Thursday, August 12, 2010

Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices?

The title of this post is the exact title of a recent editorial in the American Journal of Cardiology (1). Investigators calculated the "risk for cardiovascular disease associated with the total fat and trans fat content of fast foods", and compared it to the "risk decrease provided by daily statin consumption". Here's what they found:
The risk reduction associated with the daily consumption of most statins, with the exception of pravastatin, is more powerful than the risk increase caused by the daily extra fat intake associated with a 7-oz hamburger (Quarter Pounder®) with cheese and a small milkshake. In conclusion, statin therapy can neutralize the cardiovascular risk caused by harmful diet choices.

Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments. Although no substitute for systematic lifestyle improvements, including healthy diet, regular exercise, weight loss, and smoking cessation, complimentary statin packets would add, at little cost, 1 positive choice to a panoply of negative ones.
Wow. Later in the editorial, they recommend "a new and protective packet, “MacStatin,” which could be sprinkled onto a Quarter Pounder or into a milkshake." I'm not making this up!

I can't be sure, but I think there's a pretty good chance the authors were being facetious in this editorial, in which case I think a) it's hilarious, b) most people aren't going to get the joke. If they are joking, the editorial is designed to shine a light on the sad state of mainstream preventive healthcare. Rather than trying to educate people and change the deadly industrial food system, which is at the root of a constellation of health problems, many people think it's acceptable to partially correct one health risk by tinkering with the human metabolism using drugs. To be fair, most people aren't willing to change their diet and lifestyle habits (and perhaps for some it's even too late), so frustrated physicians prescribe drugs to mitigate the risk. I accept that. But if our society is really committed to its own health and well-being, we'll remove the artificial incentives that favor industrial food, and educate children from a young age on how to eat well.

I think one of the main challenges we face is that our current system is immensely lucrative for powerful financial interests. Industrial agriculture lines the pockets of a few large farmers and executives (while smaller farmers go broke and get bought out), industrial food processing concentrates profit among a handful of mega-manufacturers, and then people who are made ill by the resulting food spend an exorbitant amount of money on increasingly sophisticated (and expensive) healthcare. It's a system that effectively milks US citizens for a huge amount of money, and keeps the economy rolling at the expense of the average person's well-being. All of these groups have powerful lobbies that ensure the continuity of the current system. Litigation isn't the main reason our healthcare is so expensive in the US; high levels of chronic disease, expensive new technology, a "kitchen sink" treatment approach, and inefficient private companies are the real reasons.

If the editorial is serious, there are so many things wrong with it I don't even know where to begin. Here are a few problems:
  1. They assume the risk of heart attack conveyed by eating fast food is due to its total and trans fat content, which is simplistic. To support that supposition, they cite one study: the Health Professionals Follow-up Study (2). This is one of the best diet-health observational studies conducted to date. The authors of the editorial appear not to have read the study carefully, because it found no association between total or saturated fat intake and heart attack risk, when adjusted for confounding variables. The number they quoted (relative risk = 1.23) was before adjustment for fiber intake (relative risk = 1.02 after adjustment), and in any case, it was not statistically significant even before adjustment. How did that get past peer review? Answer: reviewers aren't critical of hypotheses they like.
  2. Statins mostly work in middle-aged men, and reduce the risk of heart attack by about one quarter. The authors excluded several recent unsupportive trials from their analysis. Dr. Michel de Lorgeril reviewed these trials recently (3). For these reasons, adding a statin to fast food would probably have a negligible effect on the heart attack risk of the general population.
  3. "Statins rarely cause negative side effects." BS. Of the half dozen people I know who have gone on statins, all of them have had some kind of negative side effect, two of them unpleasant enough that they discontinued treatment against their doctor's wishes. Several of them who remained on statins are unlikely to benefit because of their demographic, yet they remain on statins on their doctors' advice.
  4. Industrial food is probably the main contributor to heart attack risk. Cultures that don't eat industrial food are almost totally free of heart attacks, as demonstrated by a variety of high-quality studies (4, 5, 6, 7, 8, 9). No drug can replicate that, not even close.
I have an alternative proposal. Rather than giving people statins along with their Big Mac, why don't we change the incentive structure that artificially favors the Big Mac, french fries and soft drink? If it weren't for corn, soybean and wheat subsidies, fast food wouldn't be so cheap. Neither would any other processed food. Fresh, whole food would be price competitive with industrial food, particularly if we applied the grain subsidies to more wholesome foods. Grass-fed beef and dairy would cost the same as grain-fed. I'm no economist, so I don't know how realistic this really is. However, my central point still stands: we can change the incentive structure so that it no longer artificially favors industrial food. That will require that the American public get fed up and finally butt heads with special interest groups.


