Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years
For the bulk of my medical career, physicians thought that saturated fat caused heart disease, specifically coronary artery disease and heart attacks. Most doctors still think that. In 2009, I spent 80 hours reviewing the scientific literature supporting the saturated fat/heart disease connection. The evidence was very weak, if not nonexistent.
But what if you are already a heart disease patient? Would continuing saturated fat consumption have any effect on your longevity and risk of future heart attacks? If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.
Dr. Sigurdsson is a cardiologist in Iceland.
Some quotes from his blog:
For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.
The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.
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Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.
Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.
It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.
Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.
These recent scientific data don’t imply that we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.
So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.
On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.
It appears the jury is still out…
RTWT.
Diabetic Mediterranean Diet 
I believe that the consensus is coming around in the direction of restricting sugar and processed carbohydrates and will spin both the medical establishment and the food industry on it’s axis for a while. While I absolutely love they many triumphs and victories that our world of medical science has achieved it scares me to think how easy it is to buy into any idea about food intake as you know results can always be spun in the direction of profits.
It’s hard to change someone’s mind when their livelihood depends on the old way of thinking.
This is so true
Rimm’s study used their “Low Carbohydrate Diet score” for people in the Nurses Health Study and the Health Professionals Study, but nowhere do we learn what %carbohydrate this corresponds to, making it useless for guiding our food choices
Yes. I don’t use it to guide mine.
I would suggest that a lot of these discussions head off into the wrong directions very quickly, seemingly with no correction possible after that: It looks a lot like asking the wrong question. Years ago, in the “Panu” Blog, by Kurt Harris, M.D., Dr. Harris expressed the idea in many cases that the good results of the “Paleo diet” were to a large extent “caused” by what was NOT being eaten… Thus calories consumed in the form of fat and protein reduced greatly the calories consumed in the form of carbohydrates.
Taken even further in the IDM blog of Dr. Jason Fung, the concept is expressed in terms of limiting and reducing the insulin generated by the body in response to carbohydrate consumption. This is accomplished by either intermittent fasting (“IF”) or complete fasting (except for clear liquids and bone-broth) for some extended period. Thus insulin sensitivity is quickly (within days or weeks) improved and Type 2 diabetes “reversed” and “cured,” simply by NOT eating all the time. “Fasting” avoids the constant consumption of food, because it is the digestive process (mainly in response to carbs) itself that generates the insulin response of the body. It is not so much the excessive caloric consumption but rather the reaction to the insulin, leading to fat storage, that is the problem in obesity and insulin resistance (diabetes).
Looked at in this way the apparent confusion is resolved. People are simply not “evolved” or designed to eat three or more times per day, or to eat too many carbs each day, or to eat morning noon and night, and then have a snack before bedtime, etc. Snacking is the enemy. It is not the sugar per se that is the problem, it is the insulin generated in response to eating the sugar. Having a six or eight hour “window” within which to eat will allow you to eat sugar and carbs in moderate amounts, within that window. People should be able to do that if they are healthy.
Richard, I agree with much of what you have written. Thanks for the comment.
-Steve