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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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October 24, 2013

Dietary Fat and Heart Disease

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Posted by Derek

Here's a provocative article at the British Medical Journal on cardiovascular outcomes and diet. Now, I free admit that the BMJ has a tendency towards controversialism, but I'm hardly in a position to throw stones. The author, Aseem Malhotra, says "Saturated fat is not the issue".

Human lipidology is a very complex field, and anyone who tells you that they have the definite answers needs to be treated with caution. As has been well documented, the consensus advice about dietary fats of all kinds has varied quite a bit, and I don't think it's anywhere near settling down. The role of pharmaceutical intervention isn't settled, either, despite the huge success of the statin drugs. There's room to argue about their broad effects on cardiovascular morbidity and mortality, and how much of it is mechanism-based:

A meta-analysis of predominantly industry sponsored data reported that in a low risk group of people aged 60-70 years taking statins the number needed to treat (NNT) to prevent one cardiovascular event in one year was 345. The strongest evidence base for statins is in secondary prevention, where all patients after a myocardial infarction are prescribed maximum dose treatment irrespective of total cholesterol, because of statins’ anti-inflammatory or pleiotropic (coronary plaque stabilising) effects. In this group the NNT is 83 for mortality over five years. This doesn’t mean that each patient benefits a little but rather that 82 will receive no prognostic benefit. The fact that no other cholesterol lowering drug has shown a benefit in terms of mortality supports the hypothesis that the benefits of statins are independent of their effects on cholesterol.

You can go on from this to wonder how things are going to work out if any of the HDL-raising therapies ever make it into the general population. Do we know what we're doing there, or are we only going to find out after twenty years in the real world? On saturated fat, Malhotra says that he's not convinced by the standard recommendations, either:

Saturated fat has been demonised ever since Ancel Keys’s landmark “seven countries” study in 1970. This concluded that a correlation existed between the incidence of coronary heart disease and total cholesterol concentrations, which then correlated with the proportion of energy provided by saturated fat. But correlation is not causation. Nevertheless, we were advised to cut fat intake to 30% of total energy and saturated fat to 10%.” The aspect of dietary saturated fat that is believed to have the greatest influence on cardiovascular risk is elevated concentrations of low density lipoprotein (LDL) cholesterol. Yet the reduction in LDL cholesterol from reducing saturated fat intake seems to be specific to large, buoyant (type A) LDL particles, when in fact it is the small, dense (type B) particles (responsive to carbohydrate intake) that are implicated in cardiovascular disease.

I find this sort of thing very interesting, both as an issue in itself, and for what it says about our knowledge of medicine and human biology. You'd think that there would be nothing more well worked-out than the role of different kinds of diets in heart disease, but the closer you look, the messier the situation is. There are big public health issues here, both the obvious primary ones, and the secondary issue of causing people to become frustrated and cynical about big dietary recommendations in general.

Comments (54) + TrackBacks (0) | Category: Cardiovascular Disease


COMMENTS

1. FatFan on October 24, 2013 10:45 AM writes...

I think people are increasingly finding out that carbs rather than fat are the real problem. Just consider the recent studies questioning the relationship between BMI and life expectancy.

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2. Doctor Memory on October 24, 2013 11:01 AM writes...

@1 I am eagerly awaiting the reassessment of carbs that will happen, as seems likely, sometime in the late 2030s, at which point we will be told that lean proteins are actually the silent killers.

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3. NoDrugsNoJobs on October 24, 2013 11:20 AM writes...

I'm still impressed with the statins, frankly. If you prevent 1 heart event out of 345 in one year, thats about 3 out of 100 in ten years. Since these folks are at low risk, their framingham liklihood of a heart attack in the next ten years is probably well under 10% as it is. Therefore, reducing the 10 year risk by an absolute reduction of 3% is a substantial fraction of the total risk that group is in. People die from so many causes so no matter how great of a drug you have, its likely to only impact one out of the many causes. If you look at only one cause of mortality and then further limit that group to those at low risk, you can see that even if the drug prevented 100% of adverse heart events in that group, you would still not impact overall survival to a large extent, no drug will do that unless the patient is at extraordinary risk of whatever it is the drug is aimed at preventing.In addition.