Jana said...

You are so right!!! And until things change I will continue to pay more for my food! My 16 year old son told me the other day after trying eggs-thinking he didn't like them. this time was different. I found a local family that has been selling us eggs from pastured hens.

That wonderful teenager now loves eggs!

And when I am cooking burgers, he always that the good meat (grass fed) He know the difference. Let's all educate our kids and hopefully there will be enough of us to affect change if not now, in the future.


Paul Jaminet said...

Yes, the structure of US agriculture subsidies are probably the primary reason our lifespans are shorter than other countries.

If we ate rice instead of wheat, butter instead of soybean oil, and drank tea instead of corn syrup, Americans might be the longest-lived people in the world.

Anna said...

I saw this headline this morning and had to check the calendar to see if it was April Fool's Day!

I noted in a Science Daily article about this paper that, "one statin, simvastatin, is already available in low doses (10mg) over the counter at pharmacies without a prescription.". A few years back someone also wanted to put statins in the water in the UK.

The Science Daily article also stated at the conclusion, "The researchers note that studies should be conducted to assess the potential risks of allowing people to take statins freely, without medical supervision. They suggest that a warning on the packet should emphasise that no tablet can substitute for a healthy diet, and advise people to consult their doctor for more advice."


brian said...

When I first started reading this I thought I was in the twilight zone. But I kept reading. Once I was done, I realized that you, Dr. Stephan, may end up in the twilight zone if you continue with posts like this.

Someone from the industrial food biz may not like these indictments. :-)

Anonymous said...

Sounds like something out of a Mike Judge movie. Ever see Idiocracy? In future America there is a food shortage because the people are so stupid they are watering the crops with Gatorade.

Anonymous said...

The hamburger is probably the healthiest part of the meal. Saturated fats, even from grain finished beef, will increase the mass of large LDL particles, shifting LDL density pattern toward the less atherogenic pattern A. Thus the hamburger decreases risk of CAD.

The white flour bun, french fries cooked in vegetable oils high in trans fats and omega-6, and the milk shake probably made with high fructose corn syrup and god knows what else. are the problems.

Statins reduce inflammation which in turn improves the LDL density pattern and reduces risk of CAD. That, rather than lower cholesterol, probably accounts for whatever benefit statins have, but at a huge cost in terms of side effects.

From the Dr. Gott column today, a 72 year old woman's complaints about statin side effects, reads in part:

"My legs have become weak. I have a nightmare of leg cramps, my muscles hurt and I cope with nausea and gas. The cramps have spread to my hands and chest muscles. I formerly was walking two miles a day, now I can barely walk a half-mile, and that is with stops.---I feel good and energetic when not taking a statin: however, I'm lethargic when taking the drug. I'M afraid to quit but I am truly miserable, so which is the lesser evil?"

Doctor Gott response included a list of things that might help including eliminating fried foods, the skin on chicken and the fat on steak, limit cheese and eggs and switch to low fat milk. And, believe it or not, "place a bar of soap under your bed to alleviate cramping" Ha!

Modern medicine is insane!

Anonymous said...

I dont know if this is funny or disturbing.

Matt Lentzner said...

