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  #1   ^
Old Wed, Oct-31-18, 05:20
Demi's Avatar
Demi Demi is offline
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Default Butter nonsense: the rise of the cholesterol deniers

Quote:
From The Guardian
London, UK
30 October, 2018


Butter nonsense: the rise of the cholesterol deniers

A group of scientists has been challenging everything we know about cholesterol, saying we should eat fat and stop taking statins. This is not just bad science – it will cost lives, say experts


Butter is back. Saturated fat is good for you. Cholesterol is not the cause of heart disease. Claims along these lines keep finding their way into newspapers and mainstream websites – even though they contradict decades of medical advice. There is a battle going on for our hearts and minds.

According to a small group of dissident scientists, whose work usually first appears in minor medical journals, by far the greatest threat to our hearts and vascular systems comes from sugar, while saturated fat has been wrongly demonised. And because cholesterol levels don’t matter, they argue, we don’t need the statins that millions have been prescribed to lower them. A high-fat diet is the secret to a healthy life, they say. Enjoy your butter and other animal fats. Cheese is great. Meat is back on the menu.

This is more than bad science, according to leading scientists and medical authorities. It will cost lives. “Encouraging people to eat more saturated fat is dangerous and irresponsible,” is a typical verdict, in this case from Prof Louis Levy, the head of nutrition science at Public Health England (PHE). “There is good evidence that a high intake of saturated fat increases your risk of heart disease. We need to think about where the sources of saturated fat are and how we can reduce them. The largest contributions are dairy products, including butter, and meat and meat products.”

The advice from PHE, the World Health Organization, the British Heart Foundation (BHF), Heart UK and other institutions and top academics is consistent. Butter and cheese may be fine in modest amounts in a balanced diet, but the saturated fat that they contain is potentially risky. Too much of it causes the liver to overproduce “bad” LDL cholesterol, which is implicated in heart disease.

Mainstream scientists usually keep their disquiet to themselves. But last week, some broke cover over what they see as one medical journal’s support for advocates of a high-fat diet. More than 170 academics signed a letter accusing the British Journal of Sports Medicine of bias, triggered by an opinion piece that it ran in April 2017 calling for changes to the public messaging on saturated fat and heart disease. Saturated fat “does not clog the arteries”, said the piece, which was not prompted by original research. “Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 minutes a day and eating real food,” wrote the cardiologist Aseem Malhotra and colleagues. The BHF criticised the claims as “misleading and wrong”.
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David Nunan, from Oxford University’s centre for evidence-based medicine, and three colleagues wrote a rebuttal that the journal at first did not use and then, more than a year later, put behind a paywall, while the original article was free. Last week’s letter of complaint asked Dr Fiona Godlee, the editor-in-chief of the BMJ, which publishes the British Journal of Sports Medicine, to intervene, saying the journal had run 10 pieces advocating low-carb diets and criticising statins in the past three years and that the reluctance to run the rebuttal showed a bias and lack of transparency. She replied defending the journal’s right to challenge “the status quo in some settings”, but allowed free access to the rebuttal.

Every time a new review or opinion is published in an obscure or unlikely journal – sports medicine is, after all, primarily about helping the fit get even fitter – it is picked up by newspapers that know statin scares sell. Very often in the UK they quote Malhotra, a charming and telegenic young cardiologist in private practice whose website describes him as “one of the most influential and effective campaigning doctors in the world on issues that affect obesity, heart disease and population health”. He is, it says, “not just a cardiologist. This is a man who wants to change the world one meal at a time by not just rocking the system but by rebuilding it.”

Malhotra urges a low-carb, high-fat diet. His book, The Pioppi Diet, has the distinction of being named by the British Dietetic Association as one of the five worst “celeb” diet books in Britain – celebrities who have tried it include MPs Keith Vaz and Andy Burnham. It includes lots of fruit and vegetables, olive oil and fish, but otherwise “hijacks” the Mediterranean diet, says the BDA.

“The authors may well be the only people in the history of the planet who have been to Italy and come back with a diet named after an Italian village that excludes pasta, rice and bread – but includes coconuts – perhaps because they have a low-carb agenda,” says the BDA. “The suggestion that this Italian village should be associated with recipes for cauliflower-base pizza and rice substitute made from grated cauliflower or anything made using coconut oil is ridiculous. It also uses potentially dangerous expressions like ‘clean meat’ and encourages people to starve themselves for 24 hours at a time every week.”

