Diamond USF

Myths and Misinformation About Saturated Fat and
Cholesterol: How Bad Science and Big Business

Created the Obesity Epidemic
David Diamond, Ph.D.
Departments of Psychology, Molecular Pharmacology and

Physiology, University of South Florida
and
Research and Development Service, J.A. Haley Veterans Hospital
Bad News: Abnormal Blood Lipids
Triglycerides
(mg/dl)
800
700
600
500
400
300
200
Heart Disease Risk
100
0
2005 2006 2007 2008 2009 2010 2011 2012
Years
1
Bad News: Abnormal Blood Lipids
Total/HDL
7.0
6.5
6.0
5.5
5.0 Heart Disease Risk
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
The Solution: Diet Changes and Exercise
Total/HDL
7.0
6.5
6.0
5.5
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
2
Diet
Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread,
Vegetables, Fruit, Nuts, Cereal, Potatoes
Total/HDL
7.0
6.5
6.0
5.5
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
Diet
Total/HDL
X
7.0
6.5
6.0
5.5
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
3
Diet
Total/HDL
X
7.0
6.5
6.0
5.5
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
Really Scary News
Triglycerides
(mg/dl)
800
!
700
600
500
400
300
200
Heart Disease Risk
100
0
2005 2006 2007 2008 2009 2010 2011 2012
Years
4
Really Scary News
Total/HDL
7.0
!
6.5
6.0
5.5
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Years
Obesity and Heart Disease in My Future
Body Weight
175
(lb)
!
170
165
160
155
150 weight in 1980
145
0
2005 2006 2007 2008 2009 2010 2011 2012
Years
5
Myths and Misinformation:
Myth #1:
Consumption of food high in saturated fat and cholesterol
(beef, butter) makes people fat and causes heart disease
6
Myth #1:
Myth #2:
- Cholesterol clogs arteries and causes heart disease -
You will live longer if you take medication to lower your cholesterol
Myth #1:
Myth #2:
Misinformation:
Food and Drug Company-Supported Research and the government
have provided incorrect recommendations on ideal sources of food
for optimal health – we have been misled
7
Heart Disease
Metabolic Syndrome Alzheimers Disease
Arthritis Obesity Hypertension
Diabetes Stroke
Cancer
Historical Perspective on Diet, Obesity and Health

(1864 - Present)
55 >200 lbs

Obesity-related health problems
William Banting
(1797 – 1878)
8
(1864 - Present)
55 >200 lbs

His doctor (Dr. William Harvey)

prescribed a low carbohydrate diet:
Unlimited consumption of meat
No potatoes, bread or sugar
William Banting
(1797 – 1878)

(1864 - Present)
55 >200 lbs

His doctor (Dr. William Harvey)

prescribed a low carbohydrate diet:
Unlimited consumption of meat
No potatoes, bread or sugar
The Banting diet was a great success

Banting lost 46 lbs, enjoyed great
s.
health, and lived into his 80
(no clogged arteries!)
William Banting
(1797 – 1878)
9
An obese person ! may be given a diet of
meat, excluding bread and potatoes, and
the patient will reduce to his normal
weight. As soon as the patient returns to
his diet of bread and potatoes, he
straightaway begins to increase in weight.
1892
10
11
12
=
1972 1864
Eat Meat (fat): Lose weight

But is it a healthy diet?
Does eating red meat, full fat cheese, butter

and eggs increase serum cholesterol?
13
14
HDL (good cholesterol) Total Cholesterol Triglycerides
LDL (bad cholesterol) Ratio Total/HDL Blood Glucose
15
Low Carb Diet (unlimited red meat):
Lose Weight and Lower Cholesterol!
Low Carb Diet (unlimited red meat):

Lose Weight and Lower Cholesterol!
If a low carb diet reduces serum cholesterol,

will a high carb diet (sugar) increase serum
cholesterol?
16
600
500
400
Triglycerides
(mg/dl) 300
200
100
0 2 4 6 8 10 12 14 16 18 20
350
300
Cholesterol
250
(mg/dl)
200
150 Normal Diet No Sugar + Sugar No Sugar

0 2 4 6 8 10 12 14 16 18 20 Weeks
My Diet (2007 – Present)

Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut,
Dark Chocolate, Nuts and Vegetables (Broccoli)
Small Quantities of Fruit, Bread, Potatoes and Sugar
Triglycerides
(mg/dl)
800
700
600
500
400
300
200
Heart Disease Risk
100
0 Low Carb Diet

2005 2006 2007 2008 2009 2010 2011 2012
Years
17
Triglycerides
(mg/dl) 70% Fat
800 20% Protein
10% Carbs
700
600
500
400
300
200
Heart Disease Risk
100
0 Low Carb Diet

