Diet and Heart Disease

Approximately thirty-five years ago public health authorities in the United States decided that people should limit fat in their diet, primarily saturated fat. The main concern was as that saturated fats raise blood cholesterol and increases the risk of heart disease. The McGovern committee's report, "Dietary Goals for The United States" was published in 1977. Although possibly not based on solid scientific data, the committee's main results were confirmed a few years later by the USDA. The main conclusion was that Americans should "avoid too much fat, saturated fat and cholesterol".
Soon, the demonization of fat, primarily saturated fat, spread around the globe. Public health authorities in Scandinavia and the rest of Europe based their recommendation on the same arguments as the USDA. Although possibly a misinterpretation or oversimplification of the available evidence, in a few years time this led to something we could call the "low-fat mania".
Food manufacturers started providing us with low-fat varieties of almost every food alternative we know. But, fat is difficult to replace, because it is an essential component of good and tasty food. Instead of fat, different types of refined simple sugars, such as the famous high fructose corn syrup were used to make people like the low-fat varieties.
As the years went by it became apparent that obesity was on the rise. People were getting fatter and fatter, despite all the low-fat food. Furthermore, type 2 diabetes seemed to be skyrocketing. Was it because we were not following the public health guidelines or was it because of the guidelines themselves? Is it possible that public authorities were wrong? Is it sensible to make general recommendations on diet and nutrition that applies for everybody? Should the obese, sedentary, middle-aged male follow the same diet recommendation as the thirty years younger normal weight, well-trained university student?
Death rate from coronary heart disease has declined in the United States and Europe for the last 25-30 years. This is due to many different factors. Medical and surgical therapy has improved, smoking has become less frequent, cholesterol levels are lower and treatment of high blood pressure has improved. We do not know whether dietary recommendations have been helpful in this respect. However, many specialists believe that the increased frequency of obesity and type 2 diabetes may soon reverse the declining death rate from heart disease,

Recent research and experience has shows that one of the most effective way for an obese or overweight person to lose weight was to cut down on carbohydrates and increase fat consumption. This concept was but forward by Dr. Robert Atkins in his book, The Atkins Diet Revolution, published 1972. Although severely criticized by the scientific and medical community at that time, the low carbohydrate, high fat concepts have survived the test of time. The low carbohydrate supporters blame the "low-fat mania", induced by public health recommendations for the current obesity epidemic, that they say is all down to over consumption of sugars and carbohydrates.

For many years, a huge discussion has evolved around the concept that a calorie is a calorie. If you eat more than you burn, you will gain weight, if you burn more than you eat you will lose weight. If this is true, the cause of obesity is quite simply that people eat too much and exercise to little. The cure for obesity would also be very simple; eat less and exercise more.

However, there is a lot of evidence indicating that it is not all about calories. Some recent studies have indicated that weight loss seems to be greater on a low-carbohydrate diet than on a conventional low-fat diet that has the same number of calories. However, this is not true for all studies. Different macronutrients may possibly have different effects depending on individual factors, such as stature, body weight, age, metabolism, insulin resistance and level of physical exercise.

Recent scientific evidence indicates that public health authorities may have to reconsider their recommendations on the consumption of macronutrients such as fat and carbohydrates. The fear of fats may have been overemphasized and there is evidence that over consumption of sugar and simple refined carbohydrates may be an important causative factor in the current obesity epidemic.

Axel F Sigurdsson is a cardiologist, PhD and a Fellow of the American College of Cardiology, The Icelandic Society of Cardiology and The Swedish Society of Cardiology.

He runs his own website, http://www.docsopinion.com, dedicated to health, nutrition, healthy lifestyle and prevention of disease.

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