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Atherosclerotic coronary heart disease (CHD) is responsible for 1 in every 6 deaths in the U.S. and is the leading cause of death throughout the developed world for the past seventy years. As a result of these statistics, healthcare professionals have sought to reduce and control CHD by focusing on prevention. From a dietary perspective they have specifically focused on limiting the consumption of all fats, especially saturated fats, and convinced people to believe lean animal protein sources and whole grains/simple carbohydrates are a better alternative. The problem is this advice has only led to the acceleration of CHD in more and more Americans.
Excessive animal protein, whole grains (predominantly in the form of genetically modified corn, soy and wheat) and sugar consumption since the turn of the 20th century has played an enormous role in causing CHD. A recently published article in Progress in Cardiovascular Diseases asked the question on if the focus on only fat causing CHD has been misguided, especially since it has led to a huge spike in sugar, lean meat and dairy consumption during the same time in American history. Shouldn’t we be focusing on these elements playing a huge role in causing heart disease?
When we go back in history to understand when the movement towards Americans being strongly convinced about dietary fat and cholesterol being the principal promoters of heart disease, we must take into consideration the strong influence of two famous men: Dr. Paul Dudley White and Ancel Keys. These two prominent and politically influential personalities were instrumental in their direct influence on what we now have come to believe is common sense nutrition knowledge and its direct role in causing heart disease.
Beginning in the 1950's, both Dr. Paul Dudley White and Ancel Keys pushed for low-fat diets for the treatment and prevention of CHD. These two men strongly believed fat and cholesterol were the main culprits for causing fatty plaques on blood vessel walls which, in turn, causes vascular disease, also known as atherosclerosis and CHD. Unfortunately, their conclusions were only based on observational studies.
Dr. Paul Dudley White was a world-renowned cardiologist and one of the founders of the American Heart Association. He was also President Dwight D. Eisenhower’s personal cardiologist following his heart attack in 1955 during the president’s second year in the Oval Office. Because of his influential power, Dr. White was instrumental in damning foods naturally high in fat and to instead, believe that a low-fat diet is the key to avoiding heart disease. The problem was Dr. White never translated that a low-fat diet actually means avoidance of only saturated fats from animal protein, the main sources of fat the human body’s digestive system cannot process when excessively consumed.
During the same year Dr. White was heavily pushing his agenda for a low-fat diet, Ancel Keys released his famous “Diet Heart Hypothesis” in 1955. Keys suggested that plasma cholesterol is a huge culprit in causing heart disease and can be lowered by replacing saturated fats with vegetable oils. While just a hypothesis, Keys single handedly solidified saturated fat’s fate in the eyes of the American people, especially since his theory was readily accepted by Dr. White. Through their direct connections with the American Heart Association being the best advertiser of their agenda, Keys and White were extremely effective at convincing the entire medical community, the federal government and the American public that dietary cholesterol and fat consumption are bad. What they didn’t bother to understand nor explain was the main sources of “bad” LDL cholesterol and triglycerides are predominantly through animal protein consumption.
Intuitively, Dr. White and Ancel Keys’ analysis did make a lot of sense to Americans predominantly because of the simplicity factor, and so their idea quickly gained mass appeal starting in the 1960s. In the years following these two men’s recommendation for a low-fat and cholesterol diet, several other researchers attempted to negative their conclusions. One voice in particular, British physiologist John Yudkin, argued that through his observational studies, sugar intake may be more closely related to the onset and accelerated death rate caused by heart disease and possibly more aggressive than dietary fats alone. Yudkin’s work, released at the same time as Keys, unfortunately faded into the background partially because everyone who really mattered: the medical community and the food industry had already built a huge business linked to the low fat-cholesterol diet.
A series of scientifically proven reviews have since come out shedding light on the fact that Dr. White and Keys’s analyses were actually based on
misrepresentation of scientific data (Yerushalmy & Hilleboe, 1957; Mann, 1977); they were wrong in their simplicity of their conclusions. Sadly enough, because their myth has been spreading like wildfire for the past seventy years, it has become near impossible to shift people’s belief that not all fats are bad.