2005 2006 2007 2008 2009 2010 2011 2012
Years

Total/HDL 70% Fat

7.0 20% Protein
10% Carbs
6.5
6.0
5.5
4.5 Low Carb Diet

2005 2006 2007 2008 2009 2010 2011 2012
Years
18
Body Weight
(lb) 70% Fat
175 20% Protein
10% Carbs
170
165
160
155
150 weight in 1980
145
0 Low Carb Diet
2005 2006 2007 2008 2009 2010 2011 2012
Years
Our Current State of Confusion
19
20
Consequences of the Fat Phobia
Excess Consumption of Carbs
Carbohydrates
Fats
Protein
1970 1980 1990 2000
21
Simple Message to the Obese:
Stop the Vilification of the Atkins Diet
It
s ok to eat meat, lose weight!
Eat Less Carbs:

Less Potatoes, Bread and Anything Sweet
22
Myth #1:
X
Myth #1:
23
How Did Food Recommendations Go Awry?
Deaths from Cardiovascular Disease
Lloyd-Jones et al, 2010. Circulation
24
Deaths from Cardiovascular Disease
There is a remarkable
relationship between
death rate from heart
disease and the
proportion of fat calories
in the national diet

Keys (1953). Journal of the Mount Sinai Hospital New York
25
- Ancel Keys cheated -
He selected data from 6
countries to create the
linear relationship.
Data were actually
available from a total of
22 countries!
Keys (1953). Journal of the Mount Sinai Hospital New York
26
No Significant Relation Between Fat Significant Relation Between Sugar
Consumption and Heart Disease Consumption and Heart Disease
Mortality (r2=0.1, p > 0.05) Mortality (r2=0.41, p < 0.05)
27
A generation of citizens has grown up since the Diet/Heart
Hypothesis was launched as official dogma. They have been
misled by the greatest scientific deception of our times: the
notion that consumption of animal fat causes heart disease.
Coronary Heart Disease – Doing the Wrong Things

Nutrition Today (July, 1985)
George Mann, Sc.D., M.D.

Professor, Nutritional Biochemist,
Vanderbilt University
Associate Director of the Framingham Study
28
Intake of total fat was not significantly associated with
coronary events (heart attacks) or mortality
Intake of saturated fat (animal fat) was not significantly

associated with coronary events or mortality
Fatal heart disease was not reduced by low-fat diets or by

replacing saturated (animal) fats with polyunsaturated
(vegetable) fats
Walter Willett, M.D.

Chair, Department of Nutrition
Harvard School of Public Health
data on nearly 300,000 individuals ! clearly contradict the

low-fat-is-good-health message ! the exclusive focus on
adverse effects of fat may have contributed to the obesity
epidemic.

29
Ancel Keys – Created the Artificial Link Between Fat and CHD
Became Editor of Circulation
on the cover of Time Magazine, January, 1961
In 1977, a Senate Committee led by George McGovern released its

"Dietary Goals for the United States." Without any evidence to
support their conclusions, the committee identified fat as the
culprit causing obesity.
30
The President of the US National Academy of Sciences,
Dr. Philip Handler, an expert on metabolism, referred to
McGoverns Dietary Goals as nonsense .
Steak for Dinner, Angioplasty for Dessert?

The Myth That Cholesterol Clogs Arteries
31
Thanks solely to Madison Avenue promotion by commercial
food producers and the American Heart Association, a great
many people imagine that if they lower their blood cholesterol !
they will prevent heart disease... Few people realize that there has
never been a proven, scientific relationship between lowering
blood cholesterol levels and preventing heart disease
The Cholesterol Controversy, 1973

by Edward Pinckney, M.D.
Editor of Journal of the American Medical Association
32
An almost endless number of observations and experiments
have effectively falsified the hypothesis that dietary cholesterol
and fats, and a high cholesterol play a role in the causation of
atherosclerosis and cardiovascular disease. The hypothesis is
maintained because allegedly supportive, but insignificant
findings, are inflated and most contradictory results are ignored.
A hypothesis out-of-date: The diet-heart idea

by Uffe Ravnskov, M.D., Ph.D.
Journal of Clinical Epidemiology, 55:1057-1063, 2002
33
- of 480,000 men, screened the top 5% in
cholesterol level (290 mg/dl) to be in the study
-!followed for 7.4 years, treated with
cholestyramine or placebo
24% reduction in heart disease-related

deaths!
- of 480,000 men, screened the top 5% in

cholesterol level (290 mg/dl) to be in the study
-!followed for 7.4 years, treated with
cholestyramine or placebo
24% reduction in heart disease-related

deaths!
34
Start: 480,000 men
98% (Placebo) vs 98.4% (Treated) Survived
Start: 480,000 men
0.4% becomes 24%
35
Start: 480,000 men
0.4% becomes 24%
96.3% (Placebo) vs 96.4% (Treated) Survived
Start: 480,000 men
The $120 Million Study That Produced a Non-

