[HN Gopher] Saturated fat: the making and unmaking of a scientif...
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Saturated fat: the making and unmaking of a scientific consensus
(2022)
Author : mgh2
Score : 45 points
Date : 2024-10-26 20:51 UTC (2 hours ago)
(HTM) web link (journals.lww.com)
(TXT) w3m dump (journals.lww.com)
| dang wrote:
| We changed the URL from
| https://www.eviemagazine.com/post/american-heart-association...,
| which points to this.
|
| (Submitted title was "AHA Was Paid By P&G To Say Heart Disease
| Caused By Saturated Fat, Not Seed Oils")
| SeanLuke wrote:
| https://en.wikipedia.org/wiki/Evie_Magazine
| JumpCrisscross wrote:
| I think that story was actually better than this paper, which
| appears to have been authored by a controversial figure.
| robotnikman wrote:
| I'm not sure how we can prevent organizations from being 'bribed'
| like this, but something has to be done. Misinformation like this
| has no doubt contributed to the obesity epidemic
| JumpCrisscross wrote:
| > _not sure how we can prevent organizations from being
| 'bribed' like this_
|
| Statute that makes it fraud for a doctor (or anyone with
| medical certification) to make unsubstantiated health claims or
| strong claims based on weak science.
| KempyKolibri wrote:
| The view of SFA consumption as a risk factor for CVD is not the
| result of bribes, it's the result of the body of research on
| the subject pointing in that direction.
|
| It's rich of Nina to accuse Keys of cherry picking while
| claiming that there's no RCT data supporting the diet-heart
| hypothesis because of the dodgy Hamley meta analysis, while
| ignoring Hooper 2020, which was far more rigorous and showed a
| 21% reduction in CVD events when PUFA was substituted for SFA:
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
| dang wrote:
| Related:
|
| _Saturated fat: the making and unmaking of a scientific
| consensus_ - https://news.ycombinator.com/item?id=33942840 - Dec
| 2022 (6 comments)
| ericyd wrote:
| The only trendy food advice I'll ever follow is Michael Pollan's:
| eat food, not too much, mostly plants.
| thefz wrote:
| I remind this motto as bell but he should have put emphasis on
| "food you made"
| jvanderbot wrote:
| His definition of food is narrower than just edible things. I
| recall the book discussed processed vs more "raw" foods.
| frereubu wrote:
| The definition I've heard of his for "food" in this
| sentence was "things your grandparents would recognise",
| although by this point it might be "your great-
| grandparents".
| KempyKolibri wrote:
| Before anyone gets too excited, best to remember that Nina is
| regarded as something of a joke in nutrition science circles, and
| tends to take poetic license with the truth.
|
| If you'd like to take a look at a critical review of her other
| work on this topic, I'd highly recommend this damning analysis of
| her "Big Fat Surprise" book:
| https://thescienceofnutrition.wordpress.com/2014/08/10/the-b...
| readthenotes1 wrote:
| Are there any similar problems with this essay? I am pretty
| sure I've heard much of this before ...
| KempyKolibri wrote:
| It's large and I'm about to go to sleep and only on my phone,
| so not easy to go through the whole thing, but in short, yes.
|
| Much like in her book, Nina is grossly misrepresenting the
| evidence, and I'd say just flat-out lies or at the very least
| misleads the author. See my comment here for an example:
| https://news.ycombinator.com/item?id=41958014
| sparrc wrote:
| Nina Teicholz is a bit of a controversial figure in the nutrition
| world so I'd advise people to take this with a grain of salt...
| bitmasher9 wrote:
| This is a serious problem. How can we trust institutions that are
| suppose to provide evidence based advice to the general public?
| To me this is a crime so large that those involved should be held
| accountable for a percentage of all heart attacks. Furthermore it
| erodes trust in government, experts, and science. Right now it
| seems like the American public is actively feed extremely harmful
| food and lied to about the health consequences.
