by Lewis Chang, PhD
An editorial written by three well-known cardiologists advocates for a paradigm shift in the management of coronary artery disease (CAD). They post: dietary saturated fat is not dangerous. The real danger, they propose, lies in the inflammatory processes that contribute to plaque buildup, plaque rupture, and the formation of blood clots.1
Aseem Malhotra, MD of the Academy of Medical Royal Colleges (Stevenage, UK), Rita Redberg, MD of UCSF School of Medicine (San Francisco, CA), and Pascal Meier, MD of University Hospital Geneva (Geneva, Switzerland) and University College London (London, UK) argue that the current public health message—such as the national dietary guidelines which limit saturated fats to <10% of daily calories—focuses on the wrong target. They quote a landmark study which fails to identify an association between saturated fat consumption and heart attack, coronary heart disease, type 2 diabetes, and associated mortality.2 In studies that investigated secondary prevention of coronary heart disease (CHD), reducing fat intake did not lead to benefits.3 Also, studies of higher-fat Mediterranean diets do not demonstrate detrimental effects to coronary arteries.4
They argue the real killer to be the inflammatory processes and associated factors that contribute to chronic inflammation such as insulin resistance (which is linked to consumption of refined carbohydrates) and chronic stress. They also believe there are simple yet powerful ways to combat inflammation and improve insulin sensitivity. Regular brisk walking, eating real food (as opposed to highly processed food), and managing stress will effectively reduce inflammation and subsequently prevent and treat CAD.
Naturally, the published editorial created some debate amongst many physicians in general and some cardiologists in particular, as other experts suggested the authors of cherry-picking scientific evidence, producing inaccurate statements, or relying on obsolete methodology in their analysis. Many, including various national organizations, remained convinced that reducing consumption of saturated fat is the only way to lower risk of atherosclerosis.
When experts don’t agree, what should clinicians and patients do? Finding a way to improve outcomes may be difficult but it should be kept in mind that all parties concerned are working toward the same goal, and there are truths and valuable advice to be taken from both sides. The following lifestyle approach will improve quality of life and reduce cardiovascular mortality:
- Undertaking modest physical activity such as brisk walk can go a long way
- Eating a balanced diet while avoiding processed foods which are high in refined carbohydrates and sugars
- Managing stress
- Malhotra A et al. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med. 2017;51(15):1111-1112.
- de Souza RJ et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015;351:h3978.
- Schwingshackl L et al. Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression. BMJ Open. 2014;4(4): e004487.
- Estruch, R et al. Effect of a high-fat Mediterranean diet on body weight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(8):666-676.