Significant Treatment Difference of 3 People!
= 0.1%
36
The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant
Effect on Mortality
The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant

Effect on Mortality
The Lead Investigators Declared Victory – Predicting Heart Disease Would Be

Eradicated With Drugs
37
38
No sensible person can avoid the conclusion that the NCEP is
an expensive fraud perpetuated by avaricious business
enterprises and dishonest scientists.
George Mann, Sc.D., M.D.

Professor, Nutritional Biochemist,
Vanderbilt University
The Missing Conflict of Interest Statement
39
ATP III Update 2004: Financial Disclosure
Dr. Grundy
Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos,
Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and
Glaxo Smith Kline. Dr. Grundy
! honoraria from Merck, Pfizer, Sankyo, Bayer,
Dr. Cleeman has no financial relationships to disclose.
Merck/Schering-Plough,
Dr. Bairey Merz has received lecture honoraria from Kos,
Pfizer,Abbott, Bristol-Myers
Merck, and Kos; she has served as a
Squibb
consultant for Pfizer,and
Bayer, AstraZeneca;
and EHC (Merck); she has received unrestricted institutional grants for
Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-
! research
Myers Squibb grants
Medical Imaging; she has from
received Merck, Abbott
a research grant andsheGlaxo
from Merck; has stock in Boston
Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.
Smith Kline.
Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-
Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer,
Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.
Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers
Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-
Myers Squibb, Merck, and Pfizer.
Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck,
Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from
AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.
Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-
Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer
Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.
Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson
& Johnson.
Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers
Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a
consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.
Dr. Grundy
Squibb
Bayer, AstraZeneca;
! research
Myers Squibb grants
Smith Kline.
$150,000/drug
Plough, Fournier, company
Tularik, Esperion, and x served
Novartis; he has 10 =as$1,500,000/year!
a consultant for AstraZeneca, Pfizer,
Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck,
Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-
Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.
Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson
& Johnson.
40
Dr. Grundy
Squibb
Bayer, AstraZeneca;
! research
Myers Squibb grants
Smith Kline.
$150,000/drug
Plough, Fournier, company
Tularik, Esperion, and x served
Novartis; he has 10 =as$1,500,000/year!
a consultant for AstraZeneca, Pfizer,
Dr. Bairey Merz
! honoraria
Dr. Hunninghake has receivedfrom Pfizer,
honoraria Merck,
for consulting and bureau
and speakers Kos;fromshe has Merck,
AstraZeneca,
served as a consultant for Pfizer, Bayer and Merck;
she has
Dr. Pasternak has received
served as a speakergrants fromMerck/Schering-Plough,
for Pfizer, Merck, Pfizer, ProcterTakeda, & Kos, BMS-
Gamble, Novartis, Wyeth, AstraZeneca
Health Solutions, Johnson & Johnson-Merck, and AstraZeneca. and Merck;
she
Dr. Smith has stock
has received in research
institutional Boston Scientific,
support from Merck; heIVAX,
has stockEli Lilly, and Johnson
in Medtronic
& Johnson.
Medtronic, Johnson & Johnson ...
* These guidelines were developed by people with a financial conflict of interest.
41
Are they wrong?
A Different Opinion From Scientists Unsupported

by the Statin Industry
42
43
44
*These guidelines were developed by people with a financial conflict of interest.
**These guidelines have been disputed by scientists without a conflict of interest.
45
Isn
t there a benefit from statins in the reduction of
cardiac events?
46
Isnt there a benefit from statins in the reduction of
cardiac events?
"What if you put 250 people in a room and told them they
would each pay $1,000 a year for a drug they would have to
take every day, that many would get diarrhea and muscle
pain, and that 249 would have no benefit?"
Jerome R. Hoffman, M.D.

Professor of Clinical Medicine,
UCLA School of Medicine
Adverse Side Effects of Statins
47
Adverse Side Effects of Statins:
Erectile Dysfunction, Type 2 Diabetes, Rhabdomyolysis,
Acute Renal Failure, Cancer and Liver Dysfunction
Final 2 Issues:
What Caused the Increase in Deaths from

Cardiovascular Disease in the 20th Century?
How is Cholesterol Involved in Heart Disease?