|
| Is it possible to create a Reddit style voting system where votes
| are weighed more depending on a level of trust/expertise to
| review scientific papers. The voting could be on multiple
| factors, such as on the different types of validity, the overall
| impact, how transparent they are with methods and data, how well
| it fits with other literature, etc. The end result could be a
| paper titled "A survey of saturated fat's impact on
| cardiovascular health" where experts very publicly discuss the
| papers merits and common people interested in their health can
| review and understand where the science is. Decentralized
| informational authority.
| KempyKolibri wrote:
| It's nonsense. SFA consumption is a risk factor for
| cardiovascular disease. Nina is misreading the evidence to come
| to poor quality conclusions. The most rigorous analysis of RCTs
| on the subject shows this very clearly:
|
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
| tomohawk wrote:
| A friend stopped eating plants a year ago. Has since lost 150
| lbs. Still has weight to lose, but this is the only thing that
| ever worked for her.
|
| A family member stopped eating plants 9 months ago based on the
| friend's experience. Several medical issues that doctors were
| unable to help with for several years are gone. They were never
| in an overweight category and always ate healthy according to the
| guidelines, but they no longer need blood pressure meds, no
| longer have fibromyalgia, and the list goes on and on. This
| family member has their life back.
|
| Another friend, 77 years old, just took a hike with us. 5 miles,
| 800 feet of elevation gain and loss. She hadn't been able to do
| anything like that in over 10 years, but 9 months plant free and
| she's able to do that again. She hasn't been able to play guitar
| for years because of arthritis in her hands. That has abated so
| much she now is playing guitar.
|
| I got off plants 6 months ago, and my health has improved. I'm
| calmer and more focused.
| GrantMoyer wrote:
| This is insane.
|
| To be clear, it's quite possible for a temporary elimination
| diet to aleviate unexplained symptoms, for instance from an
| unknown food allergy or intolerance. But then you need to
| slowly reintroduce foods to find which specific food causes the
| problem, otherwise your diet is bound to be nutritionally
| deficient. Eliminating all plants from your diet permanently is
| insane.
| tomohawk wrote:
| I get that alot. If you only eat plants, people think its a
| bit quirky maybe, but fully accepted. But stop eating them
| and get great results, people can't handle it.
| maxk42 wrote:
| It's true. I ran into a friend of my wife's yesterday who
| is a nurse. The topic of food came up and I mentioned I
| haven't eaten any plants in over two years. She snidely
| remarked "How's that constipation going for you?" She's 150
| lbs overweight and looks 15 years older than her age.
| Meanwhile, I lost 20 lbs and cleared up a bunch of medical
| problems. (Including constipation.) People love to sit on
| their high horses and make snide remarks while evidence is
| staring them right in the face. It's wild.
| GrantMoyer wrote:
| The reasons one diet is typically accepted and the other
| isn't is because the two diets are materially different.
| It's possible to have a nutritionally complete diet of only
| plants where the vast majority of the nutrients are
| naturally occurring in the food. The same is not true of a
| diet without plants; it's not possible to have a
| nutritionally complete diet without plants without a
| significant portion of nutrients coming only from
| supplementation.
| profsummergig wrote:
| > It's possible to have a nutritionally complete diet of
| only plants
|
| Vegans need B12 supplementation.
| atombender wrote:
| This article is about fats, so what is the relevance of your
| comment?
|
| Anyway, did any of these people try reintroducing plants in
| their diet? If not, at most we can say that a change in diet
| caused these improvements. We cannot say that plants are
| somehow a contributor to disease.
|
| In fact, I've heard the same anecdotes as yours, except the
| diet change was the exact opposit: People who stopped eating
| meat and saw incredible changes to their health. These
| anecdotes and yours have one thing in common: Change.
|
| We have good evidence that the gut microbiome can change its
| composition very quickly, in the manner of days, based on food
| intake. It's possible that some part of the microbiota were
| reduced or boosted as a result of the radical shift in the
| diet, and that you'd see a similar effect if you went meat ->
| plants.