We can affect what food is offered to us in the grocery store. Our wallets are more powerful than any of the interest groups. Notice how the industrial food producers fell all over themselves to offer low-fat foods (as misguided as that is). Look at all the organic food that is available now.

For example, part of the reason that pastured meat is so expensive is that there is such a small demand for it. My parents are grass-fed beef ranchers, but the system is stacked against them. It takes an act of god to just get the meat inspected. If there were more small grass-fed ranchers around then it would justify having an inspector locally.

In the meantime you just have to put up with high prices and low availability. But the worm will turn sooner or later. And keep educating people you know - that helps things along.

Unknown said...

I have read that there is no evidence statins reduce total mortality or fatal cardiac events in primary prevention? Is that true?

I have also read that they do significantly reduce nonfatal events in primary prevention and that they do reduce mortality and fatal events in secondary prevention. Is that also true?

I have been wondering something about adjusting for confounding variables. Lets say A really does cause B, but we don't know it yet. A correlates with B significantly. But C, D, E and F all correlate both with A and B, but, just for the sake of the argument, the only reason they correlate with B is that they go hand in hand with A which is the real cause. But now if we look at A and adjust for all the confounding variables, aren't we adjusting for the effect of A also? So in the end we get a non-significant correlation, because we adjusted out the real causative agent with other variables that only correlated with disease through their correlation with A. Does that make sense or am I missing something?

A while ago we talked about lipoproteins and which were independent predictors of heart disease and which were not. Isn't it possible to adjust out the real causative variable as in the case of my previous example? And doesn't finding the particle to blame with observational studies require many presumptions about which is the causative variable and which do we need to adjust for which?

LeonRover said...

Hey Stephan - I go for your first explanation.

But irony and Derrida style de-constructionism does not strike any targets outside of outre SoHo basements where 30 participants applaud a new stand-up.

The NYTimes will not get it.

Anonymous said...

Getting rid of government subsidies would be the best thing to do (not shifting them as that will eventually lead to as-yet unseen consequences as well). Let competition among agriculture take hold.

Unknown said...

I think you are right - it *must* be a joke. But I never thought of cardiologists as having a sense of humor. If this were a pathology journal or a bunch of surgeons, I would say, guys, they are totally kidding! Ha hah. Well. Live and learn.

David Csonka said...

Stephan - you pretty well summed up my view of the agricultural/pharmaceutical corporate compact. Step 1) Feed America food that makes them sick. Step 2) Sell America the cure. Step 3) Profit.

Anonymous said...

" If it weren't for corn, soybean and wheat subsidies, fast food wouldn't be so cheap. Neither would any other processed food. Fresh, whole food would be price competitive with industrial food, particularly if we applied the grain subsidies to more wholesome foods. Grass-fed beef and dairy would cost the same as grain-fed."

that statement is money!!!!!!! i wish it were real though.

Rachelle Eaton said...

Hey, sorry for the off-topic comment, but I'm looking for a graph I was sure was on this blog that I just cannot find.
It's the same graph as the first one on this post but I thought there was one that had heart disease plotted on the same graph with butter and margarine consumption. Am I crazy? Can anyone help me find it?

Mrs. Ed said...

I have joked that we need a side of prednesone with our inflammatory diet, wow, It didn't dawn on me to throw in a dollop of statin. I guess this illustrates the most important role drugs have for us: To save us from ourselves.

Anna said...

Matt Lentzner,

I think awareness and willingness to buy pasture-fed foods is increasing, albeit slowly. A few years ago when I began to shop less at supermarkets and more directly via food producers, no one I knew had any idea what I was talking about and they expressed doubts they could do the same. Now not only is the concept at least becoming known and discussed, but every year I find more people are finally willing to make an effort to try ditching the supermarket in favor of "cow-pooling", CSAs, local farmers, etc. (though often it takes yet another outrageous industrial food contamination outrage to spur some to action).

