Cholesterol, Fat, and the Fickle Life of Recommendations

February 14, 2015

The US government's health institutions are probably going to drop recommendations regarding the need to avoid cholesterol in the diet. A nutrition advisory panel has decided, after reviewing the evidence, that cholesterol is no longer a "nutrient of concern."


After over 50 years of cholesterol fear mongering, this is a pretty striking announcement. How can the entire culture of modern medicine have gotten its ideas about cholesterol so wrong for so long?


Easy: ignore the research. It's been piling up for decades, while drugs to lower this unconcerning nutrient have been generating billions annually for the drug industry.


This is not so different from the eat-less-fat recommendation that was made back in 1977 and has grown into a cultural obsession to this day. A recent review of this recommendation, made in both the US and the UK, noted that "To date, no analysis of the evidence base for these recommendations has been undertaken.



And what was the conclusion of that recent review? Was fat actually found to be associated with heart disease?


"Conclusions: Dietary recommendations were introduced for 220 million US and 56 million UK citizens by 1983, in the absence of supporting evidence from [randomized controlled trials]."


Ironic, that. Millions of conventional physicians have recommended low fat diets for heart health to hundreds of millions of people over the past decades, and now we learn that the recommendation has no evidence in support of it. Probably most tragic of all, the recommendation was not just benignly wrong, but has likely contributed to an enormous amount of chronic disease over that same timespan.


Concommitant with the recommendation to drop fat over the past decades has been a rise in dietary carbohydrate intake.


"The increase in energy intake [between 1971 and 2000] is attributable primarily to an increase in carbohydrate intake, with a 62.4-gram increase among women ... and a 67.7-gram increase among men... Total fat intake in grams increased among women by 6.5 g ... and decreased among men by 5.3 g..."


The effect overall has been a drop only in the percentage of fat in the diet by dramatically increasing the amount of carbs. Look at the label of any low-fat food and note now many grams of carbs it contains. Fat makes food taste good. When it is taken out, carbs take its place.


Low carb diets are associated with lower risk of two major causes of death in the US, heart disease and diabetes. So the recommendation for low fat diets to prevent heart disease has likely caused more heart disease than it prevented, while also adding to the growing tide of diabetes diagnoses.


Conventional medicine prides itself on being "evidence based." For 50 years it has been recommending reduced cholesterol in the diet against the evidence, and it has been recommending low fat diets to prevent heart disease. The low fat diet was initially recommended without supporting evidence, and since that time evidence of its harm has accumulated. Will that recommendation be officially dropped?


Time will tell. In the meantime, remember that conventional recommendations about diet and nutrition are much more guided by tradition than by evidence.




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