|
| If you're a science-minded person, you could try introducing
| specific things you eliminated, one by one. That is the
| principle behind an elimination diet, after all. For example,
| add broccoli for a week and see what happens. If you get worse,
| maybe it _is_ the plants.
| JumpCrisscross wrote:
| It's not a healthy long-term diet. But as a treatment diet,
| going all in on fat and protein absolutely works for weight
| loss. You're probably in ketosis, for example.
| hollerith wrote:
| I find I can eat plants along with my beef, lamb and butter as
| long as those plants are very low in "carbs": fennel, daikon
| radish, cauliflower, cabbage.
|
| Although plants make up only a small fraction of my caloric
| intake, because they are much less dense in calories, they make
| up a large fraction of the mass (and volume) of the food I eat.
|
| Those veggies are mostly fiber. Fiber is technically
| carbohydrate (hence my putting "carbs" in quotes earlier), but
| unlike most of the carbs in the typical person's diet, the
| fiber in the plants I eat doesn't get converted by my gut or my
| body into fructose or glucose, so fiber is OK for me to eat.
|
| Most of the plant foods people eat that aren't loaded with the
| kind of carbs that get converted into fructose or glucose are
| loaded with oxalate, which I have tentatively concluded is a
| problem for me. Cabbage, cauliflower and radishes are extremely
| low in oxalate, for plants. Fennel is not particularly high,
| but also not particularly low in oxalate, so on days I eat
| fennel I take measures to encourage prompt elimination of the
| oxalate (i.e., I eat fennel only during the first meal of the
| day and I make sure to get plenty of calcium every meal that
| day).
| elawler24 wrote:
| High cholesterol and heart attacks are common in my family. This
| year, after my dad had intensive open heart surgery, my doctor
| recommended trying a strict plant-based diet for 90 days with a
| blood test before and after. She had been studying medical
| journals on the topic primarily from Canada (she said it's easier
| to find medical research not funded by corporations there).
|
| Before the doing the plant-based diet, I had such high
| cholesterol that I would have needed to start taking statins
| before age 35. After the 90 day diet experiment, my cholesterol
| dropped by 130 mg/dL. I no longer need to be put on medication,
| and am within a healthy range.
| readthenotes1 wrote:
| A family member went on the ornish-like diet + atorvastatin for
| 7 years* after open heart surgery for block in the left main.
|
| Hen tested (via ultra fast CT scan) the blood flow after the
| experiment -- there was no change.
|
| It may sound depressing, but it's actually very good for what
| is normally a progressive disease.
|
| The experimenter is currently now doing another 7 year
| experiment, eating a somewhat healthier than normal diet +
| statins.
|
| After getting off the ornish diet, there was hardly any change
| in total cholesterol.
|
| *The diet was ornish-like because it was hard to get anything
| to eat when going out. The experimentar ate salmon if there was
| nothing better.
| christophilus wrote:
| I had a similar experience, except with blood pressure. After
| switching to a plant based diet, it's the lowest it's been in
| my adult life.
| drewg123 wrote:
| For me it was both.. I had pretty bad BP and high enough
| cholesterol to that my doctor wanted me on a statin. Now my
| BP is normal, and my cholesterol is in the "low risk" range.
| My doctor said she'd never seen such an improvement before.
|
| In my case it was not the suggestion of a doctor, but rather
| dating and now marrying a vegan. I converted to a plant based
| diet starting with eating plant based just with her, and then
| I became fully vegan for health reasons.
| 542458 wrote:
| For what it's worth, the linked article does not dispute that
| diet can affect blood cholesterol, but does argue that it
| doesn't necessarily equal long term health.
|
| > In other words, although diet could successfully lower blood
| cholesterol, this reduction did not appear to translate into
| long-term cardiovascular gains.
