One truly horrifying landmark in our history of the connection between diet and heart disease can be found around the Framingham Study, which many of you may have heard about growing up. The Framingham Heart Study continues to be one of the pivotal studies in our understanding of heart disease. Now on its third generation of research subjects, it was started in 1948 with 5,000 participants in Framingham, MA. Over the years, it has looked at every factor researchers could imagine that might be involved in the development of heart disease.

After six years of study the investigators announced their first BIG discovery . . . that high cholesterol was a reliable predictor of heart disease. This was significant because, until that time, researchers had assumed that cholesterol was the culprit, but did not have the data to prove it. This finding also provided medical doctors with something to measure and, subsequently, to treat. 

However, what the data from the Framingham Study actually showed was that there was no difference in coronary heart disease events between individuals with cholesterol levels of 205 and those with levels of 294. Yet the vast majority of the population of the United States have cholesterol numbers within that range. Despite the data to the contrary, Director of the Framingham Study Dr. William Kannel stated in 1987 that “total plasma cholesterol is a powerful predictor of death related to coronary heart disease.” 

It was not until 10 years later and published in a lesser known journal, The Archives of Internal Medicine, that Kannel's successor at the Study, Dr. William Castelli, wrote the real truth about the findings, “The more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the people’s serum cholesterol.” And you can bet that did not make national news!! 

ARE YOU KIDDING ME? For decades doctors have used the Framingham Study to justify the theory that high cholesterol levels are predictive of heart disease (including me in the early years of my practice). Yet their clinical data showed exactly the opposite of what they concluded from the study. I find this incredibly shocking, and downright disturbing!!

Dr. George Mann, the associate director of the Framingham Study, became another of those researchers whose career was derailed when he reexamined the Framingham data and found that total cholesterol was not a reliable predictor of heart disease after all. In a 30-year follow-up he found that “for each 1% mg/dL decrease in cholesterol there was an 11% increase in coronary and total mortality.” Written another way, this means that when you decrease your cholesterol levels, you increase your chances of dying from heart disease!! That’s exactly the opposite of what we have been told! Dr. Mann’s reexamination of the Framingham data confirmed once and for all that cholesterol is not related to heart disease. 

Of course, Mann’s revelation did not go over very well with the National Institute of Health and the American Heart Association, who had so carefully crafted the direction for research about heart disease. They had established a clear bias that cholesterol and saturated fats were the cause of heart disease, despite the research showing otherwise.

Even as the false narrative connecting saturated fats to heart disease expanded, there were voices of dissent from medical doctors. Some doctors had patients who continued to gain weight even after increasing their exercise and reducing their fat calories. Dr. Blake Donaldson, an internist in Manhattan, began to experiment with a low carbohydrate diet in 1919. He had learned about the diet of the Inuit, an indigenous people of northern Canada, from the American Museum of Natural History. Consulting with experts, Donaldson found that the Inuit lived almost disease free, yet consumed the “fattiest meat that they could kill”. He began to experiment by banning all sugar and flour for his patients and allowing them to eat fatty meat three times a day. In his 40 years of practice, he successfully treated over 17,000 patients with his recommendations, emphasizing that his patients easily lost weight without feeling hungry. 

Then Dr. Alfred Pennington, a physician at Dupont, heard a lecture by Dr. Donaldson in 1944 and began to try this new approach with high-level executives who were overweight or obese. He also was successful in using the low-carbohydrate, high-fat diet with his clients. He wrote that they experienced “little hunger, increased physical energy, and an increased sense of well-being.” 

Based on his success helping overweight patients, Dr. Pennington delved into why the low-carb diet worked. He discovered work by German and Austrian researchers from the 1920s and ‘30s  which determined that hormones were the drivers of obesity. Remember that graph that showed the insulin rise after eating a high carbohydrate meal? The European researchers were onto this phenomenon 100 years ago! They already understood that obesity was a disorder of metabolism and that fat tissue was biologically active. They were early pioneers in the field of endocrinology and obesity, which was still new even in the 1950s.

