A Review of Diet, Fat, and Cholesterol Research: 25 Points.

Introduction:
Those who have heart disease generally but not always have high blood cholesterol. It is therefore theorized that high cholesterol causes heart disease. This is called a correlation. A correlation is an observation where when something increases, something else increases (a positive correlation) or when something increases, something else decreases (a negative correlation).
An example of how correlations don't necessarily prove anything is: In the last 100 years there has been an increase in global warming. And in the last 100 years women's shoe sizes have gotten bigger.
Does this show that global warming causes women's feet to get bigger?
So does high cholesterol cause heart disease? Just because many people have high cholesterol that also have heart disease doesn't prove this. Heart disease could cause high cholesterol. Or else high cholesterol could be a normal state for some people and heart disease could be caused by some other factor that causes cholesterol to clog the arteries. This is not a speculative statement as there exist at least two theories of heart disease that may make cholesterol an insignificant factor in heart disease: the homocysteine theory and the C-reactive protein theory.(1, 2)
1. Total serum cholesterol has proven not to be a strong determinant of cardiovascular risk.(3, 4)
2. HDL ratio has been proven to be a better standard to assess cardiovascular risk. What can you eat to raise HDL? Only one thing: fat.(5) All fats raise HDL but saturated fats raise HDL the most.(6)
3. The saturated fats except stearic acid do raise total serum cholesterol levels as shown in controlled and epidemiological studies.(7, 8, 9, 19, 33) This is insignificant if total cholesterol has little to do with heart disease.
4. If you have high cholesterol in most cases there is no need to avoid red meat. This is because only 30% of fats in red meat are composed of the saturated fats that raise cholesterol. What are the other 70%? Stearic acid which has a neutral effect on cholesterol comprises about 15%.(10, 19) About 50% is monounsaturated fat (like olive oil) which does not raise total cholesterol levels but raises HDL the good cholesterol.(25) And the remainder is polyunsaturated fat which lowers total cholesterol levels while raising HDL.(11) One study shows that lean red meat is equal to eating lean white meat.(12) So how do they test whether saturated fats raise cholesterol if red meat has so much of the other fats? One study used tropical oils.(9) Others have used liquid cholesterol products. When a natural diet is used, calculations are made according to percentage of each fat in each product, then elevation of cholesterol is apportioned accordingly.
5. It is beneficial that some saturated fats can raise cholesterol because if blood cholesterol gets too low, people get depressed, commit suicide or die of cancer.(13, 14, 15)
6. Studies are inconsistent regarding saturated fat. In one epidemiological study the more saturated fat one ate, the lower their serum cholesterol was.(16) In another study, saturated fats in the diet were high, but serum cholesterol levels were low.(17) Because the results of studies lack consistancy as regards to saturated fats in the diet, there must be some attenuating affect of saturated fats that negates the rise in total serum cholesterol.(19)
7. It is over-simplifying to name one villain, "saturated fat", as the culprit in heart disease especially when the results of studies on saturated fat are contradictory, inconclusive, and ambiguous at best. There are other factors that influence heart disease including but not limited to high glycemic carbohydrate intake, homocysteine, C-reactive protein, oxidative stress, smoking, and exercise to name just a few.(45) A meta-analysis of research to date states, "Despite decades of effort and many thousands of people randomized, there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality."(4)
8. In most people, however, if saturated fat raises their blood cholesterol it is probably not an important risk factor for heart disease as HDL is raised along with total cholesterol. It is also important to note that although LDL is raised too, it has been shown that there are two different types of LDL and saturated fats raise the good kind of LDL.(18) Also avoiding saturated fat may not be an important deterrent of heart disease because saturated fat is never alone in natural animal products but accompanied by monounsaturated (olive-oil-type-fats). Therefore, the combination of fats in animal products keep cholesterol levels where they should be which accounts for them not being a significant risk factor.(19)
9. Fat intake in the diet should not be decreased.(20, 19)
