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Doctors today pride themselves on practicing “evidence-based medicine.” That means using the best scientific data derived from research to make recommendations for policy and treatment.
When it comes to diet and nutrition, however, old beliefs die hard. Even when the evidence contradicts dietary dogma, health professionals may cling to outdated recommendations.
For nearly fifty years Americans have been warned to back away from butter, minimize meat and skimp on salt. This so-called healthy diet was supposed to protect us from heart attacks, strokes and other health problems like hypertension, diabetes and obesity. It turns out that these dietary guidelines were not based on solid scientific research. The recommendations did not reduce cardiovascular disease, diabetes or obesity. If anything, the twin epidemics of diabetes and obesity are far worse today than when the guidelines were issued.
The Straight and Skinny on Saturated Fat
A recent meta-analysis indicates that the dietary advice in the 1977 US guidelines to cut fat intake, especially saturated fat, was not supported by the findings from randomized controlled trials that were available at that time (Open Heart, online Feb. 9, 2015). This led the authors to remark that:
“It seems incomprehensible that dietary advice was introduced for 220 million Americans and 56 million UK citizens, given the contrary results from a small number of unhealthy men.”
Saturated fat has remained the main dietary villain for heart disease for over 50 years. Last year a meta-analysis of 72 studies with more than 600,000 participants determined that there was no association between how much saturated fat people ate and their risk of having a fatal or nonfatal heart attack (Annals of Internal Medicine, March 18, 2014).
Another study published in the Journal of Nutrition (Feb. 2015) spent almost five years following over 2,000 people with diagnosed heart disease. The volunteers filled out detailed questionnaires about their dietary habits at the beginning of the study. The conclusions were:
“There was no association between dietary intake of SFAs [saturated fatty acids] and incident coronary events or mortality in patients with established CAD [coronary artery disease].”
Such studies make headlines because they challenge traditional medical advice. One might expect that health policy would change based on the latest scientific evidence.
Don’t hold your breath. As soon as the newspapers are recycled, nutrition experts will be back to telling us all that saturated fat will harm our hearts. Never mind that the data do not support this belief.
New 2015 Dietary Guidelines Just Released
On February 19, 2015, the United States Department of Agriculture (USDA) announced that its Dietary Guidelines Advisory Committee had submitted a new report on what Americans should and should not be eating. It should not surprise you to learn that the new guidelines recommend that people avoid saturated fat. The panel of experts advises that:
“Sources of saturated fat should be replaced with unsaturated fat, particularly polyunsaturated fatty acids…”
In other words, little, if any, red meat, butter, cheese or whole milk and more vegetable oils like corn or safflower oil. The trouble with the new recommendations is that once again they have embraced belief over science. It is possible that eliminating meat, butter, cheese and full fat yogurt would be good for our health, but until there are large, long-lasting clinical trials to test this concept, there is little data on which to base this advice. By the way, there is growing evidence that a diet rich in polyunsaturated oils may be pro-inflammatory.
2015 Food Guideline Flip-Flops
Cholesterol Is No Longer Bad
The most impressive reversal in the new dietary guidelines is the elimination of the prohibition on cholesterol. For decades Americans have been exhorted to cut back on eggs and other foods that were high in this substance. Shrimp, lobster and chicken livers were verboten along with meat and cheese. Now the experts almost admit in their new report that it was all a mistake. Actually they they use stuffy scientific language to say that cholesterol never really mattered and there were no data to support the old dietary dictums. Part D of Chapter 1 on page 17 states:
“Previously the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC (Dietary Guidelines Advisory Committee) will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC (American Heart Association/American College of Cardiology report. Cholesterol is not a nutrient of concern for overconsumption.”
OK, did you catch the big challenge? The new guidelines fly in the face of the cholesterol demonization by the American Heart Association and the American College of Cardiology. Have you ever wondered how much cholesterol is in one egg? Depending of course on the size of the egg, you could get over 200 mg. Two eggs would push you over the day’s allowable limit of 300 mg. The new guidelines admit this limit was without scientific support and basically eliminate cholesterol restrictions.
What About Salt?
Like saturated fat, sodium chloride has been labeled a killer. The American Heart Association is adamant that “all Americans reduce the amount of sodium in their diet to less than 1,500 mg a day.”