Dr. Pennington’s work on obesity emerged in the early ‘50s, right around the same time Ancel Keyes was promoting the idea that saturated fats and cholesterol cause heart disease. Dr. Pennington’s work was ignored in spite of being based on physiology (how our bodies work) and evidence drawn from the actual sciences of biochemistry and endocrinology. Keys, if you remember, based his theory on flimsy evidence from dietary surveys that he manipulated to illustrate his thesis. 

You have probably heard of the most famous doctor to espouse a low-carb, high-fat diet—Dr. Robert Atkins from New York. Dr. Atkins experimented on himself with a low carbohydrate diet after reading about the diet proposed by two doctors from the University of Wisconsin Medical School. After he was successful in reducing his own expanding girth, Dr. Atkins became highly effective at helping his patients lose weight. He went on to publish several books and create a successful company. 

Unfortunately, although Dr. Atkins had many successful case records to show that his diet worked to overcome weight problems, he did not have the science to prove its effectiveness. His protocol, based on the health benefits of a low-carb, high-fat diet, was not accepted by the medical establishment. Remember that around this same time, most of the major health organizations had signed on to the Lipid Hypothesis; so they simply branded him a “kook”. The American Dietetic Association called the Atkins food plan “a nutritionist's nightmare”. 

Thankfully now we do know the value of a high-fat diet due to the tireless efforts of a few researchers and doctors committed to the work of helping patients restore their health through food. Dr. Eric Westman at Duke Medical Center is one proponent of the low-carbohydrate, high-fat diet. Learning about the Atkins diet from one of his patients, Dr. Westman actually went to New York to review Dr. Atkins’s patient charts and found that his protocol was sound and effective.

Dr. Westman’s work with a high-fat diet has focused on Type 2 diabetes, heart disease, and obesity. Clinical trials with diabetics following this diet have demonstrated that low-carb, high-fat food IS an effective treatment for this disease. Westman and colleagues have strongly argued for the low-carbohydrate, high-fat diet instead of the life-long regimen of drugs currently in use for treating Type 2 diabetes. 

In 2014 the Annals of Internal Medicine published a controversial meta-analysis entitled “Association of Dietary, Circulating and Supplement Fatty Acids with Coronary Risk.” Dr. Rajiv Chowdhury led a team of international researchers in a review of 27 controlled trials and 49 observational studies that included over 600,000 participants from 18 countries. His conclusion stated: 

Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

Ooooo-weeee!! You should have heard the hostility spewed by the scientific community. Those results do not fall in line with the current paradigm promoting a diet low in saturated fat. The American Heart Association had just released the new dietary guidelines in November 2013. Those brand new guidelines had kept saturated fats at 5-7% of daily calorie intake for people with cardiovascular disease and 10% for the general public. That allows for two tablespoons of butter per day , plus . . . nothing—no meat, no cheese, no ice cream. No wonder the powers that be were upset with Dr. Chowdhury’s findings!

Unfortunately, this was not just a disagreement between a few doctors with differing opinions about diet. The question of whether saturated fats cause heart disease goes way beyond just your heart. It has implications for every chronic disease we are experiencing in this country: obesity, diabetes, hypertension, autoimmune diseases, kidney and liver disease—the list goes on and on and on! The demonizing of saturated fats by the medical establishment not only has repercussions for your health, but for the health of your children and their children and future generations of children to come.

Now is the time to set the record straight. We must begin the transition to a healthier way of life! Stay tuned for the next chapter in our history of how healthy saturated  fats became public enemy #1. It provides the latest scientific confirmation that Dr. Chowdhury and his team are right. Vindication has finally come for all the voices in medical history who used science to prove that saturated fats are not responsible for heart disease and do not increase mortality rates. 

  This is Dr. DeLaney reminding you to eat full fats from real food!