10. Protein with 80% from animal products which includes saturated fats lessens risk of heart disease.(21, 22)
11. Lowering saturated fats and cholesterol in the diet lowers HDL and decreases secretion of the good APO A-1 cholesterol.(23, 24)
12. Replacing saturated fats in the diet with carbohydrates is bad for your serum cholesterol and bad in general for your heart disease risk and mortality.(25, 26, 27, 28, 29, 30) Carbohydrates are not an essential nutrient in the diet.(31) Carbohydrates increase C-reactive protein thereby increasing risk of heart disease.(32)
13. Some nations that eat a high amount of fats and animal products [Crete(33, 34, 3) and Spain(35)] have less heart disease than nations who eat a little fat. Total fat in the diet is not an indicator.(3, 20)
14. Dietary cholesterol has little impact on total blood cholesterol.(36) Dietary cholesterol does not increase risk for heart disease or stroke.(37) Two-thirds of the population show no change in serum cholesterol levels from intake of cholesterol.(38) Dietary cholesterol accounts for a minimum amount of cholesterol produced by the body. The liver produces most cholesterol in the body. Eating cholesterol down-regulates your body's production of cholesterol.(39)
15. Many people with low cholesterol levels die of heart disease. One article stated: "Indeed, high cholesterol levels alone could only predict at most half of all heart attacks."(2)
16. Many people with exceptionally elevated levels of cholesterol never have a heart attack.(2)
17. Researchers say if a person, group of people or nation has higher serum cholesterol that they are at greater risk for heart disease. Croatia and Japan have high cholesterol but low heart disease.(40, 41) But considering that many people have high cholesterol and do not have heart disease and many with low cholesterol do have heart disease, then this may not be a valid marker of risk.(2)
18. Once the rise in HDL is factored in, studies have shown that saturated fats are less of a risk factor for heart disease than carbohydrate.(19, 42, 43)
19. A lot of people with heart disease have high triglycerides. High triglycerides are a risk factor for heart disease.(44, 45) Eating fat, any kind of fat, lowers triglycerides.(19, 46)
20. The American Heart Association has recommended that people with low HDL go on a diet high in unsaturated fat rather than replacing fat with carbohydrate.(47)
21. Saturated fats do not increase risk of diabetes.(48) The American Diabetes Association has recently recommended a high monounsaturated fat diet to those with diabetes.(49)
22. The American Heart Association says high glycemic carbohydrates are linked to heart disease.(50)
23. The American Heart Association says Americans should eat a 30% fat diet with not less than 15% fat.(47) The American Heart Association says diets less than 15% fat can be dangerous.(51) Ironically, Americans do not know this so they try to eat 0% fat and are ruining their health. However, these guidelines limiting fat intake to 30% do not appear to have support of the studies shown here.
24. Fats are not the cause of obesity.(52, 53) Studies have shown that diets high in fat and low in carbohydrate cause a person to lose weight.(54) High fat foods like nuts decrease risk of heart disease.(55)
25. Another important consideration is what our bodies were meant to eat. For the last 2.5 million years man has evolved as a hunter/gatherer with emphasis on carnivore-hunter. In the past hundred years man may have evolved a higher consciousness and may want to be vegetarian, but our bodies are genetically still 99.8% Paleolithic man and as such require meat. The leading experts on Paleolithic Nutrition say that man has eaten mostly animal products (likely over 50%) for most of his existence on earth.(56, 57, 58) Another important factor in evolution was man's development of a larger brain vs. body size. The only way this could have happened was with a nutrient dense source. The accepted explanation is "The Expensive Tissue Hypothesis" which states that meat and fat were that source.(59) These studies show that during man's entire history on earth fat intake would have exceeded both carbohydrate and protein intake. Grains are a foreign product in human evolution. For 99.9% of man's existence on earth, man did not eat grain. In fact, man is the only primate to eat cereal grains.(60) Therefore, trying to force our bodies to accept some form of higher consciousness by trying not to eat animal products would be a foreign diet to our system causing an unbalance and malnutrition in ways that science cannot even predict. Imbalance in the human body is the cause of all disease. When the body is perfectly balanced it is disease-free. Imbalance causes cancer, heart disease, autoimmune disease, and death. In other words, man's so-called recent "higher consciousness" is killing him.