One of the biggest influencers of driving this low fat-cholesterol diet myth has been the food industry. The moment they jumped on board and began stripping their processed foods of fat and marketing them as “heart healthy”, it’s become impossible to change people’s mentality. This myth has also been heavily supported by millions of healthcare professionals around the world, especially at many elite institutions, including Harvard University, with a big push towards genetically-modified pesticide-loaded corn and soybean oils (with no saturated fat) as the healthiest oils to consume. They’ve also been heavily promoting a whole grain diet which is unfortunately laden with genetically engineered pesticide-heavy grains often associated with sugar and many other preservatives considered toxic in most other nations besides the United States.
Since humans are designed to eat real food derived from the Earth, not isolated food constituents in the form of fat, sugar, or carbohydrates, it’s the totality of their whole diet that actually matters. The packaging of fats, carbohydrates, vitamins, minerals, amino acids and microorganisms in the food people are now predominantly consuming are a huge driver in the negative impacts caused on the human body. It is critical to make this differentiation since most research studies use animals as their “guinea pig” and give them “rat chow”, 100% heavily concentrated and processed macronutrients which do not mimic how real food is actually digested and metabolized in the human body. More specifically, the high-saturated fat “foods” given in animal models are extremely toxic, so, of course, these studies yield results that look like all fat are bad.
The 2009 study in Progress in Cardiovascular Diseases evaluated the evidence linking saturated fats and sugars to cardiovascular disease (Jakobsen et al. in 2009) and found that dietary sugar consumption, especially in the form of refined added sugars and refined carbohydrates, is one of the biggest contributors to CHD. This finding has since been confirmed by many high-quality research studies.
We now know more than a half century later that dietary saturated fat intake alone is not the primary determinant of saturated fat accumulation in the body. In fact, the amount of saturated fat in the blood has little association with how much saturated fat is actually consumed in one’s diet; it is all about how fat and cholesterol are metabolized by the gut.
Let’s be clear. High amounts of saturated fats accumulating in the blood is not a good thing since it is directly linked to metabolic syndrome (Warensjö et al., 2005), diabetes (Patel et al., 2010), and vascular disease (Wang et al., 2003, Yamagishi, et al., 2010). The real culprit is linked to the digestive system, the liver and kidneys not being able to easily digest refined carbohydrates, sugar and animal protein.
When the body can no longer easily digest the food ingested and use the sugar and protein extracted for usable immediate energy, the extra sugar is stored in the liver as fat and the excess protein is excreted from the kidneys. The problem is because people are now eating multiple times per day and consuming portions significantly larger than their stomach can tolerate, their liver no longer needs to tap into utilizing this stored fat. Combined with the excessively higher-than-normal levels of daily stress, sleep deprivation, and sedentary lifestyles noted in most Americans today, the liver and kidneys are constantly in a state of storing sugar as fat and excreting excessively high levels of unusable toxic protein by the kidneys. Either way, the body begins to remain in a constant state of stress especially since it cannot use the food consumed for usable energy and instead, causes excessive cellular damage and death versus cellular repair and regeneration.
And so, blood sugars begin to rise to unsafe toxic levels. Toxins and other pathogens are not adequately cleared out by the detoxification pathways of the liver and kidneys and instead, build up inside the walls of blood vessels, tissues, and organs. As these cells and tissues become increasingly damaged over decades of abuse, sugar, protein, and saturated fatty acids build up within the wall and lumen of blood vessels (called fatty streaks and plaques) noticeable in vascular disease and Alzheimer’s (Forsythe et al., 2008; 2010; Volk et al., 2014). This insight is profound and fundamental to shifting how we approach heart disease and diabetes in medicine.
Replacing saturated fats, or any other component, from one's diet almost inevitably means replacing it with something else. When carbohydrates, particularly refined carbohydrates like sugar, replace saturated fats, this often leads to damaging effects on lipid profiles (i.e., HDL “good” cholesterol falls and triglycerides tend to rise).