Malhotra was appointed as the first medical director of Action on Sugar, formed in 2014 by Graham MacGregor, a professor of cardiovascular medicine. Two years later, the group agreed to go their separate ways. By that time, Malhotra was expressing strong views about statins, claiming in a BMJ article that was later partially retracted that they caused side-effects in 20% of patients. On BBC radio, he went further. “It was actually probably an underestimate,” he said, and questioned the benefits of the drug for any patient, citing the cholesterol sceptic Michel de Lorgeril.

He was accused by Prof Rory Collins at Oxford University of endangering lives. Collins said scare stories about statins could do as much harm as Andrew Wakefield did when he claimed that vaccines caused autism.
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When it comes to statins, there is a huge database of research. Since 1994, the Nuffield department of population health at Oxford University, led by two eminent epidemiologists, Collins and Prof Richard Peto, has been amassing and analysing the data in order to figure out how well they work in preventing heart attacks and strokes.

They have published many papers. In 2016, in a major review in the Lancet, they concluded that lowering cholesterol over five years with a cheap daily statin would prevent 1,000 heart attacks, strokes and coronary artery bypasses among 10,000 people who had already had one. It would also prevent 500 in people who were at increased risk, for instance because of high blood pressure or diabetes.

“Our review shows that the numbers of people who avoid heart attacks and strokes by taking statin therapy are very much larger than the numbers who have side-effects with it,” Collins said at the time. Most side-effects can be reversed by stopping the statin, he pointed out – but heart attacks cause permanent damage. “Consequently,” he said, “there is a serious cost to public health from making misleading claims about high side-effect rates that inappropriately dissuade people from taking statin therapy despite the proven benefits.”

But the cholesterol sceptics and statins critics reject the evidence on the basis that the trial data is from big pharma and that the raw data is not in the public domain. Maryanne Demasi, a journalist in Australia whose TV programmes questioning statins were pulled from the ABC network because of concerns over impartiality, wrote in January – again in the British Journal of Sports Medicine – of a “crisis of confidence” in the public because “the raw data on the efficacy and safety of statins are being kept secret and have not been subjected to scrutiny by other scientists … Doctors and patients are being misled.”

There were cholesterol sceptics before statins existed, doubting the hypothesis that high cholesterol in the blood, particularly in the form of LDL, furs up the arteries, leading in the worst cases to a blood clot that can trigger a heart attack or stroke. Yet, says Dermot Neely, a consultant in clinical biochemistry and metabolic medicine and a founder trustee of the Heart UK charity: “The cholesterol hypothesis is supported by a vast amount of scientific data.” Recently, an expert paper was published by the European Atherosclerosis Society summarising all the evidence, to try to silence the sceptics.

But they won’t be silenced. A website called Thincs – The International Network of Cholesterol Skeptics – links to published and unpublished papers as well as the various books its members have written, including a joint one entitled Fat and Cholesterol Don’t Cause Heart Attacks. And Statins Are Not the Solution.”

The director and author of many dissident papers is Uffe Ravnskov, a Danish doctor living in Sweden who has been an independent researcher, not part of any university, since 1979. His most recent review, with 15 others who are mostly members of Thincs, was published last month in the Expert Review of Clinical Pharmacology – an obscure source for newspaper stories that has been brought to the attention of media in the US and the UK, including the Daily Express, which has run many anti-statins pieces. “There is no evidence that high levels of ‘bad’ cholesterol cause heart disease and the widespread use of statins is ‘of doubtful benefit’, according to a study by 17 [sic] international physicians,” said the newspaper.

That is flat-earthism, says Collins. “The claims that blood LDL cholesterol levels are not causally related to cardiovascular disease (which is really in the same realm as claiming that smoking does not cause cancer) are factually false,” he maintains. He believes there is an argument for refusing to give cholesterol-deniers a platform, just as some will no longer debate with climate change sceptics.

