Fat Phobia - A fabricated fear

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In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted

- CLAUDE BERNARD

We all know about cholesterol. If you google it, you will learn how LDL is bad and HDL is good. It's feared all around the globe, and if you know me, you know I eat a lot of saturated fat and for good reasons. This post is about the fear that follows cholesterol, and how it was concluded to be a cause of heart disease. Let's start from the beginning -

History:

American president Dwight D. Eisenhower got is first heart attack at the age of 64. It was in 1955. His last cholesterol numbers before the attack was 165 (considered a very safe number). His personal physician started him on a low fat diet, barely ate red meat, eggs, cheese or butter since then. This incident made people and the medical authorities to focus on the increasing incidents of heart disease. There was a study/survey done across the country which showed that Americans had increased their red mead and fat consumption after since early 1930s. Also, a Chicago physician names James Herrick had published a paper on diagnosis in 1912, which got more recognition after his work could be confirm using electrocardiogram (ECG Machine) during 1920. His work acted as a guide to diagnose heart disease. Considering that both these studies got fame during 1920s, it was concluded that -

1. Red meat consumption had increased in America

2. More people were being diagnosed with heart disease

This increase in heart disease with increase in red meat indicated that maybe read meat and fat consumption were the cause of heart disease. This was kind of confirmed by a study published by Ancel Keys.

Ancel keys and Seven Country Study:

The entire 'fat causes heart disease' theory was first propagated by an American physiologist Ancel Keys. He did one of the most well known studies named the 'Seven Countries Study' which showed that as people (of a certain location/country) ate more and more saturated fat, there was a higher chance of them suffering a heart attack. His study began in 1956 and lasted until 1978. The study collected data of the foods people ate in their regular diet and took record of how common heart disease is in the same population. The researchers followed up every 5 years to update their data. The results of the study which got published had data of people from 7 countries which showed that as calories from fat increased, blood cholesterol increased and thus, the rate of heart disease, and deaths because of heart disease also increased.

After this, the American Heart Association and USDA came up with dietary guidelines asking people to eat less red meat, cheese and butter and more grains, fruits and vegetables in 1980. And people took this advice since by then, everyone feared fat and cholesterol.

Fast forward 50 years, the majority of the world follows the advice of low fat, healthy whole grain diet for preventing heart disease, however, the numbers actually went up this time. And they went up across the world, not just in America. So when researchers realized this, they went back and reviewed the data and realized that something was wrong with numbers.

The numbers' game:

So first, heart disease numbers went up as meat and fat consumption went up (1930s), but when everyone started following the low fat diet advice, numbers continued to go up (post 1960s, more prominent after 1970s). This raised many questions on the advice, including the famous Seven Countries Study.

Turns out, that Ancel Keys did not find any clear relation between blood cholesterol and heart disease. In fact, Ancel keys and his research team collected data from 22 countries, not just 7. They decided to hide the data of remaining 15 countries just so they can create a false graph which showed high blood cholesterol lead to more heart attacks. Upon considering the data for all 22 countries, there is no clear relation between blood (serum) cholesterol and heart disease. And everyone believed this lie. The one's who revolted couldn't stand against the political and monetary powers supporting Ancel Keys. It is now considered one of the biggest medical blunders. Here is the same graph as above but with all 22 countries displayed and you cannot draw a single line showing nay relationship.

Ancel Keys never found any relation between blood cholesterol and heart disease. But, even though the study was flawed, there were still rise in heart disease numbers right? Not really. See below -

Meat consumption was increased during 1930s: Yes it was increased when compared to the previous 2 decades. That's because, the numbers had dropped, before they went back up to normal levels. This temporary drop made it look like they went up. Here's how -

1. The first world war broke in 1914 and the government urged people to consume more grains and vegetables so meat could be supplied to soldiers. This caused the meat consumption to be low temporarily.

2. Moreover, the survey calculated meat consumption based on how much meat was bought from markets which had reduced. However, people depended on their own farms to raise animals for food instead of buying them from the market.

These 2 reasons made it look like Americans were consuming less meat prior to 1930 when they were actually having the same amount. What changed after 1930 was that people started relying on shops to purchase food which made it look like the numbers went up. Red meat consumption never went up, it was stable all throughout. Instead it had reduced when compared to the previous century when heart disease was very very low.

Heart disease rates increased: This too, was another illusion. There was an increase in number of patients suffering from heart disease because -

1. Physician James Herrick published his paper after using electrocardiogram for diagnosis and more people started diagnosing for heart disease. Doctors were now more aware of diagnosing heart disease which made the numbers go up

2. Deaths due to infectious diseases came down with better knowledge of the diseases and treatments. Average life expectancy went from 48 years to 67 years and there was a higher chance of people succumbing to degenerative diseases like heart disease.

3. The International Classification of Diseases (ICD) allowed the death certificates of the deceased to have the cause of death as 'Atherosclerotic heart disease'. Later, 'Ischemic Heart Disease' got added as a cause of death and the proportion deaths because of either of only these two went up from 22% to 90% over 2 decades which got portrayed as a rise in heart disease.

Conclusion:

Numbers by themselves don't lie. But statistics, and the perception of statistics can cause a lot of confusion. Meat consumption appeared to increase from previous century where it has actually reduced overall. The diagnosis of heart disease increased due to better awareness of disease and technology helped with more people getting diagnosed. It's like 0 was found and now everyone could count after 9. This entire unnoticed goof-up has led to decades of ill health because of faulty advice. And then heart disease actually increased around the world. There has been NO proof yet which shows that the perceived culprits which are Cholesterol and red meat, cause heart disease. In fact there are studies which imply that reducing cholesterol is in fact detrimental to health, especially as you get older.

The fear of cholesterol was cultivated across the world for personal gains (grants for more research, money, profits). And it may now take decades to undo the damage. Lack of cholesterol causes everything from brain damage, inflammation, drop in immunity, skin and hair health, etc.

As these goof ups became well known, the 2015 dietary guidelines removed the limit on how much cholesterol should be consumed. They did not support their stand clearly, but the limit on cholesterol consumption was gone. The bias and fear created 70 years ago has now deeply rooted in the minds of not just regular people, but also the experts. And it's now time to change.

To learn more about how cholesterol is in fact good for your health, reach out to me for a seminar. Till then -

Eat Good, Stay Strong, Live Free

Cheers,

Sushil Dhokne