Therefore, fat in the diet has never been the problem. Avoiding fat is the problem.


References
1 McCully KS, Wilson RB. Homocysteine theory of arteriosclerosis. Atherosclerosis 1975 Sep-Oct;22(2):215-27.
2 Gary Taubes, Does Inflammation Cut to the Heart of the Matter? Science Magazine Volume 296, Number 5566, Issue of 12 Apr 2002, pp. 242-245.
3 Hu FB, Willett WC, Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr 2001 Feb;20(1):5-19.
4 Lee Hooper et al, Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ 2001;322:757-763 (31 March).
5 Niacin also raises HDL. Tavvintharan S, Kashyap ML, The benefits of niacin in atherosclerosis. Curr Atheroscler Rep 2001 Jan; 3(1):74-82.
6 Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA 2001 May 16;285(19):2481-5.
7 Pai T, Yeh YY Stearic acid unlike shorter-chain saturated fatty acids is poorly utilized for triacylglycerol synthesis and beta-oxidation in cultured rat hepatocytes. Lipids 1996 Feb;31(2):159-64.
8 Kelly FD, Sinclair AJ, Mann NJ, Turner AH, Raffin FL, Blandford MV, Pike MJ. Short-term diets enriched in stearic or palmitic acids do not alter plasma lipids, platelet aggregation or platelet activation status. Eur J Clin Nutr 2002 Jun;56(6):490-9.
9 Francisco J. Sánchez-Muniz*, Mari Cruz Merinero*, Sonia Rodríguez-Gil*, Jose M Ordovas, Sofía Ródenas and Carmen Cuesta** Dietary Fat Saturation Affects Apolipoprotein AII Levels and HDL Composition in Postmenopausal Women The American Society for Nutritional Sciences. J. Nutr. 132:50-54, 2002.
10 Pai T, Yeh YY. Stearic acid unlike shorter-chain saturated fatty acids is poorly utilized for triacylglycerol synthesis and beta-oxidation in cultured rat hepatocytes. Lipids 1996 Feb;31(2):159-64.
11 Gary Taubes The Soft Science of Dietary Fat Science. Volume 291, Number 5513, Issue of 30 Mar 2001, pp. 2536-2545.
12 Davidson MH, Hunninghake D, Maki KC, Kwiterovich PO Jr, Kafonek S Comparison of the effects of lean red meat vs lean white meat on serum lipid levels among free-living persons with hypercholesterolemia: a long-term, randomized clinical trial. Arch Intern Med 1999 Jun 28;159(12):1331-8..
13 Kreger BE, Anderson KM, Schatzkin A, Splansky GL.Cancer Serum cholesterol level, body mass index, and the risk of colon cancer. The Framingham Study. 1992 Sep 1;70(5):1038-43
14 Hawthon K, Cowen P, Owens D, Bond A, Elliott M. Low serum cholesterol and suicide. Br J Psychiatry 1993 Jun;162:818-25.
15 Ellison LF, Morrison HI Low serum cholesterol concentration and risk of suicide. Epidemiology 2001 Mar;12(2):168-72.
16 Castelli, William, Concerning the Possibility of a Nut... Archives of Internal Med, Jul 1992, 152:(7):1371-2.
17 Posner BM, Cupples LA, Franz MM, Gagnon DR. Diet and heart disease risk factors in adult American men and women: the Framingham Offspring-Spouse nutrition studies. Int J Epidemiol 1993 Dec;22(6):1014-25.
18 Dreon DM, Fernstrom HA, Campos H, Blanche P, Williams PT, Krauss RM.Change in dietary saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in men. Am J Clin Nutr 1998 May;67(5):828-36.