Neely says a lot of people ring the nurses and dieticians staffing the Heart UK helpline after reading such stories or hearing about them from family and friends. “We’re very concerned whenever these messages result in people stopping a statin that they were prescribed after their heart attack. Every time there has been a statin scare story in the papers, there is a wave of people who just stop picking up their prescriptions. And as a result of that, many will probably be readmitted with another heart attack down the line,” he says. Some of those are young people who have high cholesterol from birth because of a mutated gene. One of Neely’s patients is a young man whose grandfather and father died of heart attacks at 50. He is on a statin and will be the first in three generations to escape that fate, says Neely.

Asked how he can be sure of his position when the vast majority of top research scientists disagree, Ravnskov says: “Because I am right. The reason why the so-called experts say that I am mistaken is that the vast majority are paid generously by the drug companies.” Asked to elaborate, since statins are out of patent and therefore no longer make money for the companies that originally put them on the market, he expounds on the corruption, illegal practices and wealth of pharmaceutical companies.

The Oxford researchers, including Collins, have published their funding. The unit has research funds from pharmaceutical companies, but the individuals do not take money from them. Ironically, say the researchers, if people refuse statins because of concerns over side-effects, they may be put on expensive newer drugs to lower their cholesterol – and this will make money for big pharma.

A furore was triggered by the recommendation by the National Institute for Health and Care Excellence in 2014 that millions more people should be offered statins. Anybody who has a 10% chance of a heart attack in the next 10 years – judged on factors including weight, age and blood pressure – should consider taking a statin, it said. Anybody who has already had a heart attack or stroke is strongly advised to take one. Because the patents had expired, the pills had become highly cost-effective.

That means statins are given to healthy people to prevent disease and side-effects have become a major issue. The stories are so widespread that people repeat them as if they are incontrovertible, yet the evidence from trials is that even the much-discussed muscle pain is rare. The sceptics dismiss that evidence. Those trials were funded by big pharma, they say, which had a vested interest in hiding any problems with the drugs.

Some side-effects may be caused by interactions with other drugs people are on, such as antibiotics. But there is also evidence that some people get muscle pain because they expect to after everything they have heard. It is called the nocebo effect.

The dissidents’ arguments are attractively simple. Eat fat, avoid carbs and don’t take the tablets, says Malhotra – who declined to answer questions for this article. We would probably all agree that we should ditch junk food and eat well instead of taking pills. But, realistically, telling people to “eat good food” isn’t going to cut it. The majority of people in the UK and the US are now overweight or obese, with all the heart and vascular problems that brings, and the trend is ever upwards.

One thing is for sure – the dissidents are not going to shut up shop. “My belief about the cholesterol sceptics is that they are a bit like religious fundamentalists,” said Neely. “They are not open to argument. Whatever argument you present, they will find another argument because this basically defines who they are.” He cites a cardiologist in the 1980s, Prof Michael Oliver, who was a sceptic of the cholesterol hypothesis that more LDL increased the risk of heart attacks and strokes. Oliver did a U-turn as more evidence accumulated, saying: “When the facts change, I change my mind.” But, says Neely, “unfortunately the cholesterol sceptics we know currently don’t do that”.


https://www.theguardian.com/lifeand...esterol-deniers
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  #2   ^
Old Wed, Oct-31-18, 06:16
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Quote:
The Oxford researchers, including Collins, have published their funding. The unit has research funds from pharmaceutical companies, but the individuals do not take money from them
There is no difference-- bringing in funds keeps jobs.

I loved "the world is flat" analogy-- it is one I started using this summer myself. lol

The beef fat issue will not go away until a good study compares grass fed beef and conventional beef. Because of the amount of beef fat I eat, I will check for grassfed beef fat but realize it will remain just out of reach.
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  #3   ^
Old Wed, Oct-31-18, 06:44
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Dodger Dodger is online now
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Any time an article cites nutrition 'experts', I know it is written to protect the status quo.

I have been eating high-fat, low-carb for over 15 years and have been able to quit all the prescription drugs that low-fat eating had put me on. I am no longer 'pre-diabetic' with low-HDL and high triglycerides.

I am at an older age than both my grandfathers, my father and two of my brothers lived to. I do not know the cause of death of one of my grandfather, but the rest of the men were type 2 diabetics and died of heart attacks.
I feel great and enjoy keeping very active.

Last edited by Dodger : Wed, Oct-31-18 at 07:39.
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  #4   ^
Old Wed, Oct-31-18, 07:11
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by Dodger
Any tie an article cites nutrition 'experts', I know it is written to protect the status quo.

