Time to admit a major medical blunder

PROFESSOR Patrick Commerford et al’s comments (“Doctors say Noakes’s diet could be harmful”, The Mercury, September 14) refers. As I wrote in Challenging Beliefs, a 2010 meta-analysis of studies involving 347 747 subjects, published in the American Journal of Clinical Nutrition, found “no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease”.

A 2011 report from the Cochrane Collaboration, an organisation that is independent of the pharmaceutical industry, found that “there was no clear evidence for dietary fat changes on total mortality or cardiovascular mortality”. Thus the scientific evidence is clear: a low-fat diet has no proven role in the prevention of (coronary) heart disease.

It is time that cardiologists began to teach this fact in our medical schools.

So if a high-fat diet does not cause heart disease then what does?

In carbohydrate-intolerant subjects, like myself, a low-fat/high-carbohydrate diet produces all of the following abnormalities, some of which are causally linked to arterial damage and heart disease:

Elevated blood glucose, insulin and glycated haemoglobin (HbA1c) concentrations. The best predictors of heart attack risk are blood HbA1c and random glucose concentrations. Elevated values in diabetics increase heart attack risk 7-fold. In contrast, an elevated cholesterol concentration increases heart attack risk about 1.3 fold, a value low enough in statistical terms to be potentially spurious.

Low blood HDL-cholesterol and high triglyceride and uric acid concentrations.

Increased numbers of small, dense LDL-cholesterol particles. In contrast a high-fat diet increases the number of large, fluffy LDL-cholesterol particles that are not related to heart attack risk.

Elevated blood Lipoprotein (a) concentrations.

Obesity and, in my opinion but as yet unproven, elevated blood pressure.

Elevated ultra-sensitive C-reactive protein concentrations indicative of a whole body inflammatory state.

Elevated blood homocysteine concentrations (due to dietary deficiencies in folic acid, vitamin B-6 and B-12 found in eggs and meat).

If the cause of heart disease was truly known (as is the cause of HIV/Aids) then the condition should have disappeared with the promotion of the so-called “hearthealthy prudent diet” and the annual prescription of tens of billions of dollars’ worth of cholesterol-lowering drugs globally.

Yet one of the leading causes of death in the US is now chronic heart failure caused by coronary heart disease. To service its burgeoning heart disease problem, the US now requires twice the number of cardiologists currently in practice (17 000). If current dietary and therapeutic advice was effective, cardiology and cholesterol-lowering drugs should be going the way of the dinosaur. Instead both are major growth industries. No wonder both fear “cholesterol denialists”.

In 1900 when most Americans cooked in lard and ate a diet full of butter and dairy produce, pork and saturated fat in meat (but low in sugar and processed foods), heart disease was so rare that their most famous cardiologist, Dr Paul Dudley White, encountered his first case only in the 1920s (although the disease has since been described in grain-eating Egyptian mummies). Today in a nation that has replaced animal fats and dairy with “healthy” carbohydrates, heart disease, like obesity and diabetes, is rampant.

With regard to statin therapy, I advise anyone who does not have established heart disease or genetic hypercholesterolaemia, and who is either already taking or considering using cholesterol-lowering drugs, to read The Great Cholesterol Con (2006) by Anthony Colpo.

This book should also be required reading for all my colleagues who are prescribing these drugs or who plan to do so in the future.

The theory that blood cholesterol and a high-fat diet are the exclusive causes of heart disease will, in my opinion, prove to be, like the miasma theory, one of the greatest errors in the history of medicine.

It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real causes of the global epidemic of obesity, diabetes and coronary heart disease. PROFESSOR TIM NOAKES University of Cape Town and Sports Science Institute of SA