941 -4 Collier G www. kidneylifescience. ca

Fats are Protective AUC Glucose Response 1 hr Eating fat reduces glucose response www. kidneylifescience. ca

The Lyons Diet Heart Study 75% Risk Reduction www. kidneylifescience. ca

Mediterranean Diet MI, Stroke, or CV Death Primary Prevention of Cardiovascular Disease with a Mediterranean Diet N Engl J Med 2013; 368: 1279 -90 PREDIMED study www. kidneylifescience. ca

Hormonal Obesity Theory Fibre Fat Obesity Vinegar High Protein High TG Low HDL Increased Insulin level Fattening Carbohydrates Hypertension Cortisol Wheat Super-carbohydrate Diseases Of Civilization Diabetes Fasting Fatty Liver Insulin Resistance Diabetes Heart Disease Cancer Periodontitis Metabolic Syndrome Fructose www. kidneylifescience. ca