I have been eating high-fat, low-carb for over 15 years and have been able to quit all the prescription drugs that low-fat eating had put me on. I am no longer 'pre-diabetic' with low-HDL and high triglycerides.

I am at an older age than both my grandfathers, my father and two of my brothers lived to. I do not know the cause of death of one of my grandfather, but the rest of the men were type 2 diabetics and died of heart attacks.
I feel great and enjoy keeping very active.

Well stated. I have a similar story and no longer require prescription drugs. Interesting in an article with so many words defending the status quo that has been the belief system since the late 1970s, it appears that those with a vested financial interest are getting nervous. They can't refute the evidence that the results of an epidemic of T2D, CVD, CHD, cancer, and other health issues since the start of the low fat, high carb recommendations represent. Pharma, food, and other interests will throw money at any position that serves to delay changes and protects revenue streams for current products. The good news is the battle lines have been drawn, and that indicates that a change is looming regardless of the posturing and debating that will occur over the next couple years.
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  #5   ^
Old Wed, Oct-31-18, 08:05
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cotonpal cotonpal is online now
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I've opted out of this fight. I know what is working for me, another older type person off all prescription drugs and no longer fat, and will not trust my health to any other expert other than myself and those "experts" who have dared to question the status quo, which clearly isn't working for the majority of people.
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  #6   ^
Old Wed, Oct-31-18, 08:31
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teaser teaser is online now
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Quote:
Saturated fat “does not clog the arteries”, said the piece, which was not prompted by original research.


Ohmigosh. That's awful. What shall we do? Wait.... neither was the reply to the article, signed by 300... or this comment. Or this one. Holy crap! I can't help myself. Maybe I should just shut up... or wait until I'm prompted by some original research.
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  #7   ^
Old Wed, Oct-31-18, 10:14
teaser's Avatar
teaser teaser is online now
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Quote:
The Oxford researchers, including Collins, have published their funding. The unit has research funds from pharmaceutical companies, but the individuals do not take money from them.


The idea that research funds have to go to the individual to have a distorting influence is sheer nonsense. One, making sure that research funds go to people likely to give the sorts of answers that you desire--or people likely to do the sort of research that's likely to give the sorts of answers you desire--is of course distorting. Also, claiming that scientists aren't motivated by things they see beneficial to their research might actually be a bit insulting to the scientists. They aren't just motivated by personal financial gain, there's also actually wanting answers to questions they think need answering, the acclaim that comes if you're actually involved in producing these answers, etc.

Collins....

https://www.thelancet.com/journals/...1357-5/fulltext

This has that 1000 fewer events in 10000 statin takers with a history of heart disease that's mentioned here--as well as the claim for 500 fewer events in 10000 people at risk but who hadn't had a previous event. A number I've seen popping around is 1 in 200 to treat to benefit one person. Some digging around to do...

https://www.thelancet.com/journals/...0367-5/fulltext

Okay, here's the actual meta study the claims are made from.

I don't really have an answer I'm happy with about whether I should be worried about my ldl cholesterol. Fortunately, social anxiety keeps me out of the doctor's office, so I have no idea what my ldl cholesterol might be.

But I do think "lowering ldl cholesterol lowers heart disease, and eating butter can raise ldl cholesterol, so not eating butter lowers heart disease" is a questionable logical jump. If somebody "reverses" or puts their diabetes into remission, or loses a bunch of weight, etc. on a low carb diet that happens to include more butter than their previous diet--can you really say none of that matters, if ldl doesn't go down? You can't even predict that eating butter in this way will raise ldl cholesterol. Dr Westman has said that it's roughly 1/3 go up, 1/3 down, 1/3 pretty much stay the same when they switch to his diet.

Collins study--lowering ldl cholesterol by 1 mM, 1000 less events in 10000 people with previous events.

https://academic.oup.com/ajcn/article/102/2/309/4564657

Random study looking at butter versus olive oil that I have no reason to believe is representative of butter's effect on ldl cholesterol generally in studies like this one--other than my past nodding off reading studies like this one suggesting I haven't seen much to get excited about before.