As mentioned above, people don't eat isolated fatty acids—they eat foods that are a mix of many constituents. While consuming saturated fats from animal sources such as from processed meats can certainly increase the risk of developing CHD. On the flip side, consuming plant-based sources of saturated fat from coconut, avocado, and olive oil, for example, can decrease the risk of CHD.
Studies have shown that eating a diet rich in sugar for just two weeks will immediately cause numerous abnormalities in patients with CHD. Sugar quickly drives up abnormal findings in the lipid profile by increasing the total cholesterol, triglycerides, and LDL “bad” cholesterol. It will also accelerate cell death versus regeneration which can be seen as an elevated uric acid level (marker for gout) and platelet count on a blood panel. Sugar is extremely detrimental to overall health.
Added fructose—typically in the form of sucrose (table sugar) or high fructose corn syrup (HFCS) in processed foods and beverages—seems particularly potent in their systemic effects. Consuming high fructose foods promotes tissue resistance to leptin, a key hormone in the maintenance of normal body weight. As a direct consequence, any consumption of added fructose will undoubtedly increase the risk for liver and kidney damage and lay down the foundation for causing CHD and non-alcoholic fatty liver disease (NAFLD). NAFLD, the #1 culprit of liver disease and cirrhosis worldwide, notable in 1 in 4 Amerians, is one of the biggest drivers for CHD. This link is even higher than the association between CHD and smoking, hypertension, diabetes, male gender, high cholesterol or metabolic syndrome. The rise in NAFLD is, not surprisingly, a result of the U.S. Dietary Guidelines for Americans, which were created without much scientific merit, but a whole lot of political investment.
In the same vein, a diet high in whole grains (aka., GMO corn, soy, wheat, rice), animal protein, and refined processed sugars promotes diabetes and CHD. Studies have clearly shown such diets cause severe narrowing of the heart’s blood vessels (or what we call heart disease).
Of course, sugars found naturally in fruits and vegetables pose no increased risk for CHD. Risk is always associated with the more processed the food is, the more concern we have. Hence, if your beverage and food is in a package, it’s likely causing more harm than good.
Products with added sugars represent 75% of all packaged foods and beverages in the U.S., and most commonly contain sucrose or HFCS, which raise CHD risk even more than other sugars such as glucose. To be packaged, shelfed, and sold, food has to be treated, heated, manipulated so much so that the final product is not even recognizable to our body as food. Hence, the best advice is to simply limit/avoid processed foods completely rather. Shift towards avoiding saturated fats from animal protein sources and, instead investing in beneficial plant-based fats (such as coconut, avocado, or olive oil).
Despite a notable lack of supporting scientific evidence, the idea that saturated fats alone are detrimental to health has been the position of the U.S. Dietary Guidelines for Americans for over seventy decades. The sheer and vicious indictment of saturated fat as utterly unhealthy was completely unjustified, given the impressive evidence showing that foods naturally high in plant-based fats can form part of a healthy diet. Please note that when dietary fat was replaced with having more whole grains and simple carbohydrates as the main staple of the American diet along with lean meats (i.e., poultry), fish, egg whites and low-fat dairy products, we have to acknowledge that this shift has directly linked to the simultaneous explosion of industrial factory farming of animals, corn, soy, and wheat in the U.S. The food and pharmaceutical industries, one of the biggest influencers of the medical and research communities, have been heavily promoting their “cash” crops as “heart-healthy” for almost a century; their livelihoods depend on it. And so, even though the rate of cardiac events and most other chronic disease epidemics in the U.S. and worldwide have exploded to deadly levels in all ages since the 1960s, promoting what needs to be sold has consistently overrode what knowledge would best serve the public.