The thorny issue of the industrial regulations being applied to small, local producers is a huge one that many are unaware of. We, the constituent voters, need to lobby our elected representatives over and over so they aren't only hearing what the deep-pocketed industry lobbyists are demanding.

TedHutchinson said...

@ Rachel
Barry Groves plots CHD together with intakes of margarines and vegetable shortenings He notes
Margarine use began around the turn of the century. Butter was expensive. The poor bought margarine as a substitute for butter and sales were brisk. The rapid rise in margarine consumption was followed a couple of decades later by that dramatic rise in heart disease deaths.

Anonymous said...

How about redirecting our tax dollars being wasted on the military industrial complex and the two senseless wars overseas and applying it to improving the health of the population by subsidizing farmers who provide whole foods. Of course that's only one way our tax money could be used in a sane manner. It won't happen, but I can dream, can't I? I'm sure the paleo-libertarians will hate this suggestion. To this I say:

futrzak said...


Hm.... maybe with next generation it will change. Interest groups, lobbying is the matter of money and politics. They are hard to change in monopolized system, but still easier than average folk eating habits.

I am not an American (came to this country 11 years ago), I was raised eating family-farm grown meat, dairy and bread made traditional way, from 2 days fermented dough. Despite eating bread with lard (cheaper than butter), whole milk and whole yogurt every day no one in my family was obese or overweight. Same as our neighbors. At this time there was no food industry at all, everyone had to prepare their food from scratch (my parents used to buy half of freshly butchered pig and utilize every single part of it, including blood and bones).

When I came to USA I noticed that Americans consider animal organs as being "inedible dog food". You cannot get anywhere (except specialized butcher) things like liver, kidney, hearts. Same about lard, tallow - unhealthy but more importantly "gross".
Even red beets salad is considered gross ;)
It is impossible to convince adults to radically change their eating habits, especially to tell them to eat things they think are "gross" and "dog's food".
But, this is an acquired taste, if you feed infant and toddler with some food, it will grow liking it :)

BTW: I am happy today because I found organic chicken liver in Whole Foods for only $2.90 a pound :)))

Blog Deleted said...

Excellent post. Thanks.

Alan said...

I was thinking about USA Agricultural subsidies and how one could change them! I think it is highly unlikely. I believe farm subsidies need to be changed by Congress. The first thing members of Congress worry about is being relected. In order to be relected they need to keep their constituents happy. The members of Congress from the farm belt will fight to keep these subsidies so the constituents remain happy and relect them. I am probably being a little negative but it is hard not to be.

Anonymous said...

i agree that fast food can be increasing risk of cardiovascular disease, but we can reduce the risk by regular sport 3-4 day per week. thanks.

Chris Masterjohn said...

Great post, Stephan. Someone in my department gave a seminar last year on a pill that was meant to mimic the effects of exercise in stimulating AMPK. I suggested they just develop an experimental research pill so that we could could just take that and develop all these other pills much faster without having to do all the research.


Stephan Guyenet said...

Hi Todd,

I love that movie.

Hi Andy,

I agree that you have to be very careful about what assumptions you're making when you statistically adjust for factors in observational studies. Yes, I do think it's possible to adjust out the relevant variable.

Hi Rachelle,

See this post for the graph you want

Stephan Guyenet said...

Hi Futrzak,

I agree, it's bizarre that we've decided as a culture in the US that muscle tissue is the only suitable part of an animal to eat.

Hi Chris,

Haha, if you come up with an experimental research pill, send me some please!

Michael Barker said...

This puts me in mind of an article I just read on gluten intolerance. Researchers were actively working on a therapy that would allow those with Celiac disease to be able to eat wheat.

Unknown said...

This is the way things are and there is more to come. I predict that in a few decades most humans will be infertile and all reproduction will be done in vitro. Most of infertility is diet-related (diabetes and PCOS, anti-androgens, pasticides, omega-6 leading to preterm birth). The solution will be more IVF and not less sugar and more fat.