Baseline, 2.88 mM/l, butter 3.04 mM/l, olive oil 2.87 mM/l. Now, comparing to corn oil would give a greater decrease in ldl cholesterol. But suppose that 1 mM decrease gives a 10 percent decrease in events held true. What would we expect if somebody at 3.04 mM went down to 2.87 mM? Suppose a pure, linear, dose response. Between olive oil and butter, 0.17 mM. We're down to 170 less events per 10000, in 5 years. Not insignificant, still. But not significant enough to offset benefits of a low carb diet, if somebody is insulin resistant/diabetic/pre-diabetic.

You could do low carb with olive oil, avocado etc., and I don't think there's anything wrong with that. But it's not perfect--one thing that's good about a ketogenic diet for me is that it becomes my habitual diet, butter and heavy cream is pretty much what I want to eat, in a way that olive oil and avocado oil just is not. I can eat them, I just don't come to prefer them.

It's sort of like the salt thing--high blood pressure is risky, absolutely. Lowering salt intake can lower blood pressure, yes. So the best diet has the least salt. Well, okay, but how much does lowering salt decrease blood pressure? Does it take you from severe hypertension to normal, or optimal? Generally you can hope for a marginal decrease, another situation where it takes tens of thousands of people before you can detect a benefit. I can detect the benefit of Atkins or a ketogenic diet in one person, me. One Shakespeare vs. thousands of monkeys typing on keyboards, to borrow an evolution denialist meme. Us denialists have to stick together. Except for that one type of denialist, I don't want to invoke Godwin's law so I'll be oblique about that. They suck.
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  #8   ^
Old Sun, Nov-04-18, 01:50
Demi's Avatar
Demi Demi is offline
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The big fat debate on cholesterol and statins

Responses to the recent Guardian article on 'cholesterol-deniers'

https://www.theguardian.com/society...rol-and-statins
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  #9   ^
Old Tue, Nov-06-18, 11:19
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JEY100 JEY100 is online now
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Uffe Ravnskov's new response in his newsletter.
With in this a Short and Simple "Popular Science" version of their 2016 paper.

http://www.ravnskov.nu/2018/11/05/c...-best-friend-2/
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  #10   ^
Old Tue, Nov-06-18, 13:57
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Ms Arielle Ms Arielle is offline
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Im paging thru Dr Mark Hymans book, Eat Fat, Get Thin. An updated version of DANDR, and easier to read format for many. He mentions a friend that trekked to the north pole, eating BUTTER , sticks of butter en-route.

Made me chuckle as Iditarod racers often feed a rubic cube of fat daily to their sled dogs....
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  #11   ^
Old Sat, Nov-17-18, 06:33
Demi's Avatar
Demi Demi is offline
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The butter wars: What you really need to know about the debate around fat in your diet

Read more at: https://inews.co.uk/opinion/comment...ra-tim-spector/
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  #12   ^
Old Sat, Nov-17-18, 08:39
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teaser teaser is online now
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Quote:
Where there is less consensus is around whether we should cut down on saturated fat (found mainly in meat and dairy) and replace it with healthier fats, starchy carbohydrates, low-fat spreads (the new name for margarine) and dairy alternatives.


I would agree that we should replace saturated fat with "healthier" fats. But that's exactly the point of contention, what's healthier? Of course we should replace things with healthier things.

Some of us want to eat healthier, grass fed cows. I'm pretty happy with cows whose muscle and arteries have been clogged with saturated fat from eating healthywholegrain, but to each their own.
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Old Sun, Nov-18-18, 19:50
M Levac M Levac is offline
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I was writing something witty, then changed my mind.

There's no way to demonstrate that the liver's purpose is to kill the heart. It's not mine, I read it once somewhere. Point is, the liver makes cholesterol and lipoproteins, and if we blame cholesterol and lipoproteins for heart disease, we blame the liver for heart disease.

The skeptics certainly seem to have at least one good reason to be so.
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Old Mon, Nov-19-18, 10:45
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deirdra deirdra is offline
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Research funds go to the grad students, post-docs and equipment needed to do the research and write the papers that the grant recipient needs to keep his/her job. No BigPharma or BigAgra funds, no job.
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Old Mon, Nov-19-18, 11:32
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Meme#1 Meme#1 is online now
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The drug companies in the US are out of control. The advertisements on TV are literally one after another to the point of shock at how many in a row they can air. Then the list of damage each prescription "may" cause is shocking!
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