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With lots of conflicting messages in the media regarding diet and heart health - it's no wonder that some of us are confused as to how to advise our patients - especially if they come with the latest research findings or, worse, myths picked up from friends, family and the media. Here we dispel some of the myths that patients bring into the surgery. You can download and keep this in a handy PDF format. To access references click on each of the individual responses below.
I’ve heard that saturated fat isn’t bad for my heart after all, so why shouldn’t I eat butter rather than ‘low fat’ spreads?
Saturated fats (like those in butter) increase LDL cholesterol
Backgound: It is clear that three saturated fats (lauric, myristic and palmitic) all increase the levels of LDL-cholesterol in the blood. These fats are found in a range of animal foods (fatty meats, butter, lard, full fat dairy) and in palm and coconut oils too. Lowering saturated fat, and very importantly replacing it with unsaturated fats, has been shown to lower both LDL-cholesterol and cardiovascular events.
"I only eat foods low in fat so I know my diet is heart healthy."
A heart healthy diet is not a low fat diet. It is vital to swap saturated fat with heart healthy fats from nuts and seeds.
Background: The cardiovascular benefits associated with reducing saturated fat intake are only achieved when saturated fat is replaced with polyunsaturated fats (PUFA) and monounsaturated fats (MUFA). These are best found in oils and spreads made from olives, nuts and seeds, from the nuts and seeds themselves and from foods such as avocado and oily fish. About a third of our energy should be provided by fat (that’s about 70g for a woman and 90g for a man each day) and of this no more than a third should be the saturated kind. Replacing saturated fat with carbohydrates just does not have the same benefits.
Astrup Arne, Dyerberg Jorn, Elwood P et al. The role of reducing intakes of saturated fats in the prevention of cardiovascular disease: where does the evidence stand in 2010. Am J Clin Nutr 2011; 93: 684-8
"Yes my cholesterol level is high, but I don’t have any other risk factors so surely that doesn’t matter?"
A raised level of cholesterol is an independent risk factor regardless of other risk factors.
Background: Exposure to high levels of cholesterol over time can result in cardiovascular disease regardless of whether you have other risk factors.
•The Cholesterol Treatment Trialists Collaboration (CTTC), involving over 90,000 people, showed that major vascular events can be reduced by about one fifth for every mmol/l reduction in LDL-cholesterol across all groups.
•The World Health Organisation have attributed a third of deaths worldwide to raised cholesterol.
•The INTERHEART case-control study estimated that 45% of heart attacks in Western Europe and 35% of heart attacks in Central and Eastern Europe are due to abnormal blood lipids. They estimated that individuals with abnormal lipids are at over three times the risk of a heart attack compared to those with normal lipids.
- CTTC (Cholesterol Treatment Trialists Collaborators) Lancet 2005; 366: 1267–78
- World Health Organisation Global status report on non communicable diseases 2011 (2010)
- Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigo J, Lisheng A, on behalf of the INTERHEART Study Investigators (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-control study. The Lancet; 364: 937-952.
"It’s not saturated fat that’s to blame it trans fats."
Trans fats are harmful but our intakes are under control. However we still eat too much saturated fat.
Background: Trans fats produced from the heating of unsaturated fats to high temperatures, often in industrial processing, can increase LDL cholesterol and also lower HDL cholesterol. So this joint effect makes trans fats a big problem. However the food industry has removed much of the trans fats from our diet so it is less of a concern. And many of us are still consuming more saturated fat than is recommended.
"I’m not losing weight with the diet advice you gave me so what’s the point of carrying on?"
Fat stored around the waistline (intra-abdominal fat) is more harmful than fat stored around the hips, so the focus should be on waist reduction.
Background: In terms of cholesterol, it is not so much about the amount of fat we have but where on the body we store it. People with central obesity (apple shaped) are more likely to store fat in and around their liver, heart and pancreas. This is associated with the metabolic syndrome and unhealthy patterns of cholesterol. So any changes you make to your diet and activity levels should focus on waist reduction not weight reduction. Routinely measuring waist circumference in clinic is therefore good addition to weight and BMI and can help motivate patients.
"I’m young, fit and slim so surely I can’t have high cholesterol?"
People who are young, slim and appear fit and healthy can have high cholesterol without knowing it.
Cholesterol is partly genetically determined, so it’s just not possible to second guess a person’s cholesterol level without a blood test. Family history of high cholesterol or early heart disease, central obesity or an unhealthy diet and lifestyle are all indicators that cholesterol might be high.
"I’m on a statin so I don't need to worry about my diet."
Even if you are on a statin eating a healthy diet can have additional benefits.
Background: Whether you are on a statin or not, eating a healthy diet is still an important part of maintaining healthy cholesterol levels. The cholesterol lowering effects of a healthy diet and a statin are additive. Cholesterol aside, eating a healthy diet can help improve and maintain general good health too.
"I have started to use coconut oil as I’ve heard it’s good for heart health."
Coconut oil is almost entirely saturated fat and raises LDL-cholesterol, your "bad cholesterol". It is best avoided.
Background: Coconut oil is solid at room temperature so there should be no surprise that it is really high in saturated fat - largely lauric and myristic acids. Both these fats increase your LDL cholesterol. Some have suggested that because lauric acid also raises HDL cholesterol it might have health benefits. However the small increase in HDL-cholesterol is far outweighed by the negative increase in LDL cholesterol.