Its interesting to me that they use this low absolute value when assessing a statin benefit as being evidence somehow that LDL doesn't matter - I don't see that at all. It is well known that people that overexpress genes or have alleles that lead to elevated cholesterol are at definite increased risk of heart attacks. It has been proven again and again that statins reduce heart attacks. That they are not 100% effective in reducing heart attacks is not an indication that LDL doesn't matter or isn't a big factor. By the time a guy has a heart attack and gets put on a statin, its kind of a lot to expect that reducing his ldl after years of formation of atherosclerotic plaques. Some things cannot be undone once they occur.

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4. Anon on October 24, 2013 11:39 AM writes...

In terms of public education it may also be the case that for certain people the science of diet and the science of the efficacy of drugs are in the same category. As they hear contradictory advice about the effect of diet on lifestyle they may relate to the efficacy of drugs in a "if they can't decide what food is good then how can they decide what drugs are good" kind of way. This may lead many off on a educational path of anecdotal/hearsay ("John's grandfather lived to be 100 and he had a hamburger and beer everyday, so that's what I eat") and homeopathy ("John's grandfather rubbed oatmeal on his hands for arthritis and he swears by it.").
Obviously we know that diet studies are often based on a retrospective analysis while drugs aren't, but the public doesn't realize this.
And at the same time, its hard to prevent someone like Dr. Oz from touting the diet of the month as there is so little evidence to speak against it as he may use to speak for it.

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5. pgwu on October 24, 2013 11:41 AM writes...

I wonder if this is similar to the salt issue. Low fat recommendation went to no fat for the gullible, and low salt recommendation went to no salt. Cells turn to something else for energy and metabolic balance.

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6. Anonymous on October 24, 2013 12:28 PM writes...

"no prognostic benefit" link is somewhat broken.

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7. NodrugsNoJobs on October 24, 2013 1:28 PM writes...

Anon 4 - Totally agree, its quite frustrating when you read stuff from sources like Life Extension magazine where they tout some amazing benefit of X,Y or Z based on some retrospective and very dubious study and use that to say - take this or that and you will have this huge benefit.

In contrast, they will constantly harangue the drug companys for any side effect or issue with a drug and allege all of that can be avoided by taking the natural stuff they are selling. The only reason we even know about most of the side effects of approved drugs is that they have been intensively examined under double blind, placebo-controlled study. I always get a laugh when a decent size, propspective study is actually run on some supplement and it inevitably does not work or has marginal effects at best. Then they point to some reason why that study should be ignored like, "they weren't looking at the right dose, or the right source, or the right population or whatever". Its such a sickening double standard and so flipping frustrating that you want to pull whatever gey hair you have left out of your scalp.

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8. watcher on October 24, 2013 3:15 PM writes...

caution: meta analysis.

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9. Laura Woodford on October 24, 2013 3:28 PM writes...

Seems fairly simple and no-brainer to just eat Whole natural REAL foods you prepare yourself from organic, local and sustainable farms. Dont over do anything and dont underdo anything, then exercise daily, be happy, be merry and an occasional glass of some fine french wine doesnt hurt either!

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10. Curt F. on October 24, 2013 3:44 PM writes...

@9 Laura Woodford. Why in the world does that seem like a "no-brainer"? The evidence is quite mixed on whether "organic" diets are better for you than the alternative. And focusing on "local" means I would never to be able to eat avocados--nor much of anything else except sagebrush--where I live. No thanks. I would also suggest that depending on your definition of "sustainable", sustainability may be in tension with "local" and "organic". Can't have it all three ways.

Plus I'm not sure how to decide if something is a "Whole natural REAL" food or not.

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11. sgcox on October 24, 2013 4:49 PM writes...

#10, She must be from Provence - the only way to make REAL foods you prepare yourself from organic, local and sustainable farms and an occasional glass of some fine french wine. BTW, the only way it can be "sustainable" while "Dont over do anything and dont underdo anything" is through lavish Common Agricultural Policy subsidies which bankrupts African and Caribbean farmers.

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12. doc on October 24, 2013 4:53 PM writes...

A comprehensive review of the topic was published by Gary Taubes as a book called "Good Calories, Bad Calories". Despite the somewhat off-putting title, the review itself was a tour de force by an extremely able science writer, and -had it not gored so many sacred cows- would have exceeded the standards of any doctoral committee I've ever met.

The book is an unabashed, comprehensive indictment of the selective data citation and bad science that has been endorsed by medical and governmental groups pursuing agenda-driven goals. Like more recent examples of fraud in science, ignoring half -or more- of the available data, and adjusting the rest to suit a foregone conclusion has been the practice in nutrition for the past half-century.

There is no need to await a comprehensive review of nutrition and heart disease. It's been published. Read it.

And have another slice of bacon for breakfast. It's good for you.

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13. metaphysician on October 24, 2013 4:57 PM writes...

I'd really like someone to show me an example of an inorganic food. No, salt does not count.

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14. sgcox on October 24, 2013 5:22 PM writes...

OK, plain water ?

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15. navarro on October 24, 2013 6:11 PM writes...

the genetic factors that are involved in the way an individual's body processes and excretes fats can also complicate the issues. like the anecdotal "100 year grandfather" mentioned above, i eat a diet high in a variety of fats-- butter, beef, pork, olive oil, any number of cow's milk/goat's milk/sheep's milk cheeses and my total cholesterol (checked twice a year) has a mean of 109 with a range of 92-125 over the past 12 years. to be sure, i register as obese with regards to my bmi but any heart problems i have will not be due to coronary plaques.

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16. dearieme on October 24, 2013 6:50 PM writes...

"Ancel Keys’s landmark “seven countries” study in 1970 ... But correlation is not causation." Especially when a crooked author simply omits data from countries which falsify his theory.

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17. Anon on October 24, 2013 8:02 PM writes...

When the doctor wanted to put me on statins and blood pressure medication, I personally took a pause asked the doctor to hold off until I could dig into the research. First thing came clear, statins are not that great. The NNT sucks, especially if you're not female with a previous cardiac event. Second, when I looked into the research behind macronutrients and heart disease it became very clear. Carbohydrates affect blood pressure much great than almost anything. Think salt is bad with its 4-10mmHg. Carbs affect upwards of 90mmHg. Also, carbs will cause a your lipid chemistry to go so far out of normal that it's not even funny. You have super high triglycerides, you are drinking too much or are eating to many carbs. LDL, yep! Carbs in excess. Low HDL, you guessed it... Carbs and not enough saturated fat.

Sorry, the second I dropped my allowable daily intake of carbs to 75-150 g/day everything resolved itself. The second I increased my fat intake HDL skyrocketed to 80. Within 3 months my readings were so improved that my physician started changing how he advises patients. BP is now 115/65 on average, resting pulse is in the 60's. HDL is now 86, LDL 98 (large particle), trigs 90.

I eat massive amounts of fat now. Before I followed all the conventional advice of what and how to eat, to the letter. It almost killed me.

Nope, saturated fat is not a problem. I eat it by the spoonful and I lost weight doing it. Improved health and changed a doctors view of diet and health.

And I'm pro-pharma and drug discovery. This is just one area that everyone is thinking poorly. I have great hopes for Gary Taubes' NUSI

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18. samadamsthedog on October 24, 2013 9:46 PM writes...

Dr. Atkins lives.

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19. Jose on October 25, 2013 12:46 AM writes...

"Ancel Keys’s landmark “seven countries” study in 1970 ... But correlation is not causation."

Moreover, don't forget the 'ecological fallacy." There's no good reason to think the people eating excess fat are the same ones with CHD- aggregate data can't address this.

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20. Dolph on October 25, 2013 4:30 AM writes...

"Yet the reduction in LDL cholesterol from reducing saturated fat intake seems to be specific to large, buoyant (type A) LDL particles, when in fact it is the small, dense (type B) particles (responsive to carbohydrate intake) that are implicated in cardiovascular disease."

Only that this assumption is dead wrong... It's the total number(!) of LDL particles that is predictive, not the size of them.