Things might change only if the industry comes up with a cheap method of growing animal tissue in factories. It will have to be genetically modified to guarantee patent protection.

Steak tartare anyone?

Tucker Goodrich said...

@PaleoDoc: It's called "Brave New World" published in 1932.

I doubt we'll be able to make it work in practice, however. We'll simply be replaced by people who eat real food.

Anna said...

Dare I mention Soylent Green? I watched it not long ago, via Netflix dvd rental.

Paul said...

Here’s something I just received from about the use of statins.

“Now the American Academy of Pediatrics (AAP) is pushing this poison to a new group.
I’m talking about children. Some as young as 8 years old!
AAP guidelines have just recommended cholesterol screenings for high-risk children ages two and up. And statin therapy for kids as young as eight with LDLs over 190mg/dl.1
Now, some are calling for even more aggressive screening measures to find kids “in need” of these drugs. All to ensure that pharmaceutical companies will keep making billions for years to come.
Consider this: AAP’s Pediatrics published a new study a couple weeks ago. Researchers screened all fifth graders in West Virginia public schools, including 5,798 who wouldn't have met cholesterol screening guidelines. They found 268 children with cholesterol high enough to be treated with drugs.2
It frightens me to even think about the implications…
Entire generations getting hooked on drugs with dangerous side effects. Ones that include:
Muscle pain
Liver damage
Lowered mental performance
Chronic fatigue
Cardiomyopathy (deterioration of your heart’s function)
Depletion of CoQ10 in the heart (which can cause congestive heart failure)
What’s more, this could open up the floodgates for pharmaceutical companies to promote their use in kids. Come to think of it, that’s already happening. I just read that Pfizer introduced a sweet and tasty “gummy-like” version of Lipitor. I’m sure it’ll boost sales before their patent runs out next year.
The lesson here is, “Just say NO to statins!” You can’t trust them – or the folks telling you to take them.
If a child came to my office with high cholesterol, I would tell him to exercise in short bursts of high intensity for at least 12 minutes a day, cut carbs, and eat foods that are rich in omega-3s, like salmon, flax seeds, and walnuts.
For most children, this would solve the problem within six weeks. Why? Because children’s bodies heal themselves quickly.”

Unknown said...

Interesting, and it might actually be recommended with no evidence from RCTs in children, as the argument is that such trials would not be ethical anyways.

But when you think about it, a bit of statin powder would probably do less damage than the highly recommended breakfast cereals. Also the cost would probably be less than the subsidy to farmers. The key question: What if the parents decide to opt out? Would they lose custody?

Ironically, the side effect of this may be increased public interest in the cholesterol theory, closer scientific scrutiny, litigation and completely unintended consequences.

Paul said...


It's the intended consequence that bothers me. I already see children indoctrinated into the culture of chemical ingestion. The objective of the chemical industry to induce people to require the routine use of chemicals to protect and enhance their bodies and to accept the routine, and largely unknown, exposure to chemicals to enhance the quality of their consumption and to drive the short-term cost of that consumption to rock bottom. The industry has largely achieved their objective, but there are still many billions of dollars to wring out of us consumers before we are discarded.

dfsd said...

So important to research products before we apply and ingest. There's a huge correlation between the advance of new products and the medical problems we are facing. Thanks for the post.

Unknown said...

Regarding the studies showing essentially zero heart disease in populations with pre-industrial/ pre-agrarian dietary patterns. It really doesn't seem like they are sufficient to prove the case. N is too small, and the way the studies are constructed allows multiple biases.

They are interesting and suggestive, but hardly conclusive.

On the other hand, the impression I've gotten from trying to track down research is you are right saturated fat isn't very dangerous, and dairy fat in particular is likely safe/ beneficial. (OTOH I still avoid fatty red meat, something in red meat causes problems)

Couves said...

Federal agricultural subsidies are making us sick. You’re right Stephan, it really is that simple - and this is probably one of the least controversial things you‘ve blogged about.