The Institute of Medicine, the country’s most prestigious medical organization, published a report last year noting that there is a lack of evidence supporting low-sodium guidelines (JAMA Internal Medicine, Jan. 2014). A meta-analysis of 25 studies found that people with the lowest salt consumption actually had an increased risk of death (American Journal of Hypertension, Sept., 2014).
The new dietary guidelines also take issue with the American Heart Association and the CDC when it comes to salt. Instead of recommending less than 1,500 mg of sodium daily, the report suggests that 2,300 mg is a more reasonable target.
Bottom Line
The Dietary Guidelines Advisory Committee has made some interesting progress with its new recommendations. The panel strongly urged Americans to cut back on sugar. At last we are hearing from nutrition experts that sugar is in fact contributing to many of our health problems including diabetes and obesity.
Hmmm. That’s something physicians knew over 100 years ago, but somehow it was forgotten in our low-fat fanaticism. Many of the low-fat foods of the 1990s had added sugar to make them more palatable.
The idea that we should eat more vegetables was something that our grandmothers used to encourage, so we’re delighted that the new dietary guidelines encourage that.
We are disappointed, however, that saturated fat is sill labeled a dietary demon. Until there is actual evidence that butter is bad and that cheese is a killer, we’re not on board with the new recommendations. Ask any Frenchman if margarine is a healthy substitute for butter or whether you should avoid Brie and Camembert and you will be laughed out of town. By the way, the French, who ignored our advice to cut back on cholesterol and shun saturated fat have less coronary heart disease. This is the so-called French paradox.
In this era of evidence-based medicine, dietary guidelines need to change to keep up with the latest scientific research. We are glad to see the flip-flop on cholesterol in the latest report. But the public health policy makers at the American Heart Association, the American College of Cardiology and the CDC will lose credibility if they continue to base their recommendations on unsubstantiated beliefs rather than on evidence.
You can read more about other dietary approaches to keeping your heart healthy in our book, Best Choices From The People’s Pharmacy.
MD
Florida
I saw a cardiologist for the first time last week. I am more confused than ever. He told me that there is no way even a horrible diet could be responsible for the numbers in my lipid profile. Which begs the question – is there a way to determine why my liver is producing way too much cholesterol?? If 80% of cholesterol is produced by the liver and there is essentially no fat or cholesterol from the diet, could the liver be over compensating and producing too much? Do we have to blame this on genetics or can we somehow figure out what the problem is? I had one grandparent with a documented heart attack – other family members (grandpa, uncle, aunt) died in their sleep and it was “assumed” to be heart related but there is no proof (and all 3 of these relatives had asthma so could it have been that instead?). I have tried Lipitor, Simvastatin, Niaspan and Lovaza and in addition to the side effects that made it difficult to get out of bed each day, ALL of them made my numbers go UP. So next visit we are to explore options – possibly easing into dosages so my body has time to adjust – lowest possible dose every other day or two to see if side effects are still problematic. Does inflammation affect cholesterol production by the liver? I do have inflammation – bone and joints, allergy and asthma. Would decreasing inflammation help?
I think part of what bothers me about all this is how cholesterol medications are marketed. If you need them, people assume you are a double bacon cheeseburger and fries addict. I am a marathoner and my dietitian shared my eating habits with her other patients as she could not improve on them and yet I still have to worry about cholesterol! Maddening. The past couple of years, joint issues have prevented me from training and because my exercise regimen has changed, I have gained weight which also affects my numbers and puts added strain on my already sore joints. I am open to any and all suggestions.
jack c
whitsett,nc
After hearing Gary Taubes speak of his research for his 2007 book “Good Calories, Bad Calories” and finding that it made sense to me, and I’ve been “on the road” talking to others since. From my research the additional factor to consider is that as much food as possible (as your wallet allows) be organic/free-range to prevent chemicals building -up in the body and causing diseases.
Thanks for your continued vigilance for our health!!!
J. David Auner
Springfield, MO, USA
The only study I saw in the 70’s to justify a switch away from saturated fat was in patients with Type 2 hyperlipidemia. These unusual patients were fed 50 grams of cholesterol and either saturated fat or vegetable oil. The total cholesterol climbed to 450 in the saturated fat group and 440 in the vegetable oil group. The data was really this thin in a study of genetic oddities.
Jon
Huntersville, NC
I am 74 years old and my most recent blood test my doctor stated “looks excellent”. My total Cholesterol/HDL Ratio is 2.0. I laugh at so many of the health guidelines. Why – I use as much as I need or want of Sea Salt (it’s good for you), Lard, Olive Oil, Canola Oil, and Butter. I eat lots of eggs and drink lots of milk. I also imbibe within reason. I lived on a farm as a boy and they knew a hell of a lot more about nutrition than many of our so-called experts today.
