Myths and Misinformation About Saturated Fat and Cholesterol: How Bad Science and Big Business Created the Obesity Epidemic Departments of Psychology,

Myths and Misinformation About Saturated Fat and Myths and Misinformation About Saturated Fat and Cholesterol: How Bad Science and Big Business Cholesterol: How Bad Science and Big Business

Created the Obesity EpidemicCreated the Obesity Epidemic

Departments of Psychology, Molecular Pharmacology and Departments of Psychology, Molecular Pharmacology and Physiology, University of South FloridaPhysiology, University of South Florida

andandResearch and Development Service, J.A. Haley Veterans HospitalResearch and Development Service, J.A. Haley Veterans Hospital

David Diamond, Ph.D.David Diamond, Ph.D.

YearsYears

Bad News: Abnormal Blood LipidsBad News: Abnormal Blood Lipids

TriglyceridesTriglycerides(mg/dl)(mg/dl)

Heart Disease Risk

Bad News: Abnormal Blood LipidsBad News: Abnormal Blood Lipids

YearsYears

Total/HDLTotal/HDL

Heart Disease Risk

The Solution: Diet Changes and ExerciseThe Solution: Diet Changes and Exercise

Total/HDLTotal/HDL

Heart Disease Risk

YearsYears

DietDietSkinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread,

Vegetables, Fruit, Nuts, Cereal, PotatoesVegetables, Fruit, Nuts, Cereal, Potatoes

Total/HDLTotal/HDL

Heart Disease Risk

YearsYears

Total/HDLTotal/HDL

Heart Disease Risk

XDietDiet

Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Vegetables, Fruit, Nuts, Cereal, PotatoesVegetables, Fruit, Nuts, Cereal, Potatoes

YearsYears

Total/HDLTotal/HDL

Heart Disease Risk

XDietDiet

Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Vegetables, Fruit, Nuts, Cereal, PotatoesVegetables, Fruit, Nuts, Cereal, Potatoes

YearsYears

Really Scary NewsReally Scary News

Heart Disease Risk


!!

YearsYears

Total/HDLTotal/HDL

Heart Disease Risk

!!

YearsYears

Really Scary NewsReally Scary News

Obesity and Heart Disease in My FutureObesity and Heart Disease in My Future

YearsYears

weight in 1980

Body WeightBody Weight(lb)(lb) !!

Myths and Misinformation:Myths and Misinformation:

Myth #1: Myth #1: Consumption of food high in saturated fat and cholesterol Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease(beef, butter) makes people fat and causes heart disease



Myth #2:Myth #2:- Cholesterol clogs arteries and causes heart disease -- Cholesterol clogs arteries and causes heart disease -

You will live longer if you take medication to lower your cholesterolYou will live longer if you take medication to lower your cholesterol


Misinformation:Misinformation:Food and Drug Company-Supported Research and the government Food and Drug Company-Supported Research and the government have provided incorrect recommendations on ideal sources of food have provided incorrect recommendations on ideal sources of food

for optimal health – we have been misledfor optimal health – we have been misled




Obesity

Heart Disease

Diabetes

Alzheimer’s Disease

Hypertension

Stroke

Cancer

Arthritis

Metabolic Syndrome

Historical Perspective on Diet, Obesity and HealthHistorical Perspective on Diet, Obesity and Health(1864 - Present)(1864 - Present)

5’5” >200 lbsObesity-related health problems

William Banting(1797 – 1878)


His doctor (Dr. William Harvey) prescribed a low carbohydrate diet:

Unlimited consumption of meatNo potatoes, bread or sugar




His doctor (Dr. William Harvey) prescribed a low carbohydrate diet:

Unlimited consumption of meatNo potatoes, bread or sugar

The Banting diet was a great successBanting lost 46 lbs, enjoyed great

health, and lived into his 80’s.(no clogged arteries!)



An obese person … may be given a diet of meat, excluding bread and potatoes, and

the patient will reduce to his normal weight. As soon as the patient returns to

his diet of bread and potatoes, he straightaway begins to increase in weight.

1892

==

1972 1864

Eat Meat (fat): Lose weightEat Meat (fat): Lose weightBut is it a healthy diet?But is it a healthy diet?

Does eating red meat, full fat cheese, butter Does eating red meat, full fat cheese, butter and eggs increase serum cholesterol?and eggs increase serum cholesterol?

HDL (good cholesterol)HDL (good cholesterol) Total CholesterolTotal Cholesterol TriglyceridesTriglycerides

LDL (bad cholesterol)LDL (bad cholesterol) Ratio Total/HDLRatio Total/HDL Blood GlucoseBlood Glucose

Low Carb Diet (unlimited red meat): Low Carb Diet (unlimited red meat): Lose Weight and Lower Cholesterol!Lose Weight and Lower Cholesterol!