19 Mensink et al. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 1992; 12: 911-9.
20 L.A. Corr, M.F. Oliver The low fat/low cholesterol diet is ineffective--European Heart Journal European Heart Journal (1997) 18, 18-22.
21 Frank B Hu, Meir J Stampfer, JoAnn E Manson, Eric Rimm, Graham A Colditz, Frank E Speizer, Charles H Hennekens and Walter C Willett Dietary protein and risk of ischemic heart disease in women American Journal of Clinical Nutrition, Vol. 70, No. 2, 221-227, August 1999.
22 Frank B Hu and Walter Willett. Reply to TC Campbell. American Journal of Clinical Nutrition, Vol. 71, No. 3, 850-851, March 2000.
23 Velez-Carrasco W, Lichtenstein AH, Welty FK, Li Z, Lamon-Fava S, Dolnikowski GG, Schaefer EJ. Dietary restriction of saturated fat and cholesterol decreases HDL ApoA-I secretion. Arterioscler Thromb Vasc Biol 1999 Apr;19(4):918-24.
24 Brinton E, S. E., Jan Breslow (1990). "A Low-fat Diet Decreases High Density Lipoprotein (HDL) Cholesterol Levels by Decreasing HDL Apolipoprotein Transport Rates." J Clin. Invest. 85(January): 144-151.
25 Kris-Etherton PM. AHA Science Advisory: monounsaturated fatty acids and risk of cardiovascular disease. American Heart Association Nutrition Committee. Circulation.. 1999;100:1253-1258
26 Simin Liu, JoAnn E Manson, Frank B Hu and Walter C Willett. Reply to DL Katz. American Journal of Clinical Nutrition, Vol. 73, No. 1, 132-133, January 2001.
27 Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000;71:1455-61.
28 Simin Liu, JoAnn E Manson, Frank B Hu and Walter C Willett, Reply to BO Schneeman, American Journal of Clinical Nutrition, Vol. 73, No. 1, 130-131, January 2001.
29 J Jeppesen, P Schaaf, C Jones, MY Zhou, YD Chen and GM Reaven Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. American Journal of Clinical Nutrition, Vol 65, 1027-1033, 1997.
30 MB Katan, Effect of low-fat diets on plasma high-density lipoprotein concentrations. American Journal of Clinical Nutrition, Vol 67, 573S-576S, 1998.
31 Eric C Westman Is dietary carbohydrate essential for human nutrition? American Journal of Clinical Nutrition, Vol. 75, No. 5, 951-953, May 2002.
32 Simin Liu, JoAnn E Manson, Julie E Buring, Meir J Stampfer, Walter C Willett and Paul M Ridker, Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. American Journal of Clinical Nutrition, Vol. 75, No. 3, 492-498, March 2002.
33 Kromhout et al. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study.Prev Med 1995; 24: 308-15
34 Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS. Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study. Am J Clin Nutr 1997 Jun;65(6):1882-6.
35 L Serra-Majem, L Ribas, R Tresserras, J Ngo and L Salleras. How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox American Journal of Clinical Nutrition, Vol 61, 1351S-1359S, 1995.
36 Boucher P, de Lorgeril M, Salen P, Crozier P, Delaye J, Vallon JJ, Geyssant A, Dante R.
Effect of dietary cholesterol on low density lipoprotein-receptor, 3-hydroxy-3-methylglutaryl-CoA reductase, and low density lipoprotein receptor-related protein mRNA expression in healthy humans. Lipids 1998 Dec;33(12):1177-86.
37 Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999 Apr 21;281(15):1387-94.
38 McNamara DJ. Dietary cholesterol and the optimal diet for reducing risk of atherosclerosis. Can J Cardiol 1995 Oct;11 Suppl G:123G-126G.
39 Jones PJ, Pappu AS, Hatcher L, Li ZC, Illingworth DR, Connor WE, Dietary cholesterol feeding suppresses human cholesterol synthesis measured by deuterium incorporation and urinary mevalonic acid levels. Arterioscler Thromb Vasc Biol 1996 Oct;16(10):1222-8.
