In regards to your COMTUNUING story about transfats in the G and M:
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British Medical Journal, 2002;324:238 ( 26 January )

Letters
Diet-heart disease hypothesis is wishful thinking

Editor:
Mann et al and Hu et al list several shortcomings in the trials reviewed by
Hooper et al that explain why dietary treatments for patients with coronary
heart disease were ineffective.1-3 Inferior studies with negative results
are prevalent, but where is the positive evidence that justifies the
dietary recommendations?

Mann et al point to the improved outcome in the subgroup analysis of the
five prolonged trials. But in that analysis Hooper et al excluded the
Sydney diet-heart study, where total mortality was significantly increased,
and included the Veterans Administration Trial, which was biased by a
significant higher number of heavy smokers in the control group.

Mann et al also say that there is an enormous body of descriptive
epidemiology that supports the link between dietary fat, cholesterol
concentrations, and coronary heart disease. The accumulated epidemiology
actually strongly contradicts such a link, as illustrated by a systematic
review.4 In a study of Japanese migrants in the United States the cultural
upbringing was the strongest predictor of coronary heart disease. Those who
were brought up in a non-Japanese fashion but preferred the lean Japanese
food had a heart attack almost twice as often as those who were brought up
in the Japanese way but preferred fatty American food.4

Masai people probably have the highest intake of animal fat in the world,
but abnormalities on electrocardiography were far less frequent than in
Americans and raised atherosclerotic lesions were rare.4 Mortality from
coronary heart disease in southern India was seven times higher than in the
north and the age at death 44 years compared with 52, although people in
the north ate 19 times more fat, mostly animal fat, and also smoked much
more.4

In 30 of 103 time periods in 33 countries fat intake increased along with
coronary mortality, but in 33 periods where the intake also increased,
coronary mortality was unchanged in 10 and decreased in 23.4 In six
case-control studies the diet of the coronary patients did not differ
appreciably from that of the controls.4 In 21 cohort studies including more
than 150 000 participants with and without coronary heart disease no study
found an eating pattern in accordance with the current view on the
influence of dietary fat.4 Hu et al have published several studies with
similar findings.

But just as is the case with the analysis by Hooper et al, these findings
and many other contradictions are always explained away with more or less
valid arguments. As Karl Popper would have said: the diet-heart disease
hypothesis is unfalsifiable and should therefore be classified as
non-science.

Uffe Ravnskov, independent researcher.
Magle Stora Kyrkogata 9, S-22350, Lund, Sweden [log in to unmask]

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1.  Mann J, Skeaff M, Truswell S. Dietary fats and prevention of
cardiovascular disease. BMJ 2001; 323: 1000[Free Full Text]. (27 October.)
2.  Hu FB, Sacks F, Willett WC. Dietary fats and prevention of
cardiovascular disease. BMJ 2001; 323: 1000[Free Full Text]. (27 October.)
3.  Hooper L, Summerbell CD, Higgins JPT, Thompson R, Capps NE, Davey Smith
G, et al. Dietary fat intake and prevention of cardiovascular disease:
systematic review. BMJ 2001; 322: 757-763[Abstract/Free Full Text].
4.  Ravnskov U. The questionable role of saturated and polyunsaturated
fatty acids in cardiovascular disease. J Clin Epidemiol 1998; 51:
443-460[CrossRef][ISI][Medline].

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