If a low carb diet reduces serum cholesterol, If a low carb diet reduces serum cholesterol, will a high carb diet (sugar) will a high carb diet (sugar) increaseincrease serum serum

cholesterol?cholesterol?

Low Carb Diet (unlimited red meat): Low Carb Diet (unlimited red meat): Lose Weight and Lower Cholesterol!Lose Weight and Lower Cholesterol!

0 2 4 6 8 10 12 14 16 18 20

0

100

200

300

400

500

600

0 2 4 6 8 10 12 14 16 18 20

150

200

250

300

350


CholesterolCholesterol(mg/dl)(mg/dl)

Normal DietNormal Diet No SugarNo Sugar + Sugar+ Sugar No SugarNo Sugar

WeeksWeeks

YearsYears

My Diet (2007 – Present)My Diet (2007 – Present)Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut,

Dark Chocolate, Nuts and Vegetables (Broccoli)Dark Chocolate, Nuts and Vegetables (Broccoli)Small Quantities of Fruit, Bread, Potatoes and SugarSmall Quantities of Fruit, Bread, Potatoes and Sugar

Heart Disease Risk


Low Carb Diet


YearsYears

Heart Disease Risk

70% Fat70% Fat20% Protein20% Protein10% Carbs10% Carbs

Low Carb Diet



YearsYears


Heart Disease Risk

Total/HDLTotal/HDL

Low Carb Diet



Body WeightBody Weight(lb)(lb)

YearsYears

weight in 1980


Low Carb Diet



Our Current State of ConfusionOur Current State of Confusion

Consequences of the Fat PhobiaConsequences of the Fat Phobia

Carbohydrates

Fats

Protein

1970 1980 1990 2000

Excess Consumption of CarbsExcess Consumption of Carbs

Simple Message to the Obese:Simple Message to the Obese:Stop the Vilification of the Atkins Diet Stop the Vilification of the Atkins Diet

It’s ok to eat meat, lose weight!It’s ok to eat meat, lose weight!

Eat Less Carbs: Eat Less Carbs: Less Potatoes, Bread and Anything SweetLess Potatoes, Bread and Anything Sweet




Myth #1: Myth #1: Consumption of food high in saturated fat and cholesterol Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease(beef, butter) makes people fat and causes heart diseaseX

How Did Food Recommendations Go Awry?How Did Food Recommendations Go Awry?

Deaths from Cardiovascular DiseaseDeaths from Cardiovascular Disease

Lloyd-Jones et al, 2010. Circulation

Deaths from Cardiovascular DiseaseDeaths from Cardiovascular Disease


Keys (1953). Journal of the Mount Sinai Hospital New York

‘‘There is a remarkable There is a remarkable relationship between relationship between death rate from heart death rate from heart

disease and the disease and the proportion of fat calories proportion of fat calories

in the national diet”in the national diet”

Keys (1953). Journal of the Mount Sinai Hospital New York

- Ancel Keys cheated -- Ancel Keys cheated -He selected data from 6 He selected data from 6 countries to countries to createcreate the the

linear relationship. linear relationship. Data were actually Data were actually

available from a total of available from a total of 22 countries!22 countries!

No Significant Relation Between Fat Consumption and Heart Disease

Mortality (r2=0.1, p > 0.05)

Significant Relation Between Sugar Consumption and Heart Disease

Mortality (r2=0.41, p < 0.05)

“A generation of citizens has grown up since the Diet/Heart Hypothesis was launched as official dogma. They have been misled by the greatest scientific deception of our times: the

notion that consumption of animal fat causes heart disease.”

“Coronary Heart Disease – Doing the Wrong Things”Nutrition Today (July, 1985)

George Mann, Sc.D., M.D.Professor, Nutritional Biochemist,

Vanderbilt UniversityAssociate Director of the Framingham Study

Intake of total fat was not significantly associated with coronary events (heart attacks) or mortality

Intake of saturated fat (animal fat) was not significantly associated with coronary events or mortality

Fatal heart disease was not reduced by low-fat diets or by replacing saturated (animal) fats with polyunsaturated

(vegetable) fats

Walter Willett, M.D.Chair, Department of Nutrition

Harvard School of Public Health

“data on nearly 300,000 individuals … clearly contradict the low-fat-is-good-health message … the exclusive focus on adverse effects of fat may have contributed to the obesity

epidemic.”