Agriculture policy is one area where government intervention in the free market has actually hurt our standard of living dramatically. But I’m afraid it won’t end as long as we keep electing politicians who think it’s their job to hand out goodies to special interest groups rather than to promote the general welfare.

Anonymous said...


I think you give those guys too much credit when you suggest that perhaps they were being facetious. I think they are dead serious.

I had a brilliant idea last night while laying awake at four a.m. after getting up to pee. Equally as brilliant as the idea of providing statins to sprinkle on your burger.

A recent study in Iran compared the effects of partially hydrogenated vegetable shortening and non hydrogenated vegetable oils on markers of inflammation. (Crp, IL-6 etc). (see link below)

Iran is a good place to do that kind of study because they eat twice as much vegetable shortening and vegetable oil compared to the U.S., about 12 grams per 100 calories of food intake.

The various markers of inflammation of those in the highest quintile of trans fat intake were 20 to 70% higher than the markers of those in the lowest quintile. Conversely, those in the highest quintile of non-hydrogenated vegetable oil intake had lower markers of inflammation than those in the lowest quintile of oil intake. The negative correlation of the non-hydrogenated oil to inflammation per unit intake was about half the magnitude of the positive correlation found in the trans fat oils.

Their conclusion was that, (1)The inflammation caused by trans fats is most impressive and (2)contrary to conventional wisdom, non hydrogenated vegetable oil does not increase inflammation but reduces it.

The data is convincing.

Getting back to the fast food, we all know that the primary cause of coronary artery disease is inflammation, and the primary cause of inflammation is trans fats. The burger and milkshake should have no trans fats. The fries are the big problem. Maybe a little trans fats in the bun.

It appears that consumption of two parts non-hydrogenated oil will balance out the inflammation caused by one part hydrogenated shortening. The solution is to drizzle about an ounce of non-hydrogenated vegetable oil on an extra large order of fries (which may contain about 14 grams trans fat).

Sure there may be some side effects like increased obesity and increased risk of diabetes, but then statins have some downsides too. Lower levels of cholesterol have been found to be associated with reduced cognitive function and increased risk of osteoporosis, Parkinson's disease and breast cancer. But both the statins and vegy oil toppings should reduce inflammation and thereby reduce risk of atherosclerosis.

I'm serious.

Anna said...

Jack C

"milkshake should have no trans fats"

You can't assume that. Milkshakes often aren't real milkshakes anymore (my definition of a milkshake is quality ice cream, milk, perhaps some flavored syrup), blended together in a carafe with a wand tipped by a small blade.

Many, if not most "milkshakes" don't even milk and some contain NO dairy ingredients at all. They typically are chock-full of transfats and other highly questionable ingredients. The liquid shake mix comes in large cartons that are poured into top of the freezing machine, frozen, and extruded, similar to "soft serve" (also not quality ice cream). Yuck.

Tip-offs the ingredients should be checked if it is called a "shake" instead of "milkshake" and/or is dispensed/extruded from a machine.

Stephan Guyenet said...

Hi Timothy,

The n is too small? The African/American/Asian autopsy study I liked to reported data from some 6,000 autopsies. It was one of the largest autopsy studies ever done. They showed that in age-matched groups, signs of silent or fatal heart attacks were almost totally absent in two regions of Africa, and atherosclerosis was lower. They even had American pathologists independently analyze a subset of the hearts. I think that study was extremely convincing, and it's consistent with a number of other studies, many of which were also large age-matched autopsy studies.

Hi Jack,

That finding is interesting, but I think it's important to remember that inflammatory markers in serum are not necessarily a good measure of inflammation in specific tissues. Another thing is that we don't know why serum inflammatory markers were down. Does it represent an unnatural suppression of immune function, as we see in cancer models fed high PUFA diets? Or does it represent an optimization of immune function, which would be good? On principle, I doubt it's the latter simply due to the fact that we didn't evolve eating these oils.

