For You Lot Data Diet-Heart: A Problematic Revisit

In 2010, Jeremiah Stamler published the editorial 4 Perhaps the cholesterol skeptics attain non portion Stamler’s involvement of saving lives, explaining why they get got chosen to refrain from informing their audience of Stamler’s findings. 

Another shortcoming of the Siri-Tarino et al. meta-analysis newspaper was the lack of acknowledgement inward the assessments together with conclusions that major cross-population studies amongst a prospective (future looking) design, such equally the Seven Countries Study found that saturated fatty was associated amongst a significantly increased run a hazard of fatal coronary pump affliction (Fig. 1).5 Consistent amongst the tendency of the findings from the Seven Countries Studies, the nomadic Kirghiz plainsmen who subsist on a diet of enormous amounts of organic grass-fed milk together with meat sense severe vascular affliction at a real immature age [reviewed previously].

Figure 1. Saturated fatty equally % of calories together with fatal coronary pump affliction inward xvi cohorts from the Seven Countries Study

In this serial of posts I volition review the diet-heart hypothesis together with the arguments against the hypothesis raised past times known cholesterol skeptics. Note that inward this review the diet-heart hypothesis refers to the hypothesis that dietary change, such equally the commutation of private dietary fats for saccharide influences serum (blood) lipids (including serum full together with LDL cholesterol), together with hence at the real to the lowest degree indirectly influences the run a hazard of developing coronary pump disease.

Stephan Guyenet, the writer of the Whole Health Source weblog has produced roughly real informative posts dispelling Gary Taubes’s misleading claims regarding saccharide metabolism, insulin together with obesity.6 Unfortunately, similar Taubes rather than embracing the preponderance of prove that has established the diet-heart hypothesis, Guyenet has chosen to confuse the discipline inward a serial of weblog posts. I get got previously commented on Guyenet’s weblog regarding i such concerning post service inward May 2011 where I raised my concerns regarding Guyenet’s arguments against the prove that saturated fatty raises serum cholesterol, together with increases the run a hazard of coronary pump disease.7  

One of my top dog concerns I presented inward my comments on Guyenet’s weblog was his lack of acknowledgement that saturated fatty was associated amongst an increased run a hazard of fatal coronary pump affliction inward the Health Professional’s Follow-up Study together with inward Stamler’s meta-analysis. Guyenet was less than appreciative of these comments, stating:

I uncovering it disturbing that yous proceed to bring upwards the Health Professionals follow-up report to back upwards your set despite the fact that in that place was no statistically pregnant association betwixt SFA intake together with whatever stair out of CHD afterward maximum adjustment. If in that place were truly a human relationship betwixt the 2 factors, yous wouldn't get got to bring upwards non-significant findings to back upwards your position.

In the newspaper from the Health Professional’s Follow-up Study cited past times Guyenet, for men inward the operate past times verses the lowest 5th of saturated fatty intake the relative run a hazard for fatal coronary pump affliction was 1.72 (95% confidence interval 1.01 to 2.90) afterward maximum adjustment.8 In other words this report found that saturated fatty intake was associated amongst a statistically pregnant 72% increased run a hazard of fatal coronary pump affliction for high compared to depression intake. Guyenet avoided straight responding to my comments regarding the finding inward Stamler’s meta-analysis for fatal coronary pump disease, together with but referred dorsum to the Siri-Tarino et al. meta-analysis which failed to address this fatal halt point.

In this detail post service that I commented on, Guyenet made several misleading statements inward reference to the findings from the Siri-Tarino et al. meta-analysis: 

Nearly every high-quality (prospective) observational report e'er conducted found that saturated fatty intake is non associated amongst pump assault risk. So if saturated fatty increases blood cholesterol, together with higher blood cholesterol is associated amongst an increased run a hazard of having a pump attack, together with so why don't people who swallow to a greater extent than saturated fatty get got to a greater extent than pump attacks?

Apart from the failure to admit that Stamler demonstrated that the cohort studies included inward this meta-analysis found that saturated fatty intake was truly associated amongst an increased run a hazard of fatal coronary pump disease, in that place are several other points inward this declaration that are problematic that volition live addressed separately.

