The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support.<p>Much of what is written here is accepted widely: that many types of fats are not really the issue driving heart disease; that fructose and other sugars are problematic; that lifestyle interventions can have a real impact; that stenting stable atherosclerosis has no benefit; and that atherothrombosis is the killer.<p>The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. That LDL is a primary contributor to cardiovascular disease, myocardial infarction, and death is supported by human genetic data and by hundreds of thousands of individuals followed in clinical trials, as well as millions of people in post marketing monitoring. The casual dismissal in this article by referring to low quality, confounded evidence (observational studies) is not responsible and it taints an otherwise useful summary.
BOOM the smoking gun goes off.<p>As a nicotine addicted person, currently on recovery (but very aware of the lifelong fight that it is for me), and as a LCHF dieter, to me the relation is very clear. In my case, sugar has the same addictive effects than nicotine, and apparently, it has as most or even worst malign effects.<p>This is not to say that everyone should follow a LCHF diet, or that it will work for everyone. I do think that if you keep your carbs under 100g daily, and they are low profile insulin type, you should be good and safe. But for me, as an addicted person, if I deviate from 15g is very easy to get into a slippery slope and the next thing I know I am eating donuts and flurries. If I smoke a cigarette on a night out, the next thing I know I am smoking a pack daily or more.<p>The thing is, as with tobacco before, the sugar industry (which is probably the 90% of volume of the whole food industry world wide) has gone ways and beyond to hook us to their products and to cover the negative effects. Too many people is addicted to High Carbs without even knowing it.<p>I hope this studies get more and more attention in the mainstream media and many more people could at least review their lifestyle with more information and asses what is best for each of them.
It is strange that anti-inflammatory drugs don't reduce risk.<p>Which fats are pro- or anti-inflammatory also seems to be an area of active research: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/" rel="nofollow">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/</a><p>Nutrition is pretty terrible. It seems to me that laymen have zero chance of getting useful advice out of the research, other than "Eat a varied diet, move regularly".
For those interested in supplementing Omega-3 oil in their diet (which should probably be everyone), don't get Omega-3 off the rack at the store. Most Omega-3 supplements (even at GNC/Vitamin Shoppe/etc) consist of a small amount of Omega-3, and a lot of filler "fish oil" which does nothing for you. Furthermore, in order to get the levels of Omega-3 you need to really see benefits (roughly 500mg DHA and 500mg EPA per day, 1000mg DHA/1000mg EPA if you have heart disease - but ask your doctor) you would need to consume so much of this filler you will really start to see side effects (fishy breath, gastrointestinal distress, etc).<p>Here's an example of what you will see at the store: <a href="https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels/dp/B00MGNMMHI/ref=sr_1_7_s_it?s=hpc&ie=UTF8&qid=1520870949&sr=1-7&keywords=omega%2B3%2Bfish%2Boil&dpID=51eg6Tzy3DL&preST=_SY300_QL70_&dpSrc=srch&th=1" rel="nofollow">https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels...</a><p>Notice there's 1000mg of fish oil there, but only 300 mg Omega-3 (only 250mg of which is actually DHA/EPA) and they don't even give you the ratio of DHA to EPA in that 250mg - you need an even split to see best benefits as they work together.<p>What you need to look for is pharmaceutical grade Omega-3, which is basically just concentrated so you don't get the filler oils. I'm a huge evangelist for OmegaVia (<a href="https://omegavia.com/" rel="nofollow">https://omegavia.com/</a>), since they also use a enteric coating on the pills so they do not dissolve until they hit your small intestine. As a result there are zero fish breath/burp side effects. Give it a try, it's a game changer.
Literally hundreds of metabolic ward studies (the gold standard in nutrition) have demonstrated a direct, causal relationship between saturated fat intake and blood cholesterol levels. And the correlation between high cholesterol levels and CVD has been known for decades. Don't be fooled by observational studies which fail to disentangle the highly variable baseline individual cholesterol levels from the effects of fat in the diet.<p>Here is a review of 395 direct feeding experiments, which are much more appropriate for measuring the effects of diet:<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/9006469" rel="nofollow">https://www.ncbi.nlm.nih.gov/pubmed/9006469</a><p><a href="http://circ.ahajournals.org/content/circulationaha/108/22/2757.full.pdf" rel="nofollow">http://circ.ahajournals.org/content/circulationaha/108/22/27...</a><p><a href="https://www.theguardian.com/science/sifting-the-evidence/2016/jun/13/dont-throw-away-your-statins-yet-ldl-cholesterol-is-still-probably-bad-for-you" rel="nofollow">https://www.theguardian.com/science/sifting-the-evidence/201...</a><p>This video sums up the issues well:<p><a href="https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/" rel="nofollow">https://nutritionfacts.org/video/the-saturated-fat-studies-s...</a>
> <i>Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions</i><p>Doesn't saturated fat <i>trigger inflammation?</i> Because if I remember that correctly, then this is a "guns don't kill people, bullets do" argument.<p>Similarly, doesn't it also cause arterial stiffening? It is not the same process as arterial clogging but definitely makes it worse and is part of heart disease.<p>Again, I may be misremembering this - I could be confusing fat and meat, for example. Either way it boils down to "eat mostly plants"
Dr. Malcolm Kendrick has a good over 40 part series on What causes heart disease? <a href="https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-disease/" rel="nofollow">https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-d...</a>.<p>It may be of interest.
A plant-based diet can be very anti-inflamatory, and its reported to revert heart disease in some cases - <a href="https://www.youtube.com/watch?v=tk0iC4TOE0E" rel="nofollow">https://www.youtube.com/watch?v=tk0iC4TOE0E</a>