Also, it's an epidemiological study. Who was eating the most vegetable oil? Were they wealthier, more educated, was their diet otherwise better? If you look at the paper, it's clear that veg oil eaters had a different overall dietary pattern. For example, they ate more vegetables and less hydrogenated fat. What variables that were not measured or adjusted for could have contributed to the observed association?

Anonymous said...

Stephan, with regard to the study in Iran on inflammation related to hydrogenated and non hydrogenated vegetable oil, I agree there is not enough information given to prove anything. If LDL density pattern had been determined, or even the ratio TG/HDL which is a fair proxy for particle size (see pubmed 14578319), perhaps some conclusions could have been drawn.

The food intake of the two groups did not appear that different to me.

It seems be widely accepted that the beneficial effects of statins are the result of reduced inflammation as indicated by improved LDL density pattern, higher HDL and lower TG (ie lower markers of metabolic syndrome.) Given your comments that the markers of inflation in the Iran study may not indicate inflammation, what is an accurate measure of inflammation in your opinion?

I started down this road looking at trans fats after reading your post of Dec 27, 08, on "Butter, Margarine and Heart Disease. It seems to me that butter and margarine had little to do with the increase in heart disease that began around 1920 since margarine consumption did not get going until after 1940 and butter consumption peaked in 1934. Vegetable shortening, which got going good in 1911 with introduction of Crisco, was and is the dominant source of trans fats. Vitamin K2 is not an issue as increased cheese consumption has offset the decrease in butter consumption.

The annual per person consumption of partially hydrogenated oils peaked about 1990 at About 31 Lbs which is about 25% of total fat consumption. Consumption of non hydrogenated vegetable oils is still increasing and now exceeds hydrogenated vegetable fats.

Anyway, increased consumption of non hydrogenated oils perhaps at least dilutes the trans fats a bit. And I still think the science behind my idea of drizzling corn oil on fries is just as strong as the science behind the idea of putting statins on the food.

Stephan Guyenet said...

Hi Jack,

I think butter, margarine and seed oils could have played a major role in heart disease based on how they changed over the course of the 20th century.

Butter consumption was basically the same (high), with minor fluctuations, until the early 1940s, when it dropped off a cliff. The CHD epidemic peaked in the 50s.

Margarine was eaten somewhat even before the 20th century, but keep in mind it was mostly made from non-hydrogenated animal fats back then. Hydrogenated margarines hit the shelves around 1911, just in time for the beginning of the CHD epidemic in the 1920s. No one has ever systematically tracked trans fat consumption in the US, but if we did, we would see that the introduction of trans fat corresponds roughly to the CHD epidemic minus 10 years of lag time.

PUFA seed oils also increased dramatically around the turn of the century, and have continued to increase through the turn of the 21st. They are also in the correct time window to have contributed to the CHD epidemic. Going from 2% to 5% dietary n-6 does not have the same biological effects as going from 5% to 8%. So you wouldn't necessarily expect CHD incidence to track linearly with the increase in PUFA.

I'm not saying these are the only factors, but the changes over time certainly make them suspects.

Couves said...

Jack C: McDonalds fries have been trans-fat free for some time now... and are a heck of a lot tastier than your fries with an ounce of corn oil drizzled on top ;)

The hamburgers and milkshakes, on the other hand, certainly DO contain significant amounts of trans fats, as do all meat and dairy products.

Elizabeth said...


Robert Andrew Brown said...


Thanks for the ref Jack.

Re paper of trans v polyunsaturated fats.

The trans fats will probably not include much olive or canola. If they include soy much of the Omega 3s may well have been hydrogenated out. We do not know what the oxidative status of these hydrogenated fats, or if they still contain any other nutrients. We already know artificial trans fats are bad news.

The unhydrogentated oils are likely overall to contain more Omega 3, be lower in oxidised products, higher in plant based antioxidants, and contain at least a hint of other nutrients.

The wider population by the sound of it has high trans fat consumption.

