Diet & Health | Dr. Malcolm Kendrick

Yes, hallelujah, the headline on a paper in the BMJ by Richard Smith, the previous editor of the journal. He has finally, if belatedly, come to realise that the dietary advice that has dominated western medicine for the last fifty years, or so, is complete nonsense.

This damascene conversion is mainly due to the fact that he read Nina Teicholz’s book ‘The Big Fat Surprise.’ As he states:

‘…the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognise which I might have known from the beginning – that science is a human activity with the error, self-deception, grandiosity, bias, self-interest, cruelty, fraud, and theft that is inherent in all human activities (together with some saintliness), but this book shook me.’

The amazing thing, to me, is not the Richard Smith has finally realised the diet-heart hypothesis is a complete crock. The amazing thing is that it still holds sway, despite the fact that it was never based on anything other than the propaganda of a power-mad egotist (Ancel Keys). Any evidence that saturated fat, or any other fat consumption, causes heart disease has always been weak at best, more usually non-existent, or just flatly contradictory.

Many years ago Dr George Mann (who was running the Framingham Study at the time) stated that:

‘The diet-heart idea – the notion that saturated fats and cholesterol cause heart disease – is the greatest scientific deception of our times…The public is being deceived by the greatest health scam of the century,’

And what effect did this comment have? Well, none. In 2008 the Food and Agricultural Organisation concluded the “there is no probable or convincing evidence” that a high level of fat in the diet causes heart disease. A 2012 Cochrane review found no benefit from total fat reduction and no effect on cardiovascular or total mortality. ”More recently we have the Women’s Health Initiative, which enrolled fifty thousand women in the randomised trials of the low fat diet and cost £460m. To quote Richard Smith again:

‘The women were followed for 10 years, and those in the low fat arm successfully reduced their total fat consumption from 37% to 29.5% of energy intake and their saturated fat from 12.4% to 9.5%. But there was no reduction in heart disease or stroke, and nor did the women lose more weight than the controls.’

A 23% cut in saturated fat intake, and no impact on anything. What effect has this had? Well, none. Evidence has never had the slightest effect on this hypothesis. As of today, you can still order posters and other information from the British Hear Foundation which announce, in bold, ‘I cut the Saturated Fat.’ The blurb underneath states¹:

‘Find out how to reduce the amount of saturated fat you eat using our A2-sized wallchart. It includes information on the different types of fat in food and advice on the healthiest options to choose both when cooking and eating out.’

So, saturated fat still demonised. And the BHF are still saying that:

‘At the crux of this debate is the role of saturated fat in our diet. Diets that are high in saturated fat have been shown to increase cholesterol. A high cholesterol level is linked to an increased risk of cardiovascular disease, so that’s why current recommendations emphasise the importance of reducing the saturated fat in our diets².’

I suppose one could laugh at all this. Because, the BHF also states (in the same article) the following

‘Last week saturated fat came back to the top of the news agenda because research we’d helped to fund suggested there isn’t enough evidence to support current guidelines on which types of fat to eat. While the latest study didn’t show saturated fat is associated with cardiovascular disease, it also didn’t show that eating more of it is better for your heart health².’

In short, the British Heart Foundation states that they funded a study which shows there is no evidence that saturated fat is bad for the heart. However, they also state that diets high in saturated fat have been shown to increase cholesterol and a high cholesterol level is linked to an increased risk of cardiovascular disease.

Be careful guys. If saturated fat does raise cholesterol, yet a high saturated fat diet does not cause heart disease then. Logically, you are stating that cholesterol does not cause heart disease/cardiovascular disease. In fact, this is exactly what they are stating. There is no escape from logic my friends.

This is just one example of the knots that people tie themselves into when they try to defend the indefensible. Luckily, for them, no-one seems able to draw the obvious conclusion from their incomprensible gibberish. Either the diet/heart (saturated fat) hypothesis is wrong, or the cholesterol hypothesis is wrong, or both. [The correct answer is, or course, both].

Of all the stupid scientific hypotheses of the twentieth century the idea that fat/saturated fat causes heart disease – or any other disease – is by all possible measures the most stupid. It is the most stupid because it has driven dietary advice to eat more and more carbohydrates a.k.a ‘sugars.’ Anyone who understood anything about human biochemistry and physiology could tell you what this would do

1: Cause millions upon millions of people to get fatter and fatter

2: Cause millions upon millions of people to become diabetic

3: Cause millions upon millions of diabetics to completely lose control of their sugar and fat metabolism, get even fatter and die prematurely

All of these things have happened, exactly as could have been predicted. Yet, our esteemed experts still propagate the dangerous myth that saturated fat is bad for us and we should stuff ourselves with carbohydrates instead.

Yes, some diets are ‘mass murder’. To quote Richard Smith for the last time:

‘Jean Mayer, one of the “greats” of nutritional science, said in 1965, in the colourful language that has characterised arguments over diet, that prescribing a diet restricted in carbohydrates to the public was “the equivalent of mass murder.” Having ploughed my way through five books on diet and some of the key studies to write this article, I’m left with the impression that the same accusation of “mass murder” could be directed at many players in the great diet game. In short, bold policies have been based on fragile science, and the long term results may be terrible.’

Richard, there is no may about it. The long term results have been terrible. So, to those ‘experts’ who continue to propagate the idea that saturated fat causes cardiovascular disease. Merry Xmas – you dangerous idiots. As it is the festive season, I shall refrain from calling them mass murderers.

