Finding Truth in the Failed Theories of Heart Disease

1. Finding Truth in the Failed Theories of Heart Disease Dr. Jim Painter, PhD, RD Eastern Illinois University jimpainterphd@gmail.com

2. Speaker Disclosure • Current Advisory Boards/Panels/Positions • University of Texas, American Heart Association Healthier Diet Business Committee, Chic-Fil-a, NDC Health and Wellness Advisory Council • Past Advisory Boards/Panels/Positions • University of Illinois, Eastern Illinois University, American Heart Association Eat Well Task Force, California Raisin Marketing Board, Sun-Maid Growers of California, Wonderful Pistachios, White Wave Foods, • Honoraria • Honorarium underwritten by Mideast Dairy • Dietitians of Canada, Exxon Mobil, Frito Lay, Midwest Dairy Council, Pennsylvania Nutrition Network, California Raisin Marketing Board, Alaska Tanker Company, Dairy Max, Texas AND, California AND, Florida AND, MINK, NY AND, South Carolina AND, Iowa AND, Nebraska AND, Manitoba Dairy Farmers, Dairy Farmers of Canada, Davidsons Safest Choice Eggs, National Dairy Council, and Cooper Vision.

3. Speaker Credentials

4. Outline Diabetes and Heart Disease Etiology • Dietary fat total • Dietary cholesterol • Dietary saturated fat What is the Recent Science saying about Dairy Dairy no association with CHD Some data says a negative association

5. I.) Total Fat

6. History of the Total Fat Dietary Guidelines 1980 • 1995 • 1985 • 2015 • 2005 • 2010 • 1990 • 2000 Reducing total fat (replacing total fat with overall carbohydrates) does not lower CVD risk

7. The Big Fat Lie: Politics vs Sound Science • Dr. Ancel Keys –influential, Seven Countries Study • 1961 Keys persuaded AHA to release 1st guidelines targeting saturated fat Andrade, 2009

8. June 2014 January 1963

10. The Seven Countries Study is the cornerstone of current cholesterol and fat recommendations and official government policies Keys had data available from 22 countries----- only used data from 7 countries that supported his hypothesis Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.

12. What We Know About Dietary Fat Has Changed “There is no probable or convincing evidence for significant effects of total dietary fats on coronary heart disease or cancers”1 • Joint FAO/WHO Expert Consultation on Fats and Fatty Acids • in Human Nutrition 2008

15. Primary End Point (Acute Myocardial Infarction, Stroke, or Death from Cardiovascular Causes

16. The Snackwell Phenomenon Food companies rushed to create low-fat versions of all foods and market it as “heart healthy” Butter was replaced with margarine which is high in trans fat! Vegetable oils were aggressively promoted as a healthy alternative to saturated fat most vegetable oils are highly processed, pro-inflammatory, and easily damaged when reheated repeatedly Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.

17. 2015 Heart Disease Risk Factors Perceptions- Total Dietary Fat

18. II.) Reduce Cholesterol

19. History of Cholesterol Dietary Guidelines

20. In the 2000 the AHA states that there is no precise basis for selecting a target level for dietary cholesterol for all individuals but recommends 300 mg/day on average.

21. Dietary Guidelines- 2015?

22. 2015-2020 DGAs for Americans

24. The Three Deciding Opinions: American Heart Association- 2014 USDA Dietary Guidelines- 2015 Most recent meta analysis- 2015 All three agree there isn’t enough evidence to make a recommendation.

25. Where did the Cholesterol Recommendations come from?

26. In 1912 Anichkov discovered that feeding cholesterol to rabbits led to atherosclerosis. * Rabbits are herbivores- metabolize cholesterol differently Konstantinov, I., Mejevoi, N., & Anichkov, N. (2006). Nikolai N. Anichkov and his theory of atherosclerosis. Texas Heart Institute Journal, 33(4), 417-423.

27. Rabbit’s Digestion

28. “These dietary recommendations proposed in the 1960s had little scientific evidence other than the known association between saturated fat and cholesterol and animal studies where cholesterol was fed in amounts far exceeding normal intakes” “These recommendations are mostly based …. On data derived from animal studies where supraphysiologic doses of cholesterol, ranging from the equivalent of 1,000 to 20,000 mg/d for humans, were fed in order to produce atherosclerosis”

29. 2015 Heart Disease Risk Factors Perceptions- Cholesterol

30. Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06) all-cause mortality (adjusted HR, 1.08) The associations between egg consumption and incident CVD (adjusted HR, 0.99) CONCLUSIONS AND RELEVANCE Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner. These results should be considered in the development of dietary guidelines and updates. JAMA. Each additional 300mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17) All-cause mortality (adjusted HR, 1.18)

31. III.) Saturated Fats: Are they really the villains everyone says?

32. History of Saturated Fat Guidelines • 2010 • 1990 • 2005 • 1980 • 2000 • 1985 • 1995 • 2015 Saturated fat is still a nutrient of concern for overconsumption particularly for those older than 50 years.

33. Saturated fat improves good cholesterol more than other fatty aids, suggesting it may reduce risk of heart disease. 2003

34. Change in: Bad Cholesterol: LDL Good Cholesterol: HDL

35. Total HDL Cholesterol Change

37. Changes in Total Cholesterol: HDL-C Ratio for Consumption of SFA, MUFA, PUFA, and TFA

38. 2010

40. WHO meta-analysis: No association between saturated fat intake and CVD, CHD, Stroke, T2D de Souza et al BMJ 2015

41. 2016

42. Linoleic Acid and Saturated Fat Composition of MCE Control and Intervention Group Diets Baseline Control Intervention Baseline Control Intervention

43. Changes in Serum LDL

45. Dairy Fat- Fat- Cholesterol- Saturated fat

46. Dairy Foods and Milk Fat on Heart Disease 2009 • Dairy Foods and Milk Fat on Heart Disease

47. Dairy Fat and Heart Disease Conclusions: “…there is no clear evidence that diary food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce diary food consumption irrespective of the nature of the dairy product should be made with caution.”

48. 2010 Conclusions: Milk fat biomarkers were associated with a lower risk of developing a first MI, especially in women.

49. 2011 Conclusion: This ..meta-analysis of prospective studies indicates that milk intake is not associated with total mortality but may be inversely associated with overall CVD risk...

50. Intake of Saturated Fat and Type 2 Diabetes August 6, 2014