In his book "Triumphs of Experience", George Vaillant writes that "countless studies claim to show that the ratio of high density lipoproteins (HDL's) and low density lipoproteins (LDL's) is an important marker for heart disease."
"We cannot find any evidence for that."
Prior to WWII knowledge about how to keep your weight under control was well known across Europe . William Banting got that secret from a French doctor, and in England, wrote a booklet about it in 1863. His "Letter on Corpulence, Addressed to the Public", recommended eating red meat, fish and game, and all vegetables except root vegetables. To be avoided were, sugar, sweet drinks, beer, cakes, bread and milk. Banting, himself, had lost 46 pounds in one year.
The best nutritional science in Europe was led by German laboratories. The French, Germans and Italians, all understood the secret. In 1921 insulin was identified as the key hormone driving the disposition of fat in the body. German and Austrian scientific research pointed to hormones as being responsible for stockpiling fat. Even in the USA, in 1905, Dr. Nathaniel Yorke-Davis recommended Banting's low carbohydrate diet to President William Taft, who subsequently lost 70 pounds.
In Europe and the USA, people had eaten red meat, and lots of saturated fat for hundreds of years. Medical records show that people suffered from gout and migraine headaches, but heart disease and cancer were virtually unknown prior to WWI. Charles Dickens reported that in the USA, in 1861, Americans were eating twice as much beef as people in England. Even the poor and slaves could expect to eat fish or meat at every meal. It's estimated that in 1909, the poorest Americans ate 136 pounds of meat a year, and that rich Americans ate more than 200 pounds of meat a year. (Today the average American eats about 100 pounds of meat a year about 60% of that poultry.) The first medical description of a heart attack in the USA was recorded in 1912. Dr Paul Dudley White (later to become well known), as a junior doctor examined 700 male patients at the Massachusetts General Hospital (about 1919) many of them over 60 years of age. He wrote that only four reported any form of chest pain.
Indigenous cultural groups that relied on meat for the staple food in the diet, the Masai, the American Indian (Navajo) and the Inuit, all lived long lives, cancer free, without gall stones, and without heart disease. Diabetes was unknown. Tooth decay was uncommon. Numerous doctors for Europe and the USA, in independent studies, reported their amazement at those findings.
Here is a video (11min) where Dr Stephen Phinney explains how athletes have lost weight and increased their endurance for athletic performance.
After WWII there was concern about the growing number of heart attacks. President Eisenhower suffered a heart attack in 1955, and his physician Dr Paul Dudley White used the opportunity to make a recommendation to the American public. People should stop smoking, they should reduce stress, and they should reduce the saturated fat in their diet to reduce the total cholesterol in the blood stream. It turns out that White's recommendation on smoking is the only one that stands the test of time. President Eisenhower followed Dr White's instructions to the letter, he stopped smoking, he was the poster boy for a low cholesterol and low fat diet. Yet he suffered several more heart attacks, and eventually died with one in 1969.
A very energetic statistician Ancel Keys, noted that during WWII the number of heart attacks declined. Keys believed that rationing caused the decline in the incidence of heart attacks. (Which was probably right.) Keys focused on the rationing of meat as his target. (Meat, butter and sugar were rationed, as were some other foods.) Keys proposed this simple mathematical hypothesis. Dietary fat contains more calories per gram (9) than either protein (4) or carbohydrate (4), so it's logical, he thought, that dietary fat makes people fat. He further assumed that this fat accumulates in the arteries and causes heart failure. Therefore, a bad diet causes heart disease. Keys looked for statistical support for this idea. His key resource was the published national statistics for countries. (Statistics which Keys understood were not necessarily reliable. They were collected and reported in quite different ways.) But this was the best data available.
Keys thought that in the following countries; Italy, Greece, Yugoslavia, Finland, Netherlands, and Japan and the USA; that there was a clear trend line confirming his theory. Countries with high fat diets also had more heart disease. He speculated that the menu in all countries with low fat diets, would share many features in common with the Italian "Mediterranean" diet. A low fat diet was a major factor in their reduced heart disease. Dr Paul Dudley White often wrote for the public about heart disease and he described Ancel Keys as a brilliant researcher. A little later, low fat diets were also supported by highly respected physicians, Dr. Frederick Stare and Dr. Theodore Van Itallie. By the 1970's Low fat diets became mainstream in medical circles.
Keys organised short term trials in 1957-1958, to investigate the effect of various fats in the diet. The work validated the previous studies of E.H. Ahrens in 1952, that when animal fats (saturated) were replaced by vegetable oils (unsaturated) in the diet, total cholesterol in the blood decreases. With this confirmation Keys was sure that saturated fats were the problem and he recommended that people stop eating eggs, dairy products, red meat, and all visible fats. If people did this he claimed; "heart disease would become very rare."