Hell, there are so many ridiculous mistakes and inaccuracies in this pieve by Mr. Malhotra that it is really sickening. I heard very bad things about the UK educational system, but I wouldn't have expected it to be THAT bad!
By the way, what is it that Doctors in the UK are so challanged by clinical evidence(!)? I think it started with their denialism about the prevention of scurvy by Vitamin C or somewhere around that point in time...

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21. Dolph on October 25, 2013 4:34 AM writes...

@3:
Absolutely correct! It's just a screaming lack of statistical and pathophysiological knowledge! CVD incidence would be hardly above zero, if everybody would keep a LDL of ~50-70 mg/dl lifelong. It's THE rate limiting factor.

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22. Anonymous on October 25, 2013 6:57 AM writes...

There's so much hubris, in the medical literature (where as we are now fully aware many results are not reproducible, or have been misinterpreted with subjective bias in self-fulfilling prophesies), and here in the comments. Frankly, I just don't trust anything, or anyone anymore. Except for the principle of evolution, and so the best advice to anyone is to enjoy life and make the most of it while it lasts. Better that, than limiting what you do in fear of not living a year longer than you would have if you just enjoyed the best years. It's so sad that we have lost perspective on this.

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23. Anonymous on October 25, 2013 7:04 AM writes...

PS. And it goes without saying: Eat a balanced diet. Not just because you hedge your bets on all the medical BS and hubristic opinions out there, but because the variety in your diet helps to make life more rich and enjoyable.

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24. NMH on October 25, 2013 8:05 AM writes...

IMO" Find the diet that is best for you. If a diet regimen doesn't cause the changes that you like, try some other diet regimen. I tried high protein, fat, and low carb and I just got fatter and my immune system became hyperactive, judging from all of the rashes I got. Now Im on a vegan diet.I lost 30 lbs and my cholesterol and blood pressure are both very low, and my immune system does not appear to be hyperactive.

Again, find the diet that is best for you.

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25. Anonymous on October 25, 2013 8:27 AM writes...

Just to show how little any of this matters:

http://www.mirror.co.uk/news/uk-news/the-woman-who-only-ever-eats-232644

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26. Kent G. Budge on October 25, 2013 9:15 AM writes...

I'm a Type 2 diabetic who does pretty well on a diet of 40% carbohydrates, 30% fats, 30% protein or thereabouts. I do try to keep the fats unsaturated and the carbohydrates low glycemic, though I'm not 100% convinced either matters.

Last A1C was 5.5%. Blood pressure is typically 95/65. Total cholesterol and triglicerides are both good. LDL was around 100 pre-statin, 80 now that I'm on a statin. The only red flag in my numbers is an HDL of only 27.

It's a shame we focus on diet, where no one really seems to know what works, when there are things we know do work. No one questions the benefits of regular moderate exercise. Few question the benefits of fiber in the diet. For Type 2 diabetics, few question that metformin is something of a wonder drug.

I'm tempted to suggest that, when no one can agree on which diet is best, it's because diet doesn't matter that much.

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27. Anonymous on October 25, 2013 9:27 AM writes...

"when no one can agree on which diet is best, it's because diet doesn't matter that much."

Precisely. I imagine it matters only to those who make a living selling a particular diet, either as a food manufacturer, or as a self-proclaimed "scientist" and/or dietary "expert".

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28. NMH on October 25, 2013 9:55 AM writes...

"when no one can agree on which diet is best, it's because diet doesn't matter that much."

Or maybe there is a spectrum of response, depending on the individual. Some people are responsive to specific diets (like me, Vegan is great), while others it just doesn't matter.

I think this hypothesis is supported by the study documented by the BBC of what happens when a cohort of 20 is overfed by a thousand (?) calories a day. Most got fat, some not so much, and the Chinese guy actually gained muscle:

http://www.youtube.com/watch?v=_6-A0iHSdcA

If this is the case, its remarkable to me that their are so many different responses.

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29. Lane Simonian on October 25, 2013 10:16 AM writes...