Mark
NC
Personally, when I eat too many carbs I gain weight, don’t sleep good and feel terrible. I am 51 and at this point my “belief” that I think is supported by the evidence is that fat is OK as long as the carbs are controlled. Wheat, oils and sugar mixed, like a doughnut, is poison.
When I have been to Italy I notice that they eat a ton of salt in their food. But, it seems to me that Italians seem to, overall, be healthier than Americans. What they don’t eat much of is fast food and no breakfast to speak of. It leads me to believe that the food pyramid in the USA is misguided at best. I ignore it. Lots of veggies and some meat is what I think works best. My blood work seems to support this too.
June
SD
I always chuckle to myself when I read about dietary guidelines. I have always eaten exactly what I please. My meals consist of white potatoes, gravy, meat or chicken, (NEVER fish), pasta occasionally, veggies (corn, peas, or green beans), white bread with butter and jelly, milk. I eat ice cream, cake, cookies, etc. Salad….hardly ever. Fruit…once in a while. I am 5′ 5 1/2″ tall, weigh 130 lbs, take NO prescription drugs. I do some exercises each day, but nothing strenuous. Since this appears to be working, why change a good thing. Oh…I am almost 81 years old.
BobK
Bluffton, SC
I’ve been asking a question for years which is my grand parents ate just about everything that had fat in it and on a daily basis. Along with that was some whiskey and an occasional cigar and no heart issues anywhere in that town that I was aware of.
The problem that I have with today’s studies is the relationships that are being used in the studies. There simply are too many variables in the test subjects used to pin a food habit/intake on a physical issue. For example in the electronics world if there is a circuit problem I can pin point the actual problem and what actually caused it. I can also use theory to prove/support these findings and they are repeatible. This is what we need in medical field. I want to know the exact relationship of say a food product that I eat and how it chemically gets transformed in the body and then the end result is plainly observed and can be reproduced time after time after time. If the same cause and affect relationship isn’t valid in the next person then I want to know why it isn’t. Until we get to this level of understanding of our bodies and the foods we eat we can only view these tests as a small piece of data that may or may not be valid. From what we’ve seen most of these studies have been invalid.
Sine
St. Louis, MO
I believe that moderation is the key. Trouble starts when we are out of balance.
Mary
It speaks loudly about the accuracy of food recommendations that most health problems have increased rather than decreased since those guidelines were put into practice.
Look specifically at obesity & diabetes as examples of where this has failed to increase health.
Some MAY do better with low saturated fats and salt. For most of us, that seems not good advice.
I do avoid standard table salts since they are more polluted than Celtic or Himalayan.
Suzanne
United States
I believe that non-evidence based” food science” has fueled the food industry’s output of contrived food products and the pharmacutical industry’s expensive drug treatments for diseases caused by consumption of these food products along with a sedentary lifestyle. Rather than offering simple foods with minimal processing to consumers, we have grocery stores chock full of food products “designed” with cheap ingredients to increase corporate profits for the food and pharmacy industry. I stand by the “diet plan” I learned 50 years ago from La Leche League: Eat a variety of foods as close as possible to their natural state. The only change I’ve added to this short mantra is “a variety of pesticide-free foods.”
farm girl
MI
I fully agree with all the points you entered.
Helene
Illinois
Excellent article on fats and cholesterol findings. I wish these “experts” and the medical society would make up their minds on what is good and bad for all the millions of consumers who are instructed to follow their guidelines. I NO longer use the “healthier” substitutes such as all the chemicals and fake ingredients that replaced the “bad” ingredients. I say, the REAL stuff in moderation and get off your butt and move around. The FAKE, CHEMICAL induced junk in foods is the REAL CULPRIT that is killing us! Anyone else agree with this??
Thank you! =)
Geoff
Wisconsin
Don’t be so negative. The change in recommendation is welcome and your criticisms on target. However, your negative attitude toward the ghosts of the past is inappropriate. (As one of those ghosts, retired FP [family practice physician], I confess a bias.)
Some points to deflate the negativism; 1) The data regarding saturated vs unsaturated fats looked very convincing at the time.
