Eat well

It's perfectly normal in this sort of analysis to use risk ratios . In the full paper, I suspect that Hooper and all will have followed their previous pattern and included http://handbook.cochrane.org/chapte...f_relative_effect_the_risk_ratio_and_odds.htm
When formulating guidelines the advice has to be at a population level and the sort of reduction in CVD events suggested is meaningful. You are right that overall mortality risk was not reduced at the level of death from all causes. In the relatively short time the controlled trials take place over, this is totally unsurprising.
CVD events are less likely to kill people than in the past because we are better at treating it. They are not benign on quality of life. They also lead to very expensive interventions
. (to put it on a personal level, the NHS must have paid many, many thousands to replace my father's aortic valve, put in stents and deal with several heart attacks, alter the rhythm of his heart, intervene when he's had embolisms and provide an ongoing cocktail of medications. I have seen wards full of men having undergone open heart surgery ,many of them very much younger than he)
You might also like to read the editorial by Rahul Bahl replying to Harcombe et al .This puts the results of meta analyses like this one in context. http://openheart.bmj.com/content/2/1/e000229.full#ref-13

I wish I could follow those guidelines, I mostly did and ended up a slim pre diabetic, I love pulses but sadly when I tested food regularly at the beginning pulses sent my blood sugar higher than other carbs. I really miss lentil soup, chick pea curry, etc.

phoenix said:

(to put it on a personal level, the NHS must have paid many, many thousands to replace my father's aortic valve, put in stents and deal with several heart attacks, alter the rhythm of his heart, intervene when he's had embolisms and provide an ongoing cocktail of medications. I have seen wards full of men having undergone open heart surgery ,many of them very much younger than he)
You might also like to read the editorial by Rahul Bahl replying to Harcombe et al .This puts the results of meta analyses like this one in context. http://openheart.bmj.com/content/2/1/e000229.full#ref-13

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What worries me is that we're in danger of applying a one rule fits all.
I know three men who've had quadruple bypasses quite young (mid 50s, I hope that's quite young LOL).
One was a very fit Karate black belt, didn't drink, didn't smoke, tended to avoid red meat preferring fish and chicken, he was the first person I knew who used olive oil in cooking, generally looked after himself. So a big shock when I was told.
The next was an Indian friend who didn't smoke, drank occasionally and ate mainly Indian food but didn't exercise, I was still surprised because he was also only mid 50s.
The third one drank, smoked, ate all the wrong things, so maybe not such a surprise.
Then there's me, although I've followed the low fat mantra for as long as I can remember and have watched calories for far too long as well, I smoked for 10 years, drank a fair bit when I was single and still struggling to lose weight (long complicated story) and I'm pleased to say that my heart and pipework are in good order, having had several ECGs, treadmill ECGs and a heart echo cardiogram (than you NHS).
I spent a long time looking into statins and the more I read, the more confused I was, my decision to stop taking statins was based on my personal reaction to the things, strengthened by my low total cholesterol achieved by cutting carbs and more recently being told that my plumbing looks OK.
In some ways I'm lucky because after so many years of low fat, I can't tolerate much fat at all.
PS I did read your link and I was right, I just got more confused.

No guidelines really say go very low fat, 35% isn't really low fat, the Med diet as in Crete wasn't low fat : it was low in sat fat .
Cochrane doesn't say that cutting total fat has any benefit at all. It does suggest that replacing part of a populations intake of saturated fat with polyunsaturated fat reduces the numbers of cases of heart disease. (it's a shame that there are still insufficient trials replacing sat fat with monounsaturated fat for them to report on that) Diet is also only one factor; those others that we all know about (smoking, exercise, weight, stress, genetics) all play big roles. It's also true that a lot of saturated fat in many diets comes as an ingredient in highly processed foods .( In the past mostly using tropical oils, this was replaced by hydrogenated fats, now its back to cheap palm oil)
http://www.todaysdietitian.com/newarchives/070114p20.shtml
Big reviews can't say is what any level of fat will do for you, as an individual . You've only got to look at individual results in smaller studies to realise that there are people who absolutely buck the trend for anything.
We all know of the person who eats, drinks, smokes and makes merry and lives a long happy life and the person who does everything 'right' and drops dead whilst jogging.
What this review also can't address is the effects on CVD or any other long term effect of eating a very low fat diet ,as in the 10-20% advocated by some or the 70% plus fat diets advocated at the other extreme.
I'll stick in the middle; and being in the middle, I enjoy eating duck, available in all it's parts here, and fortunately quite high in monounsaturated fat. I'll eat local cheeses in French size portions(30g) but am less likely to eat some of the local sausage and pâté.

phoenix said:

It's perfectly normal in this sort of analysis to use risk ratios . .....

