An increasing body of evidence strongly suggests that dietary saturated fat has wrongfully taken the blame for coronary heart disease.
The real culprit is chronic inflammation, which can be effectively reduced with healthy lifestyle changes, according to an expert panel of cardiologists who co-authored a new report published online in the British Journal of Sports Medicine.
“Coronary artery disease pathogenesis and treatment urgently requires a paradigm shift. Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong,” write a team of authors led by Dr. Aseem Malhotra, of Lister Hospital in Stevenage, U.K.
Malhotra and his colleagues say it's time to shift the focus from lowering blood fats and cutting out dietary saturated fat to making lifestyle changes such as eating "real food," taking a brisk daily walk, and minimizing stress.
To support their case, the authors cite a landmark systematic review and meta-analysis of observational studies showing no association between consumption of saturated fat and increased risk of cardiovascular disease, diabetes, and death in healthy adults. They also cite research showing no benefit from reducing saturated fat in people who already have coronary heart disease.
“It is instructive to note that in an angiographic study of postmenopausal women with coronary heart disease, greater intake of saturated fat was associated with less progression of atherosclerosis whereas carbohydrate and polyunsaturated fat intake were associated with greater progression,” they write.
To further debunk the “plumbing theory” of heart disease, they cite a series of clinical trials showing that inserting a stent (stainless steel mesh) to widen narrowed arteries fails to reduce the risk of heart attack or death.
A high ratio of total cholesterol (TC) to high density lipoprotein “good cholesterol” (HDL) is a better predictor of cardiovascular disease risk than a high ratio of TC to low density lipoprotein “bad cholesterol,” the researchers insist.
"Decades of emphasis on the primacy of lowering plasma cholesterol, as if this was an end in itself and driving a market of 'proven to lower cholesterol' and 'low fat' foods and medications, has been misguided," they write.
They suggest that selective reporting of the data may account for these misconceptions.
A high ratio between TC and HDL can be rapidly reduced with dietary changes such as replacing refined carbohydrates with healthy high-fat foods (nuts, fish, certain vegetables, and olive oil), adopting a moderate exercise regimen, and reducing stress, the authors write.
Coronary artery heart disease responds to a Mediterranean style diet, which is rich in such anti-inflammatory healthy high-fat foods.
The authors cite a study showing that an energy-unrestricted Mediterranean diet (41 percent fat) supplemented with at least four tablespoons of extra virgin olive oil or a handful of nuts was linked to a dramatic 30 percent reduction of cardiovascular events compared to a standard low-fat diet (37 percent fat).
They also cite a study of people with history of cardiovascular events who switched to a Mediterranean diet. The study showed a significantly reduced risk of a second heart attack or premature death.
“It is the alpha linoleic acid, polyphenols and omega-3 fatty acids present in nuts, extra virgin olive oil, vegetables and oily fish that rapidly attenuate inflammation and coronary thrombosis,” the authors write. “Both control diets in these studies were relatively healthy, which make it highly likely that even larger benefits would be observed if the Mediterranean diets discussed above were compared with a typical western diet.”
The authors also point out that physical activity plays a major role in the prevention and treatment of coronary heart disease. Just 30 minutes of moderate activity a day three or more times a week works wonders for reducing biological risk factors for sedentary adults.
“Compared with physically inactive individuals, those who walk briskly at or above 150 minutes per week can increase life expectancy by 3.4-4.5 years independent of body weight,” they write.
“Regular brisk walking may also be more effective than running in preventing coronary disease. And just 30 minutes of moderate activity a day more than three times/week significantly improves insulin sensitivity and helps reverse insulin resistance (i.e. lowers the chronically elevated levels of insulin that are associated with obesity) within months in sedentary middle-aged adults.”
Chronic stress is an often overlooked factor in the development of coronary heart disease because it places the body's inflammatory response on permanent high alert, they write. Childhood trauma can lead to an average decrease in life expectancy of 20 years.
“Combining a complete lifestyle approach of a healthful diet, regular movement, and stress reduction will improve quality of life, reduce cardiovascular and all-cause mortality,” the authors conclude.
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