After a very thorough analysis of the evidence, it is our hope that the dietary guidelines will shift its focus away from recommendations to reduce animal protein, GMO grains, and refined sugar, and processed food and towards recommending plant-based whole foods such as fresh vegetables, ancient whole grains (i.e., amaranth, quinoa, millet, teff), legumes (i.e., lentils), and mushrooms. This is going to be an uphill battle since the government, pharmaceutical, food, and healthcare industries are not incentivized to promote what is best for the public; it is just not in their financial interest today. And so, we, as individuals, have to take it upon ourselves to make the right changes within ourselves and for families to drive the change best suited for our own needs.
Dr. Bhandari and the Advanced Health Team Are Here to Support Your Health.
Our expert team of integrative holistic functional medical practitioners work closely together to better understand the root cause of our patients’ ailment and how they are directly causing chronic diseases. By knowing exactly how to reshift the body into optimal functioning and providing each patient with personalized treatment plans based on their unique constitution and circumstances, our team is extremely effective at reversing any disease into wellness. To learn more and book an appointment, contact Advanced Health or call 1-415-506-9393.
Forsythe, C. E., Phinney, S. D., Fernandez, M. L., Quann, E. E., Wood, R. J., Bibus, D. M., ... & Volek, J. S. (2008). Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids, 43(1), 65-77.
Forsythe, C. E., Phinney, S. D., Feinman, R. D., Volk, B. M., Freidenreich, D., Quann, E., ... & Bibus, D. M. (2010). Limited effect of dietary saturated fat on plasma saturated fat in the context of a low carbohydrate diet. Lipids, 45(10), 947-962.
Jakobsen, M. U., O’Reilly, E. J., Heitmann, B. L., Pereira, M. A., Bälter, K., Fraser, G. E., ... & Pietinen, P. (2009). Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. The American journal of clinical nutrition, 89(5), 1425-1432.
James J. DiNicolantonio, Sean C. Lucan, James H. O’Keefe (2015). The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease. Progress in Cardiovascular Diseases.
King, I. B., Lemaitre, R. N., & Kestin, M. (2006). Effect of a low-fat diet on fatty acid composition in red cells, plasma phospholipids, and cholesterol esters: investigation of a biomarker of total fat intake. The American journal of clinical nutrition, 83(2), 227-236.
Mann, G. V. (1977). Diet-heart: end of an era. New England Journal of Medicine, 297(12), 644-650.
Patel, P. S., Sharp, S. J., Jansen, E., Luben, R. N., Khaw, K. T., Wareham, N. J., & Forouhi, N. G. (2010). Fatty acids measured in plasma and erythrocyte-membrane phospholipids and derived by food-frequency questionnaire and the risk of new-onset type 2 diabetes: a pilot study in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Norfolk cohort. The American journal of clinical nutrition, 92(5), 1214-1222.
Raatz, S. K., Bibus, D., Thomas, W., & Kris-Etherton, P. (2001). Total fat intake modifies plasma fatty acid composition in humans. The Journal of nutrition, 131(2), 231-234.
Wang, L, Folsom, A. R., Zheng, Z-J., Pankow, J. S., & Eckfeldt, J.H. ARIC Study Investigators (2003). Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. The American journal of clinical nutrition, 78(1), 91-98.
Volk, B. M., Kunces, L. J., Freidenreich, D. J., Kupchak, B. R., Saenz, C., Artistizabal, J. C., ... & Phinney, S. D. (2014). Effects of step-wise increases in dietary carbohydrate on circulating saturated fatty acids and palmitoleic acid in adults with metabolic syndrome. PloS one, 9(11), e113605.
Warensjö, E., Risérus, U., & Vessby, B. (2005). Fatty acid composition of serum lipids predicts the development of the metabolic syndrome in men. Diabetologia, 48(10), 1999-2005.
Yamagishi, K., Iso, H., Yatsuya, H., Tanabe, N., Date, C., Kikuchi, S., Yamamoto, A., … Tamakoshi, A. (2010). Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study. The American journal of clinical nutrition, 92(4), 759-765.
Yerushalmy, J., & Hilleboe, H. E. (1957). Fat in the diet and mortality from heart disease; a methodologic note. New York State journal of medicine, 57(14), 2343.
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