Week after week it seems like old myths about diabetes, lipidemia and hypertension are falling by the wayside. For years we focused on calories and sugar and never made an effort to limit carbohydrates. In fact it has only been in the past five years that the ADA has even acknowledged that a low carb diet was good for glucose control.
Starting in the late 1950’s the medical profession began screaming that if you ate cholesterol you would have high LDL or triglycerides and so a low- or no-fat diet became the cure-all for heart disease. Yet after six decades of eating this way we have a higher incidence of cardiovascular disease than ever imagined and we now know that heredity and high carbohydrate diets have a much more profound influence on CVD risk than eating bacon ever did.
Even knowledgeable health professionals subscribe to these ideas and then they get passed on to patients much like myths about the Loch Ness Monster or Area 51. This was very obvious last week when I taught a group of patients at a primary care physician’s office. As we were discussing carbohydrates, proteins, and fats, and their effects on glucose levels, one of the patients saw a picture of bacon and mayonnaise and said that there was no way they could eat any saturated fat without having a heart attack. When I asked where they had heard this the answer was "my doctor." It took me a while to explain to them the differences between trans fat and saturated fat and why most recent data points to the value of saturated fats in the diet.
After the program I spoke to the physician about the changes in opinions on saturated fat and shared a recent article from the British Medical Journal written by Dr. Aseem Malhotra who is an interventional cardiology specialist at Croydon Hospital in London. In this article Dr. Malhotra makes the following comments: "The mantra that saturated fat must be removed ……has been around for almost 40 years and that is based on the idea that reduction of LDL cholesterol will reduce cardiovascular risk, yet we now know that it is the small dense (type B) particles (responsive to carbohydrate intake) that are the culprits." After the physician read the whole article he realized that his patients were more likely to benefit from a low carbohydrate diet rather than a low saturated fat diet. If you want to read the entire article from Dr. Malhotra (BMJ 2013;347;f6340) just follow this link to the PDF.
If you have patients who seem on the fence when it comes to getting a flu shot it might be worth while to let them know that it now appears that flu shots can reduce the risk of cardiovascular events by as much at 55%, which, incidentally, is higher than what most cardioprotective drugs can claim.
Dave Joffe, Editor-in-chief