The Problem of Overadjustment 

Guyenet’s proposition that the Siri-Tarino et al. meta-analysis should get got found a positive association betwixt saturated fatty together with coronary pump affliction if saturated fatty raises serum cholesterol together with serum cholesterol increases the run a hazard of coronary pump affliction is misleading. One of the nigh serious flaws inward this meta-analysis was the inclusion of overadjustments for serum lipids together with dietary lipids, which would get got obscured this diet-cholesterol-heart human relationship that Guyenet referred to. Stamler addressed this flaw inward the editorial:5 Another strength of the Seven Countries Study is that dietary intake was assessed betwixt groups of individuals which has been shown to resultant inward less measurement mistake than assessing dietary intakes betwixt individuals equally was done inward the cohort studies included inward the Siri-Tarino et al. meta-analysis.11 Another work that could get got potentially obscured the findings inward these studies, peculiarly those that lasted into the statin era is that participants amongst higher serum cholesterol equally a resultant of a high saturated fatty intake maybe to a greater extent than probable to get got received aggressive medical intervention inward lodge to foreclose cardiovascular disease. It should live emphasized hither that Stamler found inward a meta-analysis that saturated fatty was associated amongst a 32% increased run a hazard of fatal coronary pump affliction despite such problems.reviewed previously].24

Siri-Tarino et al. excluded cohort studies of type II diabetics patients from the meta-analysis which should live addressed. Two such studies found a real strong association betwixt saturated fatty together with cardiovascular disease, including the Nurses’ Health Study which too found a pregnant association for dietary cholesterol together with the Keys score.Part I together with Part II of a review addressing blood pressure, blood cholesterol, diet together with the run a hazard of stroke, which too addresses the Northern Manhattan Study which found that saturated fatty was associated amongst a tendency towards an increased run a hazard of ischemic stroke that was excluded from the Siri-Tarino et al. meta-analysis despite manifestly coming together the requirements for the inclusion criteria.31

The Problem of Reductionism

The affliction promoting properties of saturated fauna fatty cannot live ascribed purely to the commutation of saturated fatty for other macronutrients, but too to other nutritional factors including the content of dietary cholesterol, ruminant trans-fat and the lack of dietary fiber together with other phytonutrients. For example, a report on an manifestly wellness witting population included inward the Siri-Tarino meta-analysis found that spell saturated fatty was associated amongst 2.77 crease increased run a hazard of coronary pump affliction which was the value used inward the meta-analysis, the association for fauna fatty was fifty-fifty stronger, a 3.29 crease increased risk.32

In the pooled analysis of eleven large cohort studies, compared to saturated fat, monounsaturated fats which was predominantly derived from fauna fatty was associated amongst the greatest increased run a hazard of coronary events out of all the studied macronutrients. Furthermore this pooled analysis adjusted for dietary fiber, dietary cholesterol together with maybe ruminant trans-fat, which too needs to live taken into consideration equally this could get got potentially underestimated the adverse effects of increasing saturated fauna fatty intake at the expense of whole flora foods.43 

This was unfortunately non the final fourth dimension that the researchers of an manufacture influenced report would expose a newspaper that has the potential to jeopardize the wellness of so many. What is too unfortunate is that many cholesterol skeptics get got too chosen to exploit these findings inward an attempt to advocate affliction promoting diets to an uninformed audience. Follow-up posts inward this serial volition critically examine other lines of prove of the diet-heart hypothesis that cholesterol skeptics get got chosen to misinterpret together with exploit inward an attempt to confuse the full general population. 

Diet-Heart Posts

Part II - Diet-Heart: Saturated Fat together with Blood Cholesterol

Part III - Diet-Heart: The Role of Vegetarian Diets inward the Hypothesis
Part IV - Cracking Down on Eggs together with Cholesterol
Part V - Cracking Down on Eggs together with Cholesterol: Part II


Please post service whatever comments inward the Discussion Thread. 

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