Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape. I am about to fix my dinner and I do not know what to eat. Can you help me?

You probably saw the official American Heart Association's (AHA) "Presidential Advisory" on dietary fats and cardiovascular disease, by 12 distinguished authors.[1] It was published in the AHA's own journal, Circulation, on June 15, 2017, with much public relations hoopla. The authors ignored the world literature and cherry-picked four studies they considered the best, and pronounced that lowering the intake of saturated fat, coupled with a higher intake of polyunsaturated and monounsaturated fat, would reduce cardiovascular disease by about 30%.

Never mind that on March 18, 2014, a systematic review and meta-analysis[2] of many observational studies and clinical trials by six authors from Cambridge, England, published in the Annals of Internal Medicine, found no evidence that low consumption of total saturated fats and high consumption of polyunsaturated fats affected relative risks for coronary artery disease. Never mind that on Aug 12, 2015, 11 authors from Hamilton and Toronto, Ontario, Canada, reported, in a systematic review and meta-analysis of many prospective cohort studies,[3] that intake of saturated fats was not associated with all-cause mortality, cardiovascular disease, coronary heart disease, ischemic stroke, or type 2 diabetes, although trans fats, especially of industrial origin, were.

Once upon a time, in 1982, JAMA published an early paper by the Multiple Risk Factor Intervention Trial Research Group from the National Heart, Lung, and Blood Institute.[4] Back then, I was so naive that I believed that high serum cholesterol caused atherosclerosis.

David Cundiff is studying 19 different relative risk factors for cardiovascular diseases in 168 countries. They include consumption of animal products; refined carbohydrates; alcohol; tobacco; vitamin K2 intake; exercise level; body mass index; fasting blood sugar/hemoglobin A1c; blood pressure; medication for hypertension; cholesterol/HDL ratio; personal income; education level; gender; age; ethnicity; vitamin D level; air pollution; and fetal, infant, and childhood stress. That sounds pretty complicated. Results are published in Cureus.[5]

Finally, we have the great anecdotal case report of Fred Kummerow, who died on May 31, 2017.[6] Illinois professor Kummerow was born in Germany, moved to Wisconsin between the wars, and became a PhD biochemist. He never did believe much about cholesterol, saturated fats, eggs, meat, and butter having anything to do with heart disease. But from 1957 on, his research demonstrated big-time vascular damage from trans fats, margarine, and fried foods.[7,8] Four hundred Kummerow research papers later, the US Food and Drug Administration finally moved against the practice of adding manufactured trans fats to processed food.

Did I mention that he was 102 years old when he died this year? He practiced what he preached.

Meanwhile, back to the 19 risk factors. I am in good shape on 13 of them; there is nothing I can do about four; so I guess I will fix myself some beans and carrots, an apple, and one hard-boiled egg.

That is my opinion. I am Dr George Lundberg, at large at Medscape.

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