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It may be normal, but not very meaningful. The risk factor "Total cholesterol", for example, will soon be taken off the list of "nutrients of concern" in the USA.

phoenix said:

.... You are right that overall mortality risk was not reduced at the level of death from all causes. In the relatively short time the controlled trials take place over, this is totally unsurprising.

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Indeed it is unsurprising, seeing as they left out people who were acutely ill!

They showed that replacing saturated fat with carbohydrate was not beneficial. Replacing saturated fat with polyunsaturated fat reduced risk of heart deaths a little , but increased risk of death from other causes to an equal degree.

phoenix said:

CVD events ... are not benign on quality of life. They also lead to very expensive interventions

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Neither are alternate diseases we might die from benign, such as cancer.

It may be normal, but not very meaningful. The risk factor.... "Total cholesterol", for example, will soon be taken off the list of "nutrients of concern" in the USA

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Risk ratios are not the same thing at all. Dietary cholesterol is an Aunt Sally. In the US there was a limit placed on consumption; not in the UK and indeed most people in the UK don't have a high intake . see http://heartuk.org.uk/cholesterol-and-diet/low-cholesterol-diets-and-foods/dietary-cholesterol
Indeed it is meta-analyses such as this one that are instrumental in the proposed changes the US guidelines. That is exactly how evidenced based medicine is supposed to work http://ajcn.nutrition.org/content/early/2015/06/24/ajcn.114.100305.abstract
(once again findings are expressed in the form of risk ratios)
The Cochrane findings did say
"that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats."
Cancer etc:
"There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI."

Pinkorchid said:

8. Eat more beans
Beans, lentils and pulses are low in fat, high in fibre, cheap to buy and packed with nutrients. They don’t have a big impact on blood glucose and may help to control blood fats such as cholesterol. Try kidney beans, chickpeas, green lentils, and even baked beans, hot in soups and casseroles, cold in salads, in baked falafel, bean burgers and low-fat hummus and dhals.

9. What about sugar?
Even with diabetes, you can include some sugar in foods and baking. The trick is not to overdo it, by keeping sugary foods and drinks for an occasional treat, and finding alternatives where you can. Try using artificial sweeteners when sweetening food and drinks at home.

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Noooo Baked beans sent my BG horrendously high, took till the next day to get them down, and that was after half a can of the reduced sugar ones!

It doesn't have to be baked beans in a tin with a rich tomato sauce full of sugar @rowan. You can soak dried mixed beans or buy them in tins in plain water and use them in salads, stews, soups and casseroles. They come under the heading of resistant starches and are digested differently.
(RS) is starch and starch degradation products that escape from digestion in the small intestine of healthy individuals.
Resistant starch is considered the third type of dietary fibre as it can deliver some of the benefits of insoluble fibre and some of the benefits of soluble fibre

http://authoritynutrition.com/resistant-starch-101/
How Does it Work? What is The Mechanism?
The main reason why resistant starch works, is that it functions like soluble, fermentable fibre.....

catherinecherub said:

It doesn't have to be baked beans in a tin with a rich tomato sauce full of sugar @rowan. You can soak dried mixed beans or buy them in tins in plain water and use them in salads, stews, soups and casseroles. They come under the heading of resistant starches and are digested differently.
(RS) is starch and starch degradation products that escape from digestion in the small intestine of healthy individuals.
Resistant starch is considered the third type of dietary fibre as it can deliver some of the benefits of insoluble fibre and some of the benefits of soluble fibre

http://authoritynutrition.com/resistant-starch-101/
How Does it Work? What is The Mechanism?
The main reason why resistant starch works, is that it functions like soluble, fermentable fibre.....

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Yes I know there are all sorts, but I was talking about the baked beans that most people recognise. I drained the tomatoe sauce from them before eating too.
Lentils and chickpeas I can eat with no problems.