So as I see it form a quick skim is all this is telling us is that large amounts of trans fats are worse in inflammation terms than large amounts of vegetable fats with a better Omega 3 : 6 profile.

From the refs they may be equating diets high in polyunsaturates with Omega 6 when the paper refers to Omega 3s eg 32 - So it looks like there is some 3 : 6 confusion as well,which one sees quite a lot.

Couves said...

Elizabeth, which of my two points are you disputing? If it’s the first, just Google “mcdonald's fries trans fat” and choose your favorite news source. You’ll get lots of hits -- the elimination of trans fats from their fries was widely reported on.

The natural trans-fat content of meat and dairy has also been widely noted, leading to some interesting controversy:

Ross said...

I had an Acute Miocardial Infarction on the 12th... The following day I had my routine blood tests done (since I've been lowering my numbers for a year by a dramatically changed diet and exercise; no wheat, no soy if I can help it, very little refined carbs--limited to maximally 6 teaspoons of sugar per day in 2 cups of coffee, no rice, no white potatos, no corn--an extremely occasional corn tortilla, no industrial vegetable oils), which revealed (due to AST and LDH) that I had just had a heart attack. The following day (the 14th) I was recommended to an interventionist cardiologist who varified that I had indeed had the AMI and suggested an angiogram and an angioplasty... It turns out that the heart attack was more minor than he had thought (it was in the smallest of the coronary arteries, that he claim was too late to fix; it had died at least 36 hours earlier) but that the two other coronary arteries were greatly blocked and he recommended installing one medicated stent and another normal stent... That said, I've been in a battle with the cardiologist because I refuse to take the Lipitor... and have spent the past week investigating alternatives. My diet is very high in ground flaxseed for a few months now. I also cook with much fresh turmeric... consume much vitamin C, I don't have any problems with green leafy vegetables or with broccoli or with nuts and seeds, although I don't have a colon or a rectum (J-Pouch). Removing the wheat removed ALL of my digestive problems I suffered since my J-Pouch surgery in 2001. I consider myself extremely well informed, very healthy but for the heart attack after spending a week at the beach just north of Puerto Vallarta (and two weeks of eating almost exclusively fish). The doubt that my wife and I have is about the sudden rise from sea level to Guadalajara at 1,500 meters and also over a month of greatly increased consumption of vegetables very high in Vitamin K (something that I can't produce by beneficial bacteria in my non-existent colon and that I couldn't obtain for years because of the horrible inflamation I didn't know I had until I removed the wheat; I couldn't eat almost any fiber), Kale, Spinach, Bok Choy causing sudden coagulation, hence the AMI. And suddenly I found myself placing myself where I didn't want to find myself EVER in the mouth of the lion, the Cardiologist... All side affects can be created in my mind, since I read the list of possible side affects of the Beta Blocker, the Statin, the Aspirin and EFFIENT... And, if I don't take those medications, I can find myself suddenly dead at home... So, I'm looking for research and information alternative to what the meanstream cardiologists push... well aware of the statistics that 24% of those who just experienced their first AMI will die within the following year. Granted, they may not maintain my diet and be as informed as am I. But, also, it is incredibly difficult to explain why I had the heart attack when I had it, and not just over a year earlier when I my my diet was heavy on refined carbs, my glucose level was on the rise (119; and all of the new symptoms), when I weighed 32 pounds more, when my BP was as high as 170/110 with a resting heart rate near 100 causing edema in my lower extremities, when my triglycerides were at 330 and when my HDL was at 38... No thanks to ANY doctor or medication or dietician or nutritionist did I lower all of that in 5 months... So, here we are with the super unexpected heart attack, scurrying to find the best information and for untangling the political/scientific-medical confusion dominating the internet and the doctors offices and certainly horribly hindering the patient because it wastes a lot of time, energy and money... And, the reality is that my wife and I and everyone else must worry about when the "big one" is going to hit... or, if it was a very strange fluke and my diet and health truly are wonderful and I should have faith in sticking with my guns and being patient...