A few years back, a student asked me if Charlemagne ate so much meat how did he live such a long life. It turns out that Charlemagne was also a voracious eater of flaxseed. And here is likely the key. It is not so much a matter of saturated fat and low density lipids, but how many of those lipids are oxidized. If you combine saturated fats with a diet that increases that oxidation (such as high in sugar and carbohydrates) your risk of heart disease will likely increase. If you eat a diet that lowers the oxidation of those lipids such as Omega 3-fatty acids (fish oil, flaxseed, etc.) and phenolic compounds in fruits, vegetables, and spices, for instance, your risk likely goes down.

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30. DLunsford on October 25, 2013 11:31 AM writes...

Excellent video on the real lack of evidence on cholesterol:

http://vimeo.com/45485034

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31. DrSnowboard on October 25, 2013 11:41 AM writes...

@29 You really don't get evidence-based research , do you?

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32. Lane Simonian on October 25, 2013 12:04 PM writes...

I am an historian so I don't mind using careful case studies and anecdotes to back up scientific studies. What I do understand are many of the pathways that lead to a great variety of disease. I would recommend the following: Pal Pacher, Nitric oxide and Peroxynitrite in Health and Disease.

I find that many people who criticize supposed "non-scientific" approaches to disease have not carefully examined the scientific literature itself.

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33. Lane Simonian on October 25, 2013 12:07 PM writes...

I am an historian so I don't mind using careful case studies and anecdotes to back up scientific studies. What I do understand are many of the pathways that lead to a great variety of disease. I would recommend the following: Pal Pacher, Nitric oxide and Peroxynitrite in Health and Disease.

I find that many people who criticize supposed "non-scientific" approaches to disease have not carefully examined the scientific literature itself.

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34. Anonymous on October 25, 2013 12:17 PM writes...

@Lane Simonian, science is about data and statistics, but everything you post is just made up BS ideas based on anecdotal evidence. I suggest you stick to history.

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35. Lane Simonian on October 25, 2013 12:32 PM writes...

When I post studies, people complain that I am cutting and pasting. When I don't post studies, people complain that I am not presenting any evidence.

It is no great secret that lipid peroxidation is a major factor in heart disease. So you don't have to be brilliant (or a scientist) to come to the following conclusion: if you increase lipid peroxidation you increase the risk for certain forms of heart disease and if you decrease it you decrease the risk for certain heart disease.

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36. Lane Simonian on October 25, 2013 12:47 PM writes...

A specific study on flaxseed oil:

Effects of flaxseed oil on anti-oxidative system and membrane deformation of human peripheral blood erythrocytes in high glucose level

Many anecdotes are misleading or flat out wrong, but if you work backwards from the studies, you see that some anecdotal outcomes are exactly what one would predict based on the scientific evidence.

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37. NMH on October 25, 2013 12:53 PM writes...

Hmmm. I wonder if Charlemagne had the enzymne required to turn the precursor of the omega-3 found in flaxseed into the mature omega-3? About 50% of all adults don't, as I recall.

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38. NoDrugsNoJobs on October 25, 2013 1:20 PM writes...

I used to be a huge fan of omega 3's from fish oil based on many retrospective analysis, I thought it was about the best you get via nutraceuticals in health but even they seem to have been knocked down with many recent evaluations of the data. The FDA approved Amarin's omega 3 for treating high triglycerides but there are no double blind, placebo controlled studies at all to show it actually reduces cardiovascular events. Unlike statins which have been shown repeatedly to impact events in many, many powered studies. The FDA advisory panel strongly recommended the expansion of the label for use in statin-resitant patients because of the lack of any sort of evidence. But yet many millions of people around the world will continue to shun what has been approved and demonstrated to work (statins, ace inhibitors, diuretics) for fish oil, flaxseed oil, wheat germ, organic food, vitamins, snake oil, etc. I feel that while our science and drugs just keep getting better and better, the general public's ignorance grows and grows. Anecdotes and superstitions and feelings increasingly rule the conventional wisdom. I just don't get it at all.....

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39. NoDrugsNoJobs on October 25, 2013 1:31 PM writes...

Whoops, meant to say the panel recommended against the expansion of the label.....

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40. FatFan on October 25, 2013 2:07 PM writes...