|
| That said, as other commenters here have highlighted the author
| of the study has a spotty track record so, uh, big grain of
| salt.
| tomp wrote:
| what did you eliminate, i.e. what were you eating before? eggs,
| milk, cheese/yogurt (fermented diary), meat, processed meat?
| el_benhameen wrote:
| Not OP, but I recently discovered that I have moderately high
| lipoprotein-a levels and decided to try to reduce my LDL as a
| result. I cut most eggs, all butter, all full-fat milk,
| almost all cheese, and switched from whole to skim yogurt. My
| LDL dropped about 20% between the beginning of August and the
| middle of October.
| elawler24 wrote:
| Before, I ate low sugar / carb and high on cheese, meat,
| whole milk, yogurt, and veggies (close to keto). Now I eat a
| lot of rice, beans, while grains, and veggies. I'm trying to
| figure out how to get enough protein though, that's the trade
| off.
| readthenotes1 wrote:
| Although the author of the article appears to be controversial, I
| am concerned that none of the responses citing her controversial
| nature are actually rebutting anything in the paper.
|
| I believe most of what was written here appears to be factual.
| What am I missing?
|
| (Someone attacking the currently held beliefs taught by science
| is by nature controversial. More important question is whether
| they are pointing out flaws in those beliefs. )
| KempyKolibri wrote:
| I'm happy to discuss the paper. All her takes on the Seven
| Countries Studies are just poor. France wasn't excluded by
| design, for example. All this is covered by a white paper here:
| https://www.truehealthinitiative.org/wp-content/uploads/2017...
|
| As for the claims about RCTs, she straight-up lies, quote:
| "including by the prestigious Cochrane group, most recently in
| 2020. Altogether, >20 review papers, including umbrella
| reviews, have been published, with the vast majority concluding
| that the data from randomized, controlled trials do not provide
| consistent or adequate evidence for continued recommendations
| limiting the intake of saturated fat"
|
| So what did the 2020 Cochrane paper _actually_ say? Let's look:
| " There was a 17% reduction in cardiovascular events in people
| who had reduced SFA compared with those on higher SFA" "When we
| subgrouped according to replacement for SFA, the PUFA
| replacement group suggested a 21% reduction in cardiovascular
| events"
|
| So she invokes the respectability of Cochrane yet claims their
| findings are incorrect, and tries to pass it off as a Cochrane
| reviewing showing that saturated fat is unrelated to heart
| disease? This alone should tell you everything you need to know
| about Teicholz. She relies on her audience not knowing the
| papers she references, because she misrepresents them to fit
| her agenda. She's completely dishonest.
|
| Ref to Cochrane:
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
| snapplebobapple wrote:
| You picked out the one result in five or six from the summary
| of result that supports the reducing saturated fats and
| ignored the rest that said it disnt matter (and of those
| result all cause and cardiovascular mortality were in there
| in the saturated fat doesnt affect category). There are
| straight up lies here but they are in your response.
| derbOac wrote:
| FWIW I think contrarian scientific viewpoints are important if
| they're rigorous, and Teicholz makes a reasonable case for the
| viewpoint that saturated fat reductions are unrelated to
| mortality.
|
| However, I don't think Teicholz herself is really being
| entirely "factual", bringing purported conflicts of interest
| into her discourse when it goes on on both sides. People have
| pointed out that her organization has its own history with this
| problem: https://thehill.com/blogs/congress-
| blog/healthcare/257353-co....
|
| That isn't addressing your question but I guess I disagree that
| Teicholz is just dispassionately presenting a rigorous
| argument, even if I find it compelling myself. Some of what she
| writes is sort of misleading (as that linked piece points out)
| even if I think her most cogent arguments are reasonable.
|
| A lot of her arguments hinge on how you see things like the
| Cochrane meta-analysis. Her sensitivity analysis with
| colleagues is compelling in dismissing the CVE result in that
| meta-analysis, but at the same time you can whittle away any
| effect if there's not a big enough N (in a sort of inverse form
| of p-hacking), so I'm not sure I'm entirely convinced either.
