An editorial recently published in the British Journal of Sports Medicine is getting a lot of press. http://www.cnn.com/2017/04/25/health/saturated-fat-arteries-study/index.html Why? It’s throwing conventional wisdom about heart disease up in the air. The main point of the writers is this: Our focus on saturated fat (red meat, butter, full fat dairy) is misguided. We shouldn’t worry as much about the saturated fat, we should focus instead on a different set of proven strategies to reduce the impact of coronary artery disease on public health.
There are many that might raise an eyebrow that this editorial was published in the relatively obscure British Journal of Sports Medicine. It wasn’t published in prestigious journals such as the New England Journal of Medicine, the Journal of the American Medical Association, or Circulation, the journal for the American Heart Association. Keep in mind, sometimes major journals, and the people that run them, aren't ready for a shake-up.
I will say as I write this that I am not a cardiologist. However, I do try and keep up with the literature on preventive health, and in my practice I implement innovative strategies to combat the risk of heart disease in my patients. All of us, as primary care doctors, are on the front lines of keeping people out of the hospital and away from the cardiologists.
Here are my initial thoughts on the editorial:
1. The editorial writers may be cherry-picking data to prove their point. This is an important criticism, but shouldn’t completely invalidate their premise.
2. The editorialists’ key point isn't a bad one, and one we have been hearing about for a while: sugar/refined carbohydrates are really bad for us. It IS the bun, fries and sweetened beverage that are significantly contributing to worsening public health outcomes.
3. The editorialists and the critics may both be right. Think of it this way: coronary artery disease has two outcomes. A. Blockage of the heart artery that can lead to chest pain (angina) when we exercise and B. Acute clots that suddenly emerge in a heart artery that directly lead to what we call a heart attack. We need to think of them as two different issues, with potentially two different treatment approaches. This editorial may prompt this conversation.
Look, no one wants chest pain. Angina is uncomfortable and unpleasant. But a heart attack? This is different. Heart attacks kill people. So, it’s an important question as to what drives the heart attack, the widow(er) maker? Evidence seems to be pointing toward inflammation, an idea that goes back as far as a 2005 review article in the New England Journal of Medicine, an article that has been referenced by other authors over 7000 times. High levels of inflammation inside the arteries = higher risk of death.
I believe the editorial authors' focus on inflammation is NOT unfounded. I also believe the criticism of the authors' analysis is NOT completely unfounded. Can they both be correct? I say yes, particularly if you think of coronary artery disease as these two different processes.
What are the authors’ recommendations, then?
1. Eat healthy: Consume fewer processed foods. We can't argue there (unless you're "Big Food"). The closer we are to the food that we eat, the better off we are likely to be. Here in Chicago, for example, there is a company that grows great tasting tomatoes all year around. Let’s do more of this.
2. Exercise: Can't argue there. We sit too much and don't exercise enough. We all know that. And the data suggests that all we need is a brisk walk a few times a week.
3. Manage stress: Can't argue with this, either. There is a lot of emerging data on the value of meditation/mindfulness/relaxation. It doesn't mean we can't have stress; we all have stress. It just means we need to have an active strategy to manage it.
So, my take on this editorial is that we should listen. Listen to the outliers who are finding fault with conventional wisdom. If people are still dropping dead of heart attacks while on cholesterol medication, do we have the right treatment plan? Also, let’s not underestimate the influence that Big Pharma plays in this whole conversation. In the three recommendations the authors make, we don’t see a drug, do we?
Another way of saying this is to put the challenge to you and me. You and I can’t outsource our health to the maker of a pill. We need to take accountability for what we’re putting into our mouths, how we move our bodies, and how we calm our minds. The power to control the future of our health is in our control. How will we respond?
William Harper MD is the founder of Harper Health Streeterville, a membership-based primary care practice based in Chicago.