Saturated Fat and Coronary Heart Disease, Part I: Introducing Professor Rod Jackson
The other day I got an email from David Brown, proprietor over at Nutrition Education Project alerting me to an exchange he and Jimmy Moore had with a professor of epidemiology in New Zealand. Now, the first thing you need to know is that David, unlike me, is a meticulously nice guy and he employs that graciousness in what he does to try and inform and educate policy makers, researchers, nutritionists, the media and so forth.
I’m just a slash & burn, hit & run kinda guy who stumbled into this whole nutrition and fitness thing, and now here I am. So, David and Jimmy Moore have engaged professor Jackson in a polite & cordial manner. After nearly three weeks of considering what I might do, if anything, I’ve decided to do likewise; and moreover, to make it a multi-part effort over the next week or so.
In this post, I’m going to introduce you to the professor and quote some key assertions of his from that exchange with David and Jimmy. Those assertions will be the basis of the next posts. The second post is going to lay the foundation of principles. That is, our evolution strongly suggests (when not already dictated) certain things about our diet, and when those principles come in conflict with current observational study and hