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Bthe return is back. Saturated fat is good for you. Cholesterol is not the cause of heart disease. Claims of this type continue to be found in traditional newspapers and websites, even if they contradict decades of medical advice. There is a battle for our hearts and minds.
According to a small group of dissident scientists, whose work generally appears for the first time in minor medical journals, the greatest danger to the heart and vascular systems comes from sugar, while saturated fats have been wrongly demonized. And since cholesterol does not matter, they argue, we do not need statins prescribed to millions of people to reduce them. A high fat diet is the secret to a healthy lifestyle, they say. Enjoy your butter and other animal fats. The cheese is great. The meat is back on the menu.
This is more than a bad science, according to scientists and medical authorities. It will cost lives. "Encouraging people to eat more saturated fat is dangerous and irresponsible," is a typical verdict, delivered here by Professor Louis Levy, Head of Nutrition Science at Public Health England (PHE). "There is good evidence that a high intake of saturated fat increases the risk of heart disease. We need to think about saturated fat sources and how to reduce them. The most important products are dairy products, including butter, meat and meat products. "
The advice of PHE, the World Health Organization, the British Heart Foundation (BHF), Heart UK and other high-level institutions and academics are consistent. Butter and cheese may contain modest amounts in a balanced diet, but the saturated fats they contain are potentially risky. Too much of it causes overproduction by the liver of "bad" LDL cholesterol, which is involved in heart disease.
Traditional scientists usually keep their concerns to themselves. But last week, some broke the veil on what they saw as the support of a medical journal for the advocates of a high-fat diet. More than 170 academics have signed a letter accusing the British Journal of Sports Medicine of bias, following an opinion piece published in April 2017, calling for a change in public messages about saturated fats and fats. heart disease. Saturated fat "does not clog the arteries," said the piece, which was not motivated by original research. "Coronary artery disease is a chronic inflammatory disease and can be effectively reduced by walking 22 minutes a day and eating real food," wrote cardiologist Aseem Malhotra and his colleagues. The BHF criticized the claims as "misleading and erroneous".
David Nunan, from Oxford University's evidence-based medicine center, and three colleagues wrote a rebuttal that the paper did not use at first, and then more than a year later, she hid a paywall while the original article was free. Last week's letter of complaint asked Dr. Fiona Godlee, editor-in-chief of the BMJ, which publishes the British Journal of Sports Medicine, to intervene, claiming that the newspaper had published 10 articles advocating weak diets in carbs and criticizing statins in the past. three years and the reluctance to hold the refutation was biased and lacking in transparency. She responded by defending the right of the newspaper to challenge "the status quo in some contexts", while allowing free access to the rebuttal.
Whenever a new opinion or new opinion is published in an obscure or improbable journal – sports medicine aims above all to help adjustment become even more fit – it is echoed by newspapers that know that statins are scary. In the UK, they often refer to Malhotra, a charming and telegenic young cardiologist in a private practice whose website describes him as "one of the most influential and effective doctors in the world on issues related to Obesity, heart disease and the health of the population ". He is, he says, "not just a cardiologist. It's a man who wants to change the world, one meal at a time, shaking not only the system, but rebuilding it. "
Malhotra advocates a diet low in carbohydrates and fat. His book, The Pioppi Diet, was singled out by the British Dietetic Association as one of the five worst books on the diet of "celebrities" in Britain. Among the personalities who have tried it are MPs Keith Vaz and Andy Burnham. It includes many fruits and vegetables, olive oil and fish, but otherwise, it "diverts" the Mediterranean diet, says the BDA.
"The authors are perhaps the only people in the history of the planet to have gone to Italy and come back with a diet named in tribute to an Italian village that excludes pasta, rice and bread – but includes nuts coconut – maybe because they have a low carb program, "says the BDA. "It is ridiculous to suggest that this Italian village is associated with cauliflower pizza recipes and rice substitutes made from grated cauliflower or any other coconut oil product. He also uses potentially dangerous expressions such as "clean meat" and encourages people to starve for 24 hours at a time each week. "
Malhotra was named first Medical Director of Action on Sugar, created in 2014 by Graham MacGregor, a professor of cardiovascular medicine. Two years later, the group agreed to separate. At that time, Malhotra expressed strong opinions about statins, claiming in a partially retracted BMJ article that the latter had caused adverse effects in 20% of patients. On the BBC radio, he went further. "It was probably an underestimate," he said, and questioned the benefits of the drug for any patient, citing cholesterol skeptic Michel de Lorgeril.
Professor Rory Collins, of Oxford University, accused him of endangering lives. Collins said that alarmist stories about statins could do as much harm as Andrew Wakefield when he claimed that vaccines were causing autism.
With regard to statins, there is a huge database of research. Since 1994, the Nuffield Population Health Department of the University of Oxford, led by two prominent epidemiologists, Collins and Professor Richard Peto, has been collecting and analyzing data to determine their effectiveness in preventing cancer deaths. heart attacks and strokes.
They have published many articles. In 2016, in a major study published in the Lancet, they concluded that a five-year cholesterol reduction with an inexpensive daily statin would help prevent 1,000 heart attacks, strokes and artery bypasses 10 000 people who had had one. This would also prevent 500 people in people at increased risk, for example because of hypertension or diabetes.
"Our analysis shows that the number of people who avoid heart attacks and strokes while taking statin therapy is much greater than the number of people who have side effects," Collins said at the time . Most side effects can be reversed by stopping the statin, he said, but heart attacks cause permanent damage. "As a result," he said, "there is a significant cost to public health to formulate misleading claims about high side-effect rates that inappropriately deter people from taking treatment with HIV." statin despite demonstrated benefits. "
But critics of cholesterol skeptics and statins reject the evidence on the grounds that the trial data come from the big pharma and that the raw data are not in the public domain. Maryanne Demasi, an Australian journalist whose TV programs involving statins were removed from the ABC network for reasons of impartiality, wrote in January – still in the British Journal of Sports Medicine – of a "crisis" The raw data on the efficacy and safety of statins are kept secret and have not been submitted to the scrutiny of other scientists … Doctors and patients are misled. "
Before the appearance of statins, there were skeptics about cholesterol, questioning the hypothesis that a high blood cholesterol, especially in the form of LDL, stirs in the arteries, resulting in the worst case a blood clot that can trigger a heart attack or stroke. However, says Dermot Neely, consultant in clinical biochemistry and metabolic medicine and founding director of the UK Heart Heart Foundation: "The hypothesis of cholesterol is corroborated by a lot of scientific data." An expert article has recently been published by European Atherosclerosis. Society summarizing all the evidence, to try to silence the skeptics.
But they will not be silenced. A website called Thincs – The International Network of Cholesterol Skeptics – offers links to published and unpublished articles as well as to the various books written by its members, including a common site titled Fat and Cholesterol Do not Cause Seizures heart. And statins are not the answer. "
The director and author of numerous dissenting articles is Uffe Ravnskov, a Danish doctor resident in Sweden, an independent researcher who has not belonged to any university since 1979. His latest report, made up of 15 other members, mostly members of Thincs, published the last month in Expert Review of Clinical Pharmacology – an obscure source of newspaper reports that has been brought to the attention of US and British media, including the Daily Express, which has published numerous anti-statin articles. "There is no evidence that high levels of" bad "cholesterol cause heart disease, and the widespread use of statins is a" questionable benefit, "according to a study of 17 [sic] international doctors, "the paper said.
It's flat-terrism, Collins says. "The claims that LDL cholesterol levels in the blood are not causally related to cardiovascular disease (which really amounts to pretending that smoking does not cause cancer) are false," he said. He thinks there is an argument for refusing to give a platform to cholesterol negationists, just as some will no longer debate with skeptics of climate change.
Neely says that many people call nurses and dieticians from the Heart UK help line after reading such stories or hearing about them from their family and friends. "We are very concerned whenever these messages cause people to stop taking a statin prescribed after a heart attack. Whenever there has been a history of fear of statins in the newspapers, there is a wave of people who are just picking up their prescriptions. And as a result of this, many will likely be readmitted with another heart attack down the line, "he says. Some of them are young people who have high cholesterol levels from birth due to a mutated gene. One of Neely's patients is a young man whose grandfather and father died of a 50-year-old heart attack. He is on a statin and will be the first in three generations to escape this fate, explains Neely.
When asked how he could be sure of his point of view when the vast majority of top scientists disagreed, Mr Ravnskov replied, "Because I am right. The reason the so – called experts say that I am wrong is that the vast majority of them are paid generously by pharmaceutical companies. "They are asked to clarify, because the statins are no longer protected by a patent and thus no longer report anything to the companies that initially put them on the market, it exposes on corruption, illegal practices and the wealth of pharmaceutical companies.
Oxford researchers, including Collins, have published their funding. The unit has research funds from pharmaceutical companies, but individuals do not take money from them. Ironically, say the researchers, if people refuse statins because of concerns about side effects, they may be given expensive new drugs to lower their cholesterol – will make money for big pharma.
The recommendation of the National Institute for Excellence in Health and Health Care 2014 recommended that millions of additional people be offered statins. Anyone who has a 10% chance of having a heart attack over the next 10 years – judging by their weight, age and blood pressure – should consider taking a statin, he said. declared. It is strongly recommended that anyone who has ever had a heart attack or stroke undergo it. As the patents had expired, the pills had become very profitable.
This means that statins are given to healthy people to prevent diseases and that side effects have become a major problem. The stories are so widespread that people repeat them as though they were indisputable. However, clinical trials show that even the muscular pains that are much talked about are rare. Skeptics reject this proof. These trials were funded by the big pharma, they say, who had every interest in hiding any problem with the drugs.
Some side effects can be caused by interactions with other medications, such as antibiotics, that people take. But it is also proven that some people suffer from muscle aches because they expect everything they've heard. This is what is called the nocebo effect.
The arguments of the dissidents are simple and attractive. Eat fat, avoid carbs and do not take pills, says Malhotra – who declined to answer questions about this article. We would all probably agree that we should give up junk food and eat well instead of taking pills. But, realistically, telling people to "eat good food" will not cut it. The majority of Britons and Americans are now overweight or obese, with all the heart and vascular problems involved, and the trend is on the rise.
One thing is certain: dissidents will not shut up. "My belief about skeptics about cholesterol is that they look a bit like religious fundamentalists," said Neely. "They are not open to discussion. Whatever argument you present, they will find another argument because it essentially defines who they are. He quotes a cardiologist in the 1980s, Professor Michael Oliver, who was skeptical about the hypothesis of cholesterol that more LDL increased the risk of heart attacks and strokes. Oliver turned around as new evidence had accumulated: "When the facts change, I change my mind." But, says Neely, "unfortunately, the cholesterol skeptics we know today do not do it."
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