|
| Also as that piece points out, Teicholz seems dismissive of
| anything that's not mortality as an outcome, which I'm not sure
| I agree with.
|
| I'm sympathetic to Teicholz's arguments, I guess I just feel
| like she doesn't make them any more convincingly to me than
| those she criticizes.
|
| At this point for me personally my reading of the literature is
| that a lot of things are related to individual physiology, and
| I'm skeptical of a lot of blanket recommendations regarding
| nutrition. Reducing saturated fats has been good for me
| personally so I stick with that.
| jvanderbot wrote:
| The book Outlive has a great discussion about CVD and diet. There
| is a link, and food types matter, but reducing foods to their
| saturated fat content is of course ridiculous as we now know.
| profsummergig wrote:
| Anyone else have alternative takes on cholesterol based on
| personal experience?
|
| Some alternative theories I've come across:
|
| - There's a theory that cholesterol is good for you. It's
| necessary for brain functioning. Low levels of "bad" cholesterol
| have been linked to depression.
|
| - There's a theory that the high levels of cholesterol in blood
| clots found around ripped arteries may be due to the body trying
| to heal a rupture with cholesterol.
|
| - There's a theory that seed oils and table sugar, which have
| only been mass consumed for the last 100 years or so, are what
| cause heart disease.
|
| Personally, I have a very high level of both good and bad
| cholesterol. They shot up after I started eating a lot of non-veg
| food. And after they shot up, I stopped having depressive
| episodes.
| elawler24 wrote:
| I do have a fear that staying vegan will have other negative
| effects, unrelated to cholesterol - esp brain and bone density
| related. For me that means cutting out cheese, milk, and butter
| as much as possible. But having fish and lean meats 1-2 times
| per week.
| nradov wrote:
| Cholesterol by itself isn't harmful. For most people with
| typical genetics, cholesterol only becomes a problem when
| arterial plaques form as a reaction to vascular damage.
| Limiting cholesterol is one fairly effective approach to
| preventing those plaques, but a better approach is to avoid the
| damage in the first place. In other words, it doesn't matter if
| a little extra cholesterol is floating around in your
| bloodstream as long as it doesn't stick to the walls.
| ano-ther wrote:
| Nutrition science is hard. The effects are long-term and easily
| confounded by all the other things one eats. Randomized
| controlled trials are not easy to pull off. It's only loosely
| regulated and and a big market. And everyone eats, so everyone
| has an opinion.
|
| Perhaps that's why there is a lot of sketchy results, hyperbole
| in communication, and a cycle of debunking (of the debunking)
| around.
| mgh2 wrote:
| *Original article submitted to HN:
| https://www.eviemagazine.com/post/american-heart-association...
| gurjeet wrote:
| TL;DR from the fine article:
|
| Summary
|
| The idea that saturated fats cause heart disease, called the
| diet-heart hypothesis, was introduced in the 1950s, based on
| weak, associational evidence. Subsequent clinical trials
| attempting to substantiate this hypothesis could never establish
| a causal link. However, these clinical-trial data were largely
| ignored for decades, until journalists brought them to light
| about a decade ago. Subsequent reexaminations of this evidence by
| nutrition experts have now been published in >20 review papers,
| which have largely concluded that saturated fats have no effect
| on cardiovascular disease, cardiovascular mortality or total
| mortality. The current challenge is for this new consensus on
| saturated fats to be recognized by policy makers, who, in the
| United States, have shown marked resistance to the introduction
| of the new evidence. In the case of the 2020 Dietary Guidelines,
| experts have been found even to deny their own evidence. The
| global re-evaluation of saturated fats that has occurred over the
| past decade implies that caps on these fats are not warranted and
| should no longer be part of national dietary guidelines.
| Conflicts of interest and longstanding biases stand in the way of
| updating dietary policy to reflect the current evidence.
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