Ancel Keys – Created the Artificial Link Between Fat and CHD Ancel Keys – Created the Artificial Link Between Fat and CHD Became Editor of Became Editor of CirculationCirculation

on the cover of Time Magazine, January, 1961on the cover of Time Magazine, January, 1961

In 1977, a Senate Committee led by George McGovern released its "Dietary Goals for the United States." Without any evidence to support their conclusions, the committee identified fat as the

culprit causing obesity.

The President of the US National Academy of Sciences, Dr. Philip Handler, an expert on metabolism, referred to

McGovern’s “Dietary Goals” as “nonsense”.

Steak for Dinner, Angioplasty for Dessert?The Myth That Cholesterol Clogs Arteries

““Thanks solely to “Madison Avenue” promotion by commercial Thanks solely to “Madison Avenue” promotion by commercial food producers and the American Heart Association, a great food producers and the American Heart Association, a great

many people imagine that if they lower their blood cholesterol … many people imagine that if they lower their blood cholesterol … they will prevent heart disease... Few people realize that there has they will prevent heart disease... Few people realize that there has

never been a proven, scientific relationship between lowering never been a proven, scientific relationship between lowering blood cholesterol levels and preventing heart disease”blood cholesterol levels and preventing heart disease”

The Cholesterol Controversy, 1973The Cholesterol Controversy, 1973by Edward Pinckney, M.D.by Edward Pinckney, M.D.

Editor of Journal of the American Medical AssociationEditor of Journal of the American Medical Association

““An almost endless number of observations and experiments An almost endless number of observations and experiments have effectively have effectively falsifiedfalsified the hypothesis that dietary cholesterol the hypothesis that dietary cholesterol and fats, and a high cholesterol play a role in the causation of and fats, and a high cholesterol play a role in the causation of atherosclerosis and cardiovascular disease. The hypothesis is atherosclerosis and cardiovascular disease. The hypothesis is

maintained because allegedly supportive, but maintained because allegedly supportive, but insignificant insignificant findings, are inflatedfindings, are inflated and most contradictory results are ignored.” and most contradictory results are ignored.”

A hypothesis out-of-date: The diet-heart ideaA hypothesis out-of-date: The diet-heart ideaby Uffe Ravnskov, M.D., Ph.D.by Uffe Ravnskov, M.D., Ph.D.

Journal of Clinical Epidemiology, 55:1057-1063, 2002Journal of Clinical Epidemiology, 55:1057-1063, 2002

- of 480,000 men, screened the top 5% in cholesterol level (290 mg/dl) to be in the study

-followed for 7.4 years, treated with cholestyramine or placebo

24% reduction in heart disease-related deaths!

- of 480,000 men, screened the top 5% in cholesterol level (290 mg/dl) to be in the study

-followed for 7.4 years, treated with cholestyramine or placebo

24% reduction in heart disease-related deaths!

Start: 480,000 men

98% (Placebo) vs 98.4% (Treated) Survived 98% (Placebo) vs 98.4% (Treated) Survived

Start: 480,000 men

0.4% becomes 24% 0.4% becomes 24%

Start: 480,000 men

0.4% becomes 24% 0.4% becomes 24%

96.3% (Placebo) vs 96.4% (Treated) Survived 96.3% (Placebo) vs 96.4% (Treated) Survived

Start: 480,000 men

The $120 Million Study That Produced a Non-The $120 Million Study That Produced a Non-Significant Treatment Difference of 3 People! Significant Treatment Difference of 3 People!

= 0.1%= 0.1%

The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant Effect on MortalityEffect on Mortality

The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant Effect on MortalityEffect on Mortality

The Lead Investigators Declared Victory – Predicting Heart Disease Would Be The Lead Investigators Declared Victory – Predicting Heart Disease Would Be Eradicated With DrugsEradicated With Drugs

“No sensible person can avoid the conclusion that the NCEP is an expensive fraud perpetuated by avaricious business

enterprises and dishonest scientists.”

George Mann, Sc.D., M.D.Professor, Nutritional Biochemist,

Vanderbilt University

The Missing Conflict of Interest Statement

ATP III Update 2004: Financial Disclosure

Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline. Dr. Grundy

Dr. Cleeman has no financial relationships to disclose.

Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.

Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.

Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.

Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.

Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.

Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.

Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.

Dr. Grundy

… honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb and AstraZeneca;… research grants from Merck, Abbott and Glaxo Smith Kline.











Dr. Grundy


$150,000/drug company x 10 = $1,500,000/year!











Dr. Bairey Merz

… honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer and Merck; she has received grants from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca and Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson ...

Dr. Grundy


$150,000/drug company x 10 = $1,500,000/year!