#29 Lane Simonian: Interesting. I guess that could also explain the benefits of exercise which oxidizes fat. I am also willing to bet that in the good old days, people like Charlemagne got plenty of exercise.

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41. sgcox on October 25, 2013 3:36 PM writes...

NoDrugsNoJobs; I do not think we live in any special time of increasing ignorance. It is simply the ways of communications had increased so much that we get overloaded when start concentrating on any specific topic. For example, you can get many more reports of racism in football (sorry, soccer) although in fact it has dropped to the noise level compared to say 20 years ago. So do not worry, common sense will prevail.

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42. Robert on October 25, 2013 3:44 PM writes...

The author of the BMJ article cites a Lancet-published meta analysis in support of his notion that cholesterol lowering may not be important. However, the authors of that Lancet article seem to have come to a different interpretation:

"In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered."

I should mention that I do not have access to the complete article. The quote is from the summary that is available to me.

As to the notion that low cholesterol is associated with elevated mortality, this was argued decades ago, and at least a tentative conclusion was that individuals with unusually low cholesterol had some existing health problems that may have been responsible for the low cholesterol and which predisposed them to premature mortality. I no longer have those references, though.

Natural genetic "experiments" (i.e., LDL receptor deficiency (or absence) and PCSK9 deficiency) would seem to suggest a relationship between LDL levels and mortality. It will be interesting to monitor the fate of the PCSK9 inhibitors that are in development.

I suspect the author does have a good point about sugar, however. Sugar (especially fructose) stimulates de novo lipogenesis leading to overproduction of palmitate which is pro-inflammatory. Elevated palmitate can lead to activation of NADPH oxidase and overproduction of reactive oxygen species, which can be linked to development of hepatic insulin resistance, diabetic nephropathy, diabetic neuropathy and diabetic retinopathy, to beta cell destruction, and to increased atherosclerosis. So there's probably a good story there somewhere.

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43. ArtImitatesScience on October 25, 2013 3:58 PM writes...

From the script of W Allen's Sleeper 1973

Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk."

Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.

Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?

Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.

Dr. Melik: Incredible.

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44. Lane Simonian on October 25, 2013 8:19 PM writes...

A study that Charlemagne would have appreciated.

The α-linolenic acid content of flaxseed can prevent the atherogenic effects of dietary trans fat.

A saying Woody Allen would appreciate: Life is short. Eat your dessert first.

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45. dearieme on October 26, 2013 5:31 AM writes...

"This benefit greatly exceeds any known hazards of statin therapy." Known to whom? My friend The Retired Epidemiologist tells me that far more of his statinated pals have had nasty side-effects than you'd infer from the published figures.

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46. NMH on October 26, 2013 12:15 PM writes...

@16: Watch and learn:

http://www.youtube.com/watch?v=xm52NOQJRts

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47. NoDrugsNoJobs on October 26, 2013 3:15 PM writes...

I'd definitely listen to a retired epidemiologist I know who has determined from some of his pals that the statin "nasty side effects" rate are higher than published, than believe a bunch of double-blind, placebo controlled studies with thousands of randomized individuals combined with real world data examining benefits v risks in large populations around the world. There all corrupt, even UK's NICE whose only goal is to examine the cost of saving lives versus the life itself. My guess is they really want to kill people to save money and have conspired with many other institutions to hide the real data that your epidemiologist friend has observed in his statin taking pals. I know a lot of people who take statins and don't have side effects and many who probably should not be alive given their overall health and history but I sure wouldn't substitute for my own evaluation of many of the clinical studies and reviews on the subject. However, I would definitely listen to a retired epidemiologist who has friends with more side effects than what has been published (how many friends, n=? What else were they taking?) Anyway, sounds convincing to me Dr Dearime, I will throw away my pills today and subscribe to yours and Dr Lane Simonian's newsletter, where can I sign up.

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48. Lane Simonian on October 26, 2013 5:10 PM writes...

Here is the most comprehensive study on the side effects of statins: Golomb and Evans, Statin Adverse Effects: A Review of the Literature and Evidence for Mitochondrial Mechanism.

