As you can see, the clear relationship that existed before has now disappeared. The original use of data was selective (and misleading), and we can be similarly selective, too, if we wish. How about if we choose the points on the following page instead?
Now, apparently, we see that the countries with the most saturated fat in their diets have the lowest rates of heart disease.
This may seem far-fetched, but let’s suspend judgement for a moment until we discover what the most up-to-date data turns up. In the following graph, I have put forty-five countries from the European region in order of ascending levels of saturated fat in the diet (represented as black dots).29 I’ve put in a trend line too (going upwards from left to right).
Within the graph, I have also added death rates due to heart disease for the same forty-five countries (represented by white dots). The points are scattered on the left-hand side, but notice how they cluster down to the right-hand side. I’ve drawn a trend line for these points too.
Taking as wide a view as possible, this graph shows that as saturated fat intake rises, deaths from heart disease fall.
Much as this evidence supports the evolutionary theory of nutrition beautifully, it is still epidemiological in nature, and can therefore only tell us about the relationship between saturated fat and heart disease (and not whether or not saturated fat causes heart disease).
That said, the facts are:
It was epidemiological evidence that was originally used to incriminate saturated fat back in the 1970s
The original data was very selective in nature
More recent and complete data show the polar opposite finding: that higher intakes of saturated fat are associated with lower risk of heart disease
For what it’s worth, all recent reviews of the epidemiological evidence have simply failed to find an association between saturated fat intake and risk of heart disease.1,30,31 All this weight of epidemiological research, however, will never trump the results of intervention studies, where the health outcomes of individuals eating lower-fat diets are compared with those who eat fat to their heart’s content. What does the evidence show here?
The most comprehensive meta-analysis in this area amassed the results of forty-eight individual studies.32 Each of these studies tested the effect of either reducing the amount of fat in the diet (especially saturated fat) and/or modifying fat in the diet (such as replacing saturated fat with supposedly healthy ‘vegetable oils’ (see below for more on these). The review assessed the impact of these dietary changes on the risk of chronic conditions and the overall risk of death. (Note: risk of death is ultimately 100 per cent for all of us, of course, but in these studies risk of death is assessed over a finite period of time. This allows researchers to compare the numbers of deaths in different groups over this set time period.)
This biggest and best review of the evidence revealed that when individuals eat less saturated fat and/or replace it with ‘healthier’ fats, there is:
No reduction in risk of heart attack
No reduction in risk of stroke
No reduction in risk of diabetes
No reduction in risk of cancer
No reduction in risk of death from cardiovascular disease (e.g. death from heart attack or stroke)
No reduction in overall risk of death
In other words, no benefits are found at all. If eating less saturated fat or replacing it with supposedly healthier fats does not improve health or extend life, one might ask what’s the point of eating this way? The point is: there is no point.
Bearing in mind just how often and vociferously we’ve been told that saturated fat gums up our arteries, this notion may come as a shock. Yet it is utterly in keeping with the primal principle: saturated fat is a component in red meat and has been part of the human diet for as long as we have been, well, human.
The Question of Cholesterol
Before we leave the subject of saturated fat, there’s just one more attribute of this foodstuff that demands our attention: the idea that it raises blood cholesterol levels. The thinking here is that higher cholesterol levels cause heart disease, so if saturated fat raises cholesterol, it must cause heart disease.
Actually, the bulk of the evidence does not find a strong relationship between saturated fat levels in the diet and cholesterol levels in the bloodstream at all. One recent review of the literature concluded that: ‘The influence of dietary fats on serum cholesterol has been overstated.’33
And even if eating saturated fat does raise cholesterol levels, it’s irrelevant anyway. This is because the impact anything (e.g. a food or drug) has on cholesterol levels is not the important thing – it’s the impact it has on health that really matters. With regard to this, here are the facts:
Eating more saturated fat is not linked with an increased risk of heart disease (some evidence suggests that it’s quite the reverse, actually)
Eating less saturated fat and/or replacing it with ‘healthier’ fats has not been found to have benefits for health
Any data that exists regarding the impact of saturated fat and cholesterol levels is now completely redundant.
These facts, rooted in research and not rhetoric, will not stop food companies marketing cholesterol-reducing foods with the promise that they are good for the heart (see section ‘Spreading the Risk’ below). The idea that eating in a way that reduces cholesterol will cause our heart disease risk to come tumbling down is actually based on studies in which cholesterol-modifying medications have been found to reduce the risk of heart disease. However that’s quite a leap of faith, because the mechanisms of a drug’s action are, generally, entirely different to those induced by dietary change, and the benefits may not transfer at all.
Also, while cholesterol reduction with certain medications has been found to reduce the risk of cardiovascular disease, a more important measure of benefit is their impact on overall risk of death. That’s because, while a medication may reduce the risk of one condition, it may increase the risk of others (low cholesterol is associated with an increased risk of cancer, for instance) and possibly have side effects that pose hazards for health. So, just how effective are cholesterol-reducing agents at saving lives?
When the Drugs Don’t Work
The most commonly prescribed cholesterol-lowering drugs are known as ‘statins’, and these have been shown to reduce the risk of death in individuals who have had a previous heart attack or stroke (and who are therefore at relatively high risk of future problems). However, statins do not appear to save the lives of individuals without this sort of history and who are, essentially, healthy.34 These people, by the way, represent the great majority of people prescribed these drugs.
Also, many other cholesterol-modifying treatments have not been found to reduce the risk of death at all, even in individuals with a prior history of heart disease.35 Failures here include