In a new op-ed from the British Medical Journal, two leading doctors and a cardiology expert reignite the debate about the link between fat, cholesterol and coronary disease.
The authors, Drs Aseem Malhotra, Rita Redberg and Pascal Meier, argue that “the conceptual model of dietary saturated fat clogging a pipe is just plain wrong,” and dismiss the drive for low-fat, low-cholesterol foods as misguided.
In addition to undermining decades of dietary advice, their report in the BMJ redefines when heart disease begins and points to research suggesting that problems start before artery plaque is detectable, through inflammation and problems with insulin.
As such, their argument goes, the patching up of arteries with plaque, called atherosclerosis, should be considered as a complex metabolic disease and current diagnosis and prevention fail to address this.
According to further evidence put forth by the three doctors, the way heart disease risk has been traditionally assessed by measuring cholesterol based on the Framingham study is fallacious.
Framingham has led generations of doctors to believe that heart disease is solely caused by too much “bad” LDL cholesterol, but emerging research now shows that “LDL cholesterol is not associated with cardiovascular disease,” explain the authors.
The authors also used the editorial piece to get into possible prescriptive strategies, which involve modifications of Nutrition, physical activity, smoking cessation and stress reduction.
Among all of those prescriptive leanings, the authors focus largely on diet, and especially on reducing dietary factors that fuel the fire of insulin resistance, the key mechanism that also leads to type 2 diabetes, and promote too much inflammation in the body.
For Malhotra, Redberg and Meier, low-fat diets do not aid heart disease risk reductio, as “greater intake of saturated fat is associated with less progression of atherosclerosis, whereas carbohydrate intake is associated with greater progression.”
Instead, they flag up evidence of the usefulness of the Mediterranean diet, which is made of about 40 per cent fat from foods like vegetables, healthy oils, nuts and oily fish, in achieving significant reductions in heart complications and attenuating inflammation.
This is based on the recovery of long-lost raw data from the 40-year-old Minnesota coronary study which, at the time of their publication in the BMJ late last year, raised a lot of new questions about fats.
The experts also refer to studies they said suggest that replacing refined carbohydrates with healthy high fat foods leads to improvements to the overall cholesterol balance, thereby reducing heart disease risk.
The authors concluded that many lines of evidence show that heart disease risks can be effectively reduced with healthy lifestyle interventions, such as being active and eating a balanced, low-carb diet.

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