It might be time to call the stock broker and short drug manufactures who make their profits from statins.
Credit Suisse Research Institute
Fat: The New Health Paradigm
Full report
https://doc.research-and-analytics.csfb ... RvaRWdQ%3d
Summary
We have spent almost a year looking into this complex topic: fat as a nutrient and as an important component of any diet. We leveraged our internal resources, we reviewed over 400 medical research papers and books, accessed global databases on food consumption, and consulted several academics and industry experts. What are main conclusions of our analysis?
• Fat consumption has increased globally over the past fifty years from 19.5% of total energy intake in 1961
to 26% in 2011. We expect this trend not only to continue but to accelerate over the next fifteen years.
• Triangulating several topics such as anthropology, breast feeding, evolution of primates, height trends in the human population, or energy needs of our various vital organs, we have concluded that natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
• The 1960s brought a major change in the perception of fat in the world and particularly in the U.S., where saturated fat was blamed for being the main cause behind an epidemic of heart attacks. We will see that it was not saturated fat that caused the epidemic as itsconsumption declined between 1930 and 1960. Smoking and alcohol were far more likely factors behind the heart attack epidemic.
• Saturated fat has not been a driver of obesity: fat does not make you fat. At current levels of consumption the most likely culprit behind growing obesity level of the world population is carbohydrates. A second potential factor is solvent-extracted vegetable oils (canola, corn oil, soybean oil, sunflower oil, cottonseed oil). Globally consumption per capita of these oils increased by 214% between 1961 and 2011 and 169% in the U.S. Increased calories intake—if we use the U.S. as an example—played a role, but please note that carbohydrates and vegetable oils accounted for over 90% of the increase in calorie intake in this period.
• A proper review of the so called “fat paradoxes” (France, Israel and Japan) suggests that saturated fats are actually healthy and omega-6 fats, at current levels of consumption in the developed world, are not necessarily so.
• The big concern regarding eating cholesterol-rich foods (e.g. eggs) is completely without foundation. There is basically no link between the cholesterol we eat and the level of cholesterol in our blood. This was already known thirty years ago and has been confirmed time and time again. Eating cholesterol rich foods has no negative effect on health in general or on risk of cardiovascular diseases (CVDs), in particular.
• Doctors and patients’ focus on “bad” and “good” cholesterol is superficial at best and most likely misleading. The most mentioned factors that doctors use to assess the risk of CVDs—total blood cholesterol (TC) and LDL cholesterol (the “bad” cholesterol)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles (pattern A or B) and the ratio of TG (triglycerides) to HDL (the “good” cholesterol). A VAP test to check your pattern A/B costs less than $100 in the U.S., yet few know of its existence.
• Based on medical and our own research we can conclude that the intake of saturated fat (butter, palm and coconut oil and lard) poses no risk to our health and particularly to the heart. In the words of probably the most important epidemiological study published on the subject by SiriTarino et al: “There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.” Saturated fat is actually a healthy source of energy and it has a positive effect on the pattern A/B.
• The main factor behind a high level of saturated fats in our blood is actually carbohydrates, not the amount of saturated fat we eat. Clinical trials show that a low carbohydrate diet is much more effective in lowering the level of saturated fat in our blood than a low-fat diet.
• The same cannot be said about transfats. Since 1933, research has consistently shown that transfats have negative health effects. After the U.S. ban on transfats, we believe more countries will follow suit. Main substitutes of transfats in the food chain could be palm oil and the oleic versions of some of the solvent-extracted vegetable oils.
• Among the “good” fats we find omega-3 (flaxseed, salmon, fish oil) and monounsaturated fat (olive oil, meat and nuts). Most research on omega-3 consistently shows benefits from additional intake of this fatty acid. Additional intake of 1 gram per day of omega-3 reduces the risk of CVD death by 5-30%. It has been shown to be beneficial also in lowering the risk of mental illnesses such as Alzheimer or dementia.