40 Menotti A, Keys A, Blackburn H, Kromhout D, Karvonen M, Nissinen A, Pekkanen J, Punsar S, Fidanza F, Giampaoli S, Seccareccia F, Buzina R, Mohacek I, Nedeljkovic S, Aravanis C, Dontas A, Toshima H, Lanti M. Comparison of multivariate predictive power of major risk factors for coronary heart diseases in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up. J Cardiovasc Risk 1996 Feb;3(1):69-75.
41 Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA 1995 Jul 12;274(2):131-6.
42 Walter C Willett, Reply to AE Hardman American Journal of Clinical Nutrition, Vol. 72, No. 4, 1061-1062, October 2000.
43 Walter C. Willett Will High-Carbohydrate/Low-Fat Diets Reduce the Risk of Coronary Heart Disease? Proc Soc Exp Biol Med 2000 Dec; 225(3):187-90.
44 Lapidus L, Bengtsson C, Lindquist O, Sigurdsson JA, Rybo E. Triglycerides--main lipid risk factor for cardiovascular disease in women? Acta Med Scand 1985;217(5):481-9.
45 Harjai KJ. Potential new cardiovascular risk factors : left ventricular hypertrophy, homocysteine, lipoprotein(a), triglycerides , oxidative stress, and fibrinogen. Ann Intern Med 1999 Sep 7;131(5):376-86.
46 Walter Willett, Meir Stampfer, Nain-Feng Chu, Donna Spiegelman, Michelle Holmes and Eric Rimm Assessment of Questionnaire Validity for Measuring Total Fat Intake using Plasma Lipid Levels as Criteria American Journal of Epidemiology Vol. 154, No. 12 : 1107-1112
2001.
47 Ronald M. Krauss, et al, AHA Dietary Guidelines : Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association Circulation 0: 2296-2311.
48 Salmeron J, Hu FB, Manson JE, Stampfer MJ, Colditz GA, Rimm EB, Willett WC. Dietary fat intake and risk of type 2 diabetes in women.Am J Clin Nutr 2001 Jun;73(6):1019-26.
49 Marion J. Franz, et al. Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications Diabetes Care 25:148-198, 2002.
50 Barbara V. Howard, PhD; Judith Wylie-Rosett, RD, EdD AHA Scientific Statement Sugar and Cardiovascular Disease A Statement for Healthcare Professionals From the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association Circulation. 2002;106:523
51 Very low fat diets may harm some people. BMJ 1998 Feb 21;316(7131):573
52 Willett WC Dietary fat plays a major role in obesity: No. Obesity Review 2002 May;3(2):59-68.
53 Walter C Willett Is dietary fat a major determinant of body fat? Am J Clin Nutr 1998;67(suppl):556S-62S. 1998
54 Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE, Effect of 6-month adherence to a very low carbohydrate diet program. Am J Med 2002 Jul;113(1):30-6.
55 Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, Speizer FE, Hennekens CH, Willett WC. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998 Nov 14;317(7169):1341-5.
56 Loren Cordain, Janette Brand Miller, S Boyd Eaton, Neil Mann, Susanne HA Holt and John D Speth Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, Vol. 71, No. 3, 682-692, March 2000.
57 Cordain L, Eaton SB, Miller JB, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. Eur J Clin Nutr 2002 Mar;56 Suppl 1:S42-52.
58 Loren Cordain, Janette Brand Miller, S Boyd Eaton and Neil Mann Macronutrient estimations in hunter-gatherer diets American Journal of Clinical Nutrition, Vol. 72, No. 6, 1589-1590, December 2000.
59 Aiello LC, Wheeler PE. The expensive-tissue hypothesis. Current Anthropol 36:199-221, 1995.
60 S. Boyd Eaton, MD, Stanley B. Eaton III Evolution, Diet and Health , poster session, the Williamsburg-ICAES conference 1998.