1: https://www.bhf.org.uk/publications/healthy-eating/cut-the-saturated-fat

2: https://www.bhf.org.uk/news-from-the-bhf/news-archive/2014/march/saturated-fats-explained

One of the most pervasive and stupid things that we are currently told to do is to reduce salt intake. This advice has never been based on controlled clinical studies, ever. Yet, as with the cholesterol myth, the dogma that we should all reduce salt intake has become impervious to facts. I find that the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger.

Very recently, a study was done in Australia looking at salt intake. Actually it looked at sodium intake, not salt intake. I find this interesting, as no-one that I know eats sodium. In fact, it would be interesting to see someone try. To quote from Wikipedia

‘Sodium is generally less reactive than potassium and more reactive than lithium. Like all the alkali metals, it reacts exothermically with water, to the point that sufficiently large pieces melt to a sphere and may explode; this reaction produces caustic sodium hydroxide and flammable hydrogen gas.’

Consuming two grams sodium would likely cause you to explode, splattering sodium hydroxide over the walls. Along with various organs and other body parts.

So why do people talk about sodium consumption? I have never really worked this one out. But it does make things rather confusing. The latest guidelines suggest we should consume less than 2300mg of sodium a day, even as low as 1500mg. Go on, try it. Any idea how much salt (NaCl) that would be? Any idea how much salt you consume every day? No, thought not.

Yes, we have been given guidelines that are totally meaningless, and impossible to follow. In fact 2300mg of sodium is roughly 6000mg of salt (NaCl). So why are we not advise to eat six grams of salt a day? I have no idea. Perhaps someone can tell me. What is this sodium nonsense? [Not that anyone has any idea what six grams of salt even looks like poured out of a salt shaker – I know, I have tried this several times.]

Of course, when I started looking into this area, I went at it sideways. If we eat salt we are eating both sodium, and chloride. You cannot have one without the other. So I became interested in the chloride issue, not the sodium. We are always warned about sodium, but no-one ever mentions chloride levels. Is there any evidence that high chloride consumption is bad for us?

This is an area mostly defined by silence, and zero research. But I have found a few papers looking at chloride levels in the blood and, guess what? They have all found that a low chloride level is associated with a higher mortality. Here is one such, entitled ‘Serum chloride is an independent predictor of mortality in hypertensive patients.’

‘Low, not high Serum Chloride- (<100 mEq/L), is associated with greater mortality risk independent of obvious confounders. Further studies are needed to elucidate the relation between Cl- and risk.’ (view here)

There you go. Having a low chloride level makes it more likely you will die early. Yet, having a high level of sodium consumption makes is supposed to kill you? And you cannot eat sodium without eating chloride at the same time. Go figure. You mean you can’t?

Anyway, to return to the, not yet published Australian study, here is what they found.

‘In a multivariate-adjusted model, those who consumed less than 3000 mg of sodium per day had a 25% increased risk of all-cause mortality and cardiovascular events compared with those who consumed between 4000 mg and 5990 mg/day (reference group).’ [1]

The guidelines tell us to eat less than 2300mg of salt. At this level, if we use the Australian data, overall mortality will be increased by 25%. Excellent advice then. And this is not just one contradictory study. Several other trials have clearly demonstrated that reducing salt intake significantly increases mortality in high risk patients. Particularly those with heart failure, where it would be expected that salt reduction would have the greatest benefit. Yet the trials showed the exact opposite.

As explained in the Journal Stroke. The section I have quoted below is taken from a reply to an article entitled “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” In this article Appel, the author, argues strongly that we must, absolutely must, reduce sodium intake. In reply, three cardiologists make the following points:

‘In regards to patient-oriented outcomes, Appel dismisses randomized trials in patients with heart failure as irrelevant because of the unconventional treatment approach of the investigators. Yet these trials—showing increases in hospitalizations and mortality with low-sodium intake versus normal-sodium intake—tested identical diets in intervention and comparison arms with the only difference being the level of ingested sodium (making these trials more relevant than DASH-Sodium and other trials Appel cites). Also, Appel fails to cite 3 relevant heart failure trials, all consistently show harm with reduced sodium intake.’ [2]

In short, Appel, along with most ‘experts’ in this area had dismissed evidence he did not like.

The simple fact is this. If you strip out all the data on salt consumption there is considerably more, and considerably more powerful data, suggesting a strong link between low salt consumption and increased mortality than the other way around.

In reality, you can eat just about as much salt as you can stand – without harm. (Unless you have damaged kidneys and/or very high blood pressure)

How can I possibly state this? Well, a very wise Swedish professor pointed something out to me a few years ago. If a patient is very ill in hospital and cannot eat, or drink, they will have a drip put up to replace fluids. This very often contains 0.9% NaCl. Or nine grams of salt per litre. Quite often the patient will have two litres of this replacement fluid a day – which is (as you may have figured) 18 grams of salt.

So, we quite happy to give critically ill patients 18 grams of salt per day to help them get better – which has no discernable effect on their blood pressure, or anything else. Yet we tell people that they cannot eat more than six grams a day. Ho, ho. You earthlings are so funny.

References (may require site registration or membership to access)
[1] http://www.medscape.com/viewarticle/824749?src=emailthis
[2] http://webappmk.doctors.org.uk/Session/1405533-8qblkO84E9hsUXe6OUa4-aoqmidt/MIME/INBOX/125637-02-B/Stroke-2014-DiNicolantonio-STROKEAHA.114.005067.pdf to be published soon