* These guidelines were developed by people with a financial conflict of interest.

Are they wrong?

A Different Opinion From Scientists Unsupported by the Statin Industry

*These guidelines were developed by people with a financial conflict of interest.

**These guidelines have been disputed by scientists without a conflict of interest.

Isn’t there a benefit from statins in the reduction of cardiac events?

"What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle

pain, and that 249 would have no benefit?"

Jerome R. Hoffman, M.D.Professor of Clinical Medicine,

UCLA School of Medicine

Isn’t there a benefit from statins in the reduction of cardiac events?

Adverse Side Effects of Statins

Adverse Side Effects of Statins: Erectile Dysfunction, Type 2 Diabetes, Rhabdomyolysis,

Acute Renal Failure, Cancer and Liver Dysfunction

Final 2 Issues:Final 2 Issues:

What Caused the Increase in Deaths from What Caused the Increase in Deaths from Cardiovascular Disease in the 20Cardiovascular Disease in the 20thth Century? Century?

How is Cholesterol Involved in Heart Disease?How is Cholesterol Involved in Heart Disease?Villain or Misunderstood Hero?Villain or Misunderstood Hero?


Does Butter or Saturated Fat Consumption Parallel the Does Butter or Saturated Fat Consumption Parallel the Increase in Heart Disease-Related Death?Increase in Heart Disease-Related Death?

Deaths from Cardiovascular Disease

No Relation of Butter Consumption to Heart

Disease

No Relation of Saturated Fat Consumption to

Heart Disease


Clear Relation of Smoking to Heart

Disease


Cross Section of a Damaged ArteryWhat Causes Coronary Heart Disease?

sugar

What Causes Coronary Heart Disease?


LDL

WBC


Thickening of the Artery Wall Following Repeated Injury and Repair




Myth #1: Myth #1: Consumption of food high in saturated fat and cholesterol Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease(beef, butter) makes people fat and causes heart diseaseX





X





XX


Misinformation:Misinformation:We have been misledWe have been misled




XX

The Bittersweet End Of Humans as HuntersThe Bittersweet End Of Humans as Hunters

My MentorsMy Mentors

Anthony ColpoAnthony Colpo Gary Taubes Gary Taubes Barry Groves Barry Groves

Paul Rosch, M.D.Paul Rosch, M.D. Jeff Volek, Ph.D. Jeff Volek, Ph.D. Rodney Hayward, M.D.Rodney Hayward, M.D. Walter Willett, M.D.Walter Willett, M.D.Joel Kauffman, Ph.D.Joel Kauffman, Ph.D. John Abramson, M.D.John Abramson, M.D.Walter Willett, M.D., Ph.D.Walter Willett, M.D., Ph.D. Robert C. Atkins, M.D.Robert C. Atkins, M.D.Uffe Ravnskoff, M.D., Ph.D.Uffe Ravnskoff, M.D., Ph.D. Germain Brisson, Ph.D.Germain Brisson, Ph.D.James H. Salisbury, M.D.James H. Salisbury, M.D. Emmet Densmore, M.D.Emmet Densmore, M.D.C. De Lacy EvansC. De Lacy Evans Marcia Angell, M.D.Marcia Angell, M.D.Jean Anthelme Brillat-SavarinJean Anthelme Brillat-Savarin John Abramson, M.D.John Abramson, M.D.George Mann, ScD., M.D.George Mann, ScD., M.D. James H. Salisbury, M.D.James H. Salisbury, M.D.Duane Graveline, M.D.Duane Graveline, M.D. Kilmer McCully, M.D.Kilmer McCully, M.D.Nancy Appleton, Ph.D.Nancy Appleton, Ph.D. Bruce Fife, C.N., N.D.Bruce Fife, C.N., N.D.Jay S. Cohen, M.D.Jay S. Cohen, M.D. William Rothstein, Ph.D.William Rothstein, Ph.D.Edward H. Ahrens, M.D.Edward H. Ahrens, M.D. Michael F. Oliver, M.D.Michael F. Oliver, M.D.

Edward R. Pinckney, M.D. and Cathey PinckneyEdward R. Pinckney, M.D. and Cathey PinckneySally Fallon and Mary G. Enig, Ph.D.Sally Fallon and Mary G. Enig, Ph.D.

Are there any questions?

Myths and Misinformation About Saturated Fat and Cholesterol: How Bad Science and Big Business Created the Obesity Epidemic Departments of Psychology,

Documents

cholesterol slide

sugar slide

heart disease slide

diet of bread

diet of meat

sugar weeks slide

banting diet

scary news slide