Statins work not so much because they lower "bad" cholesterol but because they lower the activity of g proteins and the subsequent inflammation and oxidation that results from such activation. However, by lowering coenzyme Q10 levels they can contribute to global amnesia, diabetes, and mitochondrial dysfunction. That is why coenzyme Q10 supplementation is often recommended for people taking statins.

I don't deny that drugs can be of some benefit, but they are sometimes prescribed to populations who either don't need them, do not benefit from them, or are harmed by them. Trying to convince people that the side effect are more rare than they actually are does not help pharmaceutical companies in the long run nor the population in general.

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49. Anonymous on October 27, 2013 9:21 AM writes...

They lower the activity of the G proteins!! YEESSSSS!!! Nasty G proteins! Sock it to them, statins!

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50. NoDrugsNoJobs on October 27, 2013 6:43 PM writes...

Lane, certainly you realize that the UK's NICE is not run by pharma companies, there goal is to save lives as cheaply as possible. The UK's NICE has broadened their use beyond the normal constraintsfor statins (eg all adults over 40 with diabetes). I know they may not be as well researched as you but I think it can be said that they do their homework and with their main goal is saving lives at a low cost, the idea they would pay for statins is that they recognize the value even on the most common and basic of denominators. It doesn't count the reductions in non-fatal strokes, heart attacks, dementia, etc.

It amazes me how people somehow think pharma companies somehow minimize side effects. How, by fraud?Have you ever seen a drug commercial on tv, is any consumer product so beset with warnings? Where are the double blind placebo controls for the natural crap you seem to espouse? What are the side effects? Of course you don't even know but somehow can recommend this or that without any understanding of the safety at all? Then you are hypocritical enough to suggest it is in nobody's interest to minimize side effects -what are the side effects of the nutritional/health crap products? They don't even know!!
Its frigging crazy that the drugs we discover, that are based on science and rigorously studied under the most stringent of conditions and unlike anything else in our commercial world, must prove their benefit v risk. Ironically though, we subject them to the most suspicion, hate and doubt while they are actually what is most proven. Instead, we live in a world with 21st century drugs and 18th century attitudes and superstitions. Never has their been a bigger gap between the state of art in science and the knowledge and understanding of the average citizen. We believe the charlatans selling snake oil and leeches but unlike the 18th century where there wasn't an alternative, we are now living longer and better thanks to modern drug discovery. I guess its human nature, better to ignore that which appears complicated and adhere to what is simple and reassuring. Unfortunately, millions are being deprived or ignoring the drugs that could be prolonging and improving their lives for that which amounts to leeches and snake oil, all available at GNC and Whole Foods.

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51. Joseph Hertzlinger on October 27, 2013 8:04 PM writes...

Wait a moment... The "saturated fats are evil" theory came from a study with SEVEN data points?

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52. Anonymous on October 28, 2013 2:52 AM writes...

@51: Yes, people believe in good stories that make "sense" and sound credible, regardless of how much or little statistical data there is to support them. Read Nobel laureate Daniel Kahneman's book, "Thinking, Fast and Slow", and you will see just how irrational humans are in this way.

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53. NMH on October 28, 2013 6:53 AM writes...

@51,52: Even if you plot all 22 points for the 22 counties a correlation between dietary fat and heart disease is very clearly seen:

http://www.youtube.com/watch?v=xm52NOQJRts

Keys gave reason why he selected the 6 in 1953, judge the paper for yourself.

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54. Oblarg on October 28, 2013 2:39 PM writes...

Oh come on; if it took you this long to become "cynical and frustrated" with dietary "science," you've been divorced from reality. The overwhelming majority of the field consists of wild goose-chase correlation hunts done by people with no sense of statistics or proper experimental design. You know, I can correlate TV ownership very well to average lifespan, globally. Perhaps I ought to publish this?

Look, when the fundamental claims of a field change every couple of years, it's probably safe to disregard what they're saying. You don't see physicists constantly changing the basics of classical mechanics.

The fact is, between the massive bias towards positive results and the near-complete lack of any fundamental understanding of the underlying system, published findings in nutritional science are essentially orthogonal to truth. Ignore them, and wait for the actual scientists (i.e. biochemists) to sort it out.

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