2) RCTs [randomized controlled trials] in dietary studies are extremely difficult and frequently not well controlled. Either a large number of subjects or a long period of study is needed. Try getting 500 people to eat an identical diet for 5 years. Might as well herd cats.
3) Meta-analysis studies are limited in validity. An inherent defect is that different groups are studied with different criteria and then combined into one result. Look at the study you quote. Out of 98 studies found they could only use 6. The other studies were valid studies. What did they show?
4) Science progresses. We know more today than we did yesterday. That does not mean we were negligently wrong yesterday, rather we were incompletely informed.
5) The meta-analysis you quote does not reveal any evidence of what is a good diet. It debunks “knowledge” we thought we had but does not replace it with anything.
Bringing this study and paradigm shift to our attention is necessary. You do a great job of seeing and revealing the whole picture. But please don’t be so harsh on us old folks that were acting in good faith on behalf of our patients.
Geoff
The People's Pharmacy
Dear Dr. Geoff,
Thank you for taking time to comment on our article. We very much appreciate your perspective.
Neither physicians nor ordinary people should be blamed for acting in good faith on past advice. (Some of the policy-makers knew that the process of making those recommendations had a lot of politics in it. We’ll let others decide if they should be let off the hook.)
What we worry about is the authorities that seem to be clinging to old dietary dogma as an article of faith, without considering new research results. We grant that dietary studies are difficult. One of the most impressive modern dietary studies, PREDIMED, has been justifiably criticized for being stopped too soon. We continue to be very interested in learning how the many possible dietary patterns that support human life affect our health.
Kathleen
Tustin, CA
It’s past time to take all statins off the shelf and burn them! If there is no correlation between consuming cholesterol and heart disease, where is the collation between lowering LDL levels and death from heart disease? The number needed to treat needs to be re examined, as does death from other causes. The side effects of these awful drugs have caused many more problems than they’ve solved.
J. David Auner
Some statins are too toxic for human use – Mevacor(lovastatin) is one of these poisons. Many people need a statin to live longer and with proper monitoring can take these drugs safely. Zocor and Pravachol have antioxidant properties along with lowering LDL-cholesterol levels which is helpful in patients with vascular disease. I have seen one patient reverse his vascular disease without a statin but I have helped dozens stop or reverse vascular disease with statins included in a multiple risk reduction regimen.
Greg
Dallas
To add to this story, reading Nina Teicholz’s book “The Big Fat Surprise” really opened my eyes to the development and implementation of the misguided dietary guidelines based on flawed studies. A must read for those who want to understand how all this happened.
Rick Matz
Springfield, MO
I am acquainted with a research cardiologist and an early contributor to development of the stent used in coronary problems. He told me over 20 years ago that the focus on dietary cholesterol was meaningless.
Judy
NC
Thank you for your informative emails, I enjoy learning about the newest things in our health! This report is making me laugh. At 75 I have been asking my Dr. to take me off statins as my muscles felt like water every time I used them. We tried MANY with no good results.
After years of fighting this I quit totally only to find out that my Dr. had good news; after 75 if you have had no “events” you can decide to quit statins! Wow who would believe that our bodies actually do tell us what is good for us!
My other chuckle is salt. My Mother who is 95 has always craved salt. Who would have guessed that she wasn’t crazy after all! Thanks
Jeanne E
Charlottesville,VA
I enjoy listening to your People’S Pharmacy every Saturday a.m. Every topic is different.
Recently, I particularly enjoyed the Dietician given valuable and delicious advice on broths. I will try her chicken broths’ recipes, but could not find chicken feet nor heads at Whole Foods’ Market; only necks and backs. Forgot to buy some fresh herbs and garlic, though.
Wish me luck! Keep up the good work. Thank you. Jeanne (je suis francaise!!!)
Richard
SW VA
Jeanne,
May I suggest you visit farmers markets in your area that sell fresh chicken. The firsts ones may be available late spring. But some farmers may have chicken heads and feet frozen in bulk even now, for their own stocks. We do! Your area market managers could give you direct contact info for the farms raising poultry on a small scale, who do their own processing. There are also local food guide(s) for your area that would list such farms.
Thankfully, in Virginia, on-farm poultry processing is legal. If you are willing to visit the farm and pick up the heads and feet during processing, that may hold down the cost for you. Else expect to pay more for the packaging and transport by the farmers.
Please remember your local farmers and markets for any new, traditional or uncommon food requests. We want to make a living and provide for you, through local foods!