Villain or Misunderstood Hero?
48
Does Butter or Saturated Fat Consumption Parallel the
Increase in Heart Disease-Related Death?
No Relation of Butter
Consumption to Heart
Disease
Deaths from Cardiovascular

Disease
49
No Relation of Saturated
Fat Consumption to
Heart Disease

Disease
50
Clear Relation of
Smoking to Heart
Disease

Disease
What
CrossCauses Coronary
Section Heart Disease?
of a Damaged Artery
sugar
51
What Causes Coronary Heart Disease?
52
WBC
LDL
Thickening of the Artery Wall Following Repeated

Injury and Repair
53
Myth #1:
X
Myth #1:
54
X
Myth #1:
Myth #2:
X
Myth #1:
X
Myth #2:
55
X
Myth #1:
X
Myth #2:
Misinformation:
We have been misled
The Bittersweet End Of Humans as Hunters
56
My Mentors
Anthony Colpo Gary Taubes Barry Groves
Paul Rosch, M.D. Jeff Volek, Ph.D.

Rodney Hayward, M.D. Walter Willett, M.D.
Joel Kauffman, Ph.D. John Abramson, M.D.
Walter Willett, M.D., Ph.D. Robert C. Atkins, M.D.
Uffe Ravnskoff, M.D., Ph.D. Germain Brisson, Ph.D.
James H. Salisbury, M.D. Emmet Densmore, M.D.
C. De Lacy Evans Marcia Angell, M.D.
Jean Anthelme Brillat-Savarin John Abramson, M.D.
George Mann, ScD., M.D. James H. Salisbury, M.D.
Duane Graveline, M.D. Kilmer McCully, M.D.
Nancy Appleton, Ph.D. Bruce Fife, C.N., N.D.
Jay S. Cohen, M.D. William Rothstein, Ph.D.
Edward H. Ahrens, M.D. Michael F. Oliver, M.D.
Edward R. Pinckney, M.D. and Cathey Pinckney
Sally Fallon and Mary G. Enig, Ph.D.
Are there any questions?
57

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Myths and Misinformation About Saturated Fat and

Cholesterol: How Bad Science and Big Business

David Diamond, Ph.D.

Departments of Psychology, Molecular Pharmacology and

Bad News: Abnormal Blood Lipids

5.0 Heart Disease Risk

The Solution: Diet Changes and Exercise

5.0 Heart Disease Risk

5.0 Heart Disease Risk

5.0 Heart Disease Risk

5.0 Heart Disease Risk

Really Scary News

5.0 Heart Disease Risk

Obesity and Heart Disease in My Future

150 weight in 1980

Myths and Misinformation:

Metabolic Syndrome Alzheimers Disease

Arthritis Obesity Hypertension

Historical Perspective on Diet, Obesity and Health

55 >200 lbs

55 >200 lbs

His doctor (Dr. William Harvey)

Historical Perspective on Diet, Obesity and Health

55 >200 lbs

His doctor (Dr. William Harvey)

The Banting diet was a great success

Eat Meat (fat): Lose weight

Does eating red meat, full fat cheese, butter

LDL (bad cholesterol) Ratio Total/HDL Blood Glucose

Low Carb Diet (unlimited red meat):

If a low carb diet reduces serum cholesterol,

150 Normal Diet No Sugar + Sugar No Sugar

My Diet (2007 – Present)

0 Low Carb Diet

0 Low Carb Diet

My Diet (2007 – Present)

Total/HDL 70% Fat

5.0 Heart Disease Risk

4.5 Low Carb Diet

150 weight in 1980

Our Current State of Confusion

Excess Consumption of Carbs

1970 1980 1990 2000

Eat Less Carbs:

Deaths from Cardiovascular Disease

Lloyd-Jones et al, 2010. Circulation

Lloyd-Jones et al, 2010. Circulation

Keys (1953). Journal of the Mount Sinai Hospital New York

Keys (1953). Journal of the Mount Sinai Hospital New York

Coronary Heart Disease – Doing the Wrong Things

George Mann, Sc.D., M.D.

Intake of saturated fat (animal fat) was not significantly

Fatal heart disease was not reduced by low-fat diets or by

Walter Willett, M.D.

data on nearly 300,000 individuals ! clearly contradict the

In 1977, a Senate Committee led by George McGovern released its

Steak for Dinner, Angioplasty for Dessert?

The Cholesterol Controversy, 1973

A hypothesis out-of-date: The diet-heart idea

24% reduction in heart disease-related

- of 480,000 men, screened the top 5% in

24% reduction in heart disease-related

98% (Placebo) vs 98.4% (Treated) Survived

Start: 480,000 men