• The research on monounsaturated fat has in most cases been carried out as research on the so called “Mediterranean diet” which for years has been touted as one of the reasons for lower CVD death rates in Southern Europe. It is, however, pretty difficult to define what a “Mediterranean diet” actually is. Our view based also on our own research is that monounsaturated fatty acids are neutral from a health point of view. There is little to support that nuts and olive oil help reduce the risk of CVD deaths.
• In our view, the most controversial area in the research on the health implications of fat intake is polyunsaturated omega-6 fatty acids. Per capita consumption of omega-6 fatty acids has increased by 89% over the past fifty years driven by the wider adoption of solvent-extracted vegetable oils and transfats by the food industry. On the positive side, intake of omega-6 (replacing carbohydrates or saturated fat) lowers both total cholesterol and the “bad” LDL cholesterol. As stated previously, neither is a good indicator of CVD risk. Among fifteen studies looking directly at the effects on actual CVD deaths only a couple show that there is a small statistically relevant positive benefit—20% reduction in CVD death risk—linked to an increase of omega-6 consumption replacing carbohydrates or saturated fat. Most studies though were carried out increasing both omega-6 and omega-3, so it is not clear which was responsible for the positive effects.
• Clinical studies that increased only omega-6 are old, but they show that a high intake (of 10-15% of total energy) could increase CVD events and deaths by similar percentages. Our own analysis carried out on a group of 22 European countries shows that there is actually a positive correlation between the increase in omega-6 intake and the level of CVD deaths. More research on the topic is therefore needed before anybody can assess the full impact of a high level of omega-6 intake on health.
• We conducted two proprietary surveys of doctors, nutritionist and consumers to understand better their perception of the issues we mentioned previously. All three groups showed superficial knowledge on the potential benefits or risks of increased fat consumption. Their views are influenced significantly more by public health bodies or by WHO and AHA rather than by medical research. Even on the “easy” topic of cholesterol, 40% of nutritionist and 70% of the general practitioners we surveyed still believe that eating cholesterol-rich foods is bad for your heart.
• Consumers show a positive perception of fish, nuts, chicken, eggs, yogurt and milk as sources of fat and a negative view of beef, pork, cheese, margarine and butter. They are neutral to positive on vegetable oils in general, and olive oil commands a very positive “healthy” image.
• Health care officials and government bodies have been consistently behind developments on the research front. Research showed that transfats were quite unhealthy as early as 1993, yet a full ban of transfats in the U.S. will only happen in 2018, while in Europe only Switzerland and Denmark have so far banned them. The stance of most officials and influential organizations such as WHO or AHA is now well behind research in two main areas: saturated fats and polyunsaturated omega-6 fats. Our view is that saturated fats intake is at worst neutral for CVD risks and the current 10% upper limit should be lifted. We would also expect a review at some point of the neutral stance on carbohydrates; carbohydrates are one if not the major cause behind the fast growth of metabolic syndrome cases in the U.S.—4% a year—which includes type 2 diabetes and obesity.
• What is the outlook? Globally, we expect fat to grow from the current 26% of calorie intake to 31% by 2030, with saturated fat growing the fastest and going from 9.4% of total energy intake to 13%. This implies that fat consumption per capita will grow 1.3% a year over the next fifteen years versus a rate of 0.9% over the last fifty years. We expect saturated fat to grow at 2% a year versus a historical rate of 0.6% a year; monounsaturated at 1.3% a year versus 1.0%; polyunsaturated omega-6 to decline 0.2% a year versus a 1.3% past growth rate and polyunsaturated omega-3 to grow at 0.7% a year versus 1.6% a year over the last 50 years.
• Among foods, the main winners are likely to be eggs, milk and dairy products (cheese, yogurt and butter) and nuts with annual rates of growth around 2.5-4%. The losers are likely to be wheat and maize and to a lesser extent solvent-extracted vegetable oils. Meat consumption per capita should grow at 1.4% a year and fish at 1.6% supported by a fast expanding aquaculture industry.