This message was taken up by industry, and changes were made to food preparation and processing which used more vegetable oils and unsaturated fats because they were "more healthy". Because unsaturated fats were liquid a room temperature, they were hydrogenated to make them more stable. This created a new form of fat we call trans fat, which was supposed to be the "healthy" way to cook chips, or add fat to baking. Lard was replaced by Crisco. This major change became the mainstay of the commercial food industry. In 1957 Fred Kummerow published a paper suggesting that trans fats were dangerous to health. He fought a lonely battle for years to prove his point. Studies from Europe, finally proved that trans fats raised rather than lowered LDL-C (1970's). This was confirmed in the 1990's and trans fats were quietly removed from most products over the next 10 years. Industry has tried many vegetable oils, trying to claim the prize for being the healthy alternative. They've failed. Unsaturated fats are by their nature unstable, they tend to go rancid and they produce health damaging chemicals when heated. This remains an unsolved problem.
Many researchers understood that Keys was wrong. They include Dr George V. Mann, Jacob Yerushalmy, E.H. Ahrens, Dr John Yudkin, Dr Charlotte Young, and Fred Kummerow, but the mood of the day was running against them. Ancel Keys was being hailed as a national hero. Everyone seemed to agree that poor diet; too much saturated fat, raised cholesterol, clogged the arteries and caused heart disease. Case closed, but the hypothesis had never been tested.
In 1960 the highly respected George V. Mann, who had been associate director of the Framingham Study, in a study supported by the National Institutes of Health, collected food consumption data from 1000 subjects, and concluded that eating saturated fat was not in any way related to heart disease. National Institutes of Health were unwilling to allow him to publish his results. After that many journals refused to publish his work and he couldn't get funding for his research. His career suffered, and his membership of important committees lapsed. George V. Mann died in 2012 at 90 years of age, still believing (correctly) in his research findings.
In a similar manner, Prof. Stephen Phinney and later Dr. Jeff Volek both had problems finding anyone to fund their research into low carbohydrate, high fat diets. Neither the government nor the pharmaceutical companies would fund research on any hypothesis suggesting that a low carbohydrate and high fat diet might be good for human health. Dr Volek adopted a method of working with athletes, in very small groups, strictly controlling their diets by preparing all their food for periods like three to six weeks. (Recently in trials lasting close to six months.) Serious dietary science, not work based on what people said they ate, but very expensive, and invasive of people's lives.
Twenty years went by. Over time dozens of studies and millions of dollars have been spent trying to prove the hypothesis that a low fat diet prevents heart disease. Although the researchers often claimed success, there is in fact no good evidence for that. There are many cases where an "association" between diet and heart disease is indicated, but that doesn't prove a causal link in any way. The best trials of the low fat diet are the Framingham Health Study (started in 1947) and the Women's Health Initiative (started in 1993) both intended to provide definitive proof that the diet- cholesterol - heart disease, hypothesis was valid. Both trials provided conflicted evidence, and both trials tended to prove the opposite of what the researchers expected. (More below)
In 1977 Senator McGovern was very concerned that the American diet rich in red meat and saturated fats and cholesterol was causing heart disease, obesity, diabetes and some forms of cancer. McGovern had lost weight following the dietary ideas of Nathan Pritikin. Pritikin favoured a diet that was almost totally vegan, a low-fat diet, where about 80% of the energy was coming from carbohydrates. Dr Dean Ornish, developed this idea on the basis of research with just 28 patients. He claimed that he could reverse heart disease, and for 30 years he was very influential. Time magazine honoured him as "The Healer of Hearts."
Senator McGovern employed an assistant, Nick Mottern, a vegetarian who believed that red meat was unhealthy for humans. Mottern wrote the report for Senator McGovern's Committee. This report became "Dietary Goals for Americans," issued in February, 1980. This proposal was eagerly accepted, by doctors, by heart foundations, by nutritionist's and by diabetes associations. The objective now was to get the American public (and the world) to follow the recommendations.
From a medical point of view, what was now needed was clinical marker, that pinpointed people who run the risk of a heart attack. In 1961 it was thought that total cholesterol was a good marker. By 1980, it was obvious that the predictive value of total cholesterol was weak. The Framingham Study was intended to produce the most conclusive evidence. The study began in 1948. By 1978, after 30 years this was the result.
|Men and Women||205-264 mg/dL||No relationship|
|Men||Less than 220 mg/dL||Increased risk|
|Men||Mid-range mg/dL||Increased risk|
|Men||Greater than 220 mg/dL||Decreased risk|
So that's a total failure to prove that high total cholesterol causes heart attacks. More-over the evidence shows that at least for older men high total cholesterol might be protective.
In 1992, Dr William Castelli, who had been a director of the Framingham Health Study, admitted the failure of the low-fat and low cholesterol diet. "We found that the people who ate the most cholesterol, ate the most saturated fat, and ate the most calories, weighed the least and were the most physically active."
The Woman's Health Initiative, was started in 1993, enrolling 49000 women; with the objective of proving once and for all, the great value of a low fat diet.
The women were encouraged to eat more fruit and vegetables and whole grains. They were to eat less meat (chicken preferred) and avoid excessive fat.
Over 9 years the women reduced their fat intake from 37% to 29% of calories. They were successful in reducing the amount of saturated fat they ate. And they did lose weight, on average a tiny 1 pound each.
Result: Women in the study failed to lose as much weight as expected.
There was no significant reduction in the risk of either heart disease or cancer.
This was the Rolls Royce of studies, and the researchers looked at their results in disbelief. Tim Byers, one of the principle researchers said; "Everyone already knew that eating a lot of fruits and vegetables and cutting back on fat constituted a healthy diet. (So) we are scratching our heads over some of these results." He could not bring himself to say that the "final word" is this: low fat diets don't work as expected.
By 1980 it was clear that total cholesterol was a hopeless marker for indication future heart disease. It's possible of course that cholesterol is totally irrelevant. One significant problem is that regardless of the cholesterol in your diet, the body produces it's own cholesterol. So the connection between your diet and cholesterol in your blood is weak. In addition, cholesterol is essential for the construction of cell membranes and nerve fibres. The highest concentration of cholesterol in the body is in the brain, where it's involved in clear thinking and the development of new memories.
There are more than 20 studies that show that for people over 70, those with higher cholesterol live longer than those with low cholesterol. Studies also show that high HDL-C is protective both for the brain and for reduced heart disease risk (See below). The "official view" of all Heart Societies and Medical Institutes or University Hospitals, (judging from their web sites) is that cholesterol is bad and that saturated fats should be minimised in your diet, and replaced with complex carbohydrates. This apparent fact, has become a question mark.
In 1996, and again in 2001, there were clear studies demonstrating that high blood pressure increases the risk of cardiovascular disease. Thirty years ago we thought we understood the 'cause' of heart disease. Today we are uncertain, the 'cause' has become mysterious. We don't know. Thickening and/or breaking down tissues in the walls of blood vessels, but why? Best guess, inflammation? The sources of inflammation might be smoking, small high density particles in LDC-cholesterol, high blood pressure, or the effects of insulin resistance. Or maybe something else? Why did heart disease become a problem in the twentieth century, when it was unknown in the nineteenth century? Dr Paul Dudley White examined 700 older male patients at the Massachusetts General Hospital (1919) and found few signs of heart disease. The Masai, the American Indian (Navajo) and the Inuit, in the early twentieth century lived long lives free of heart disease. A scientific understanding of the problem has to make sense of all these strange facts.
There are two types of cholesterol in the blood, LDL-C which is produced in the liver and sends cholesterol and other lipids to the organs of the body via the bloodstream. In contrast, HDL-C carries lipids from the organs to the liver for disposal. After the Framingham study produced an unsatisfactory result using total cholesterol as a marker in 1978, they tried to get inside the cholesterol issue more intensely. In 1998 they showed that high HDL-C was clearly protective both for the brain and for reduced heart disease risk. That led to the notion of good cholesterol (HDL-C) and bad cholesterol (LDL-C). This recommendation should have made targeting high HDL-C as a marker of low heart disease risk an easy recommendation. But the opposite happened.
For some reason, perhaps pressure from drug companies, the chosen target was low LDL-C. Pharmaceuticals, statins, have proven effective in reducing LDL-C. The wide adoption of statins as a protection against heart disease has made billions for drug companies. This may or may not be sensible public health policy. LDL-C includes light fluffy lipids that are considered harmless, and small dense particles that might or might not be harmful. Taking a statin will reduce the production of LDL-C, but many researchers now question if that has any value. It may be that LDL-C is irrelevant as a marker for heart disease.
It's possible to increase your HDL-C by changing to a LCHF diet. We do know that a higher HDL-C protects against heart disease and improves brain health. People who eat more fat are also less likely to suffer strokes.
In 2010 the Dietary Guidelines Advisory Committee Report, confirmed the view established 30 years previously. The Report is unambiguous, "Healthy diets are high in carbohydrates." Americans are told to: "Shift food intake to a more plant-based diet that emphasizes vegetables , cooked dry beans and peas, fruits, whole grains, nuts and seeds." Whole grain foods are especially recommended. The Report is certain that a healthy diet "increases the carbohydrate intake and decreases fat, saturated fat, cholesterol and salt consumption."
The Report says that: "The incidence of heart disease, cancer, hypertension, obesity and tooth decay could be reduced by making qualitative and quantitative changes to the American Diet."
The Advisory Committee say, "the primary focus should be on reducing excessive calorie intake." They complain that Americans are getting obese because they are consuming more calories than 30 years ago. They defend the macronutrient recommendations they have made, the "Healthy Diet" is apparently not the problem, the problem is clearly stated as the lack of controlled calorie intake. The public is blamed for not following the guidelines.
Recall that at the beginning of the twentieth century the poorest Americans were eating 130 pounds a meat a year (200 pounds if you were rich), and that was mostly red meat. Saturated fat was used daily for cooking. Poultry was very expensive. Hunting and fishing were common activities. Heart disease was not a problem, although obesity was for some.
In America today, people eat less that 100 pounds of meat a year, often less that 80 pounds and 60% of that is poultry. Fewer than 35% of calories are fat, and dietary cholesterol is less than 300mg per day. In the last 40 years the number of calories sourced from meat, eggs and nuts has increased slightly, about 20 calories a day. Saturated fat consumption is down. On the other hand as recommended, the intake of carbohydrate has increased. That increase in carbohydrates adds about 180 calories a day to the diet. Does that indicate a problem? The Report says conclusively: There are "no detrimental effects of carbohydrates as a source of calories for these (coronary heart disease, type 2 diabetes, body weight or dental caries) or other health outcomes, reported."
The Report makes the case that protein is a critical part of the diet and that the quality of proteins is variable. The best sources of quality protein are meat, fish, milk and eggs, and yet people are advised to "consume only moderate amounts of lean meats, poultry and eggs." It seems that the Committee is worried about saturated fat, (In 1960 George V. Mann, concluded that eating saturated fat was not in any way related to heart disease. (Confirmed by recent science.) Besides, the fat you eat is not the source of increased body weight.) and total cholesterol (which is hard to control by diet, and in any case is probably irrelevant as a marker of heart disease.).
In the last 40 years American diets have moved exactly in the direction that the Dietary Guidelines for Americans recommends. Carbohydrate consumption has increased, overall fat, saturated fat and cholesterol consumption have decreased. But, the prevalence of overweight and obese people in the USA has increased dramatically.
The Framingham Health Study, and the Woman's Health Initiative, have failed to confirm that the recommended low fat diet is in fact a "healthy diet". The results are 'complicated' and they fail to produce the results researchers expected. So maybe what we all know; "that a low fat, high carbohydrate diet, rich in vegetables, fruits, nuts and whole grains, low in red meat, but incorporating some fish and poultry, is the best diet for humans," may not be valid after all.
In this video (5min) Eric Westman Explains How To Successfully Lose Weight.
This is a SCIENCE based diet. It seems strange at first, so contrary to what we've been taught all our lives. But much closer to how great grandma might have cooked and ate on the farm 100 years ago. Fat, saturated fat, becomes your friend. Moreover, you will never feel hungry (unless you sneak in some carbohydrate).
Prof. Stephen Phinney and Dr. Jeff Volek who are the main modern researchers for this diet call it LCHF (Low Carbohydrate High Fat) diet. Popular media might call it the Atkins Diet, because it confirms the key ideas of the late Dr Atkins. There is a revised version, the "New Atkins Diet", commercially available. Prof. Stephen Phinney and Dr. Jeff Volek and Dr Eric C Westman, are the research gurus behind the "New Atkins Diet."
Another version also based on the work of Prof. Stephen Phinney and Dr. Jeff Volek with additional work in South Africa by Tim Noakes, Prof. of Exercise and Sports Science at the University of Capetown, and his associates, Sally-Ann Creed and Jonno Proudfoot. Their book is "The Real Meal Revolution" they call it the Banting Diet, after William Banting.
Prof. Stephen Phinney and Dr. Jeff Volek tell us that the key effects of the strictly applied LCHF diet are:
120% reduction in the production of insulin.
10% reduction in body fat.
100% reduction in leptin.
150% reduction in triglycerides.
Increase in HDL-C by 12%
Decrease in small LDL-C particles by 15%
In addition the triglyceride : HDL-C ratio is about 140% better.
So there you are; when choosing to eat a low fat diet, we've been doing exactly the wrong thing. Our diet has been making us sicker. With this new knowledge we can now act differently, except that it's difficult to make this sort of change quickly. To do something about this you need some help. I've purchased several books and I've worked quite hard for a year to make the change. It took me months to get used to the idea of eating fat. My wife still struggles with that idea. We change our habits slowly. I needed support and you will need support. Join a group of people who are taking the same journey. Get good information. The best single simple source is this book, "The Real Meal Revolution." a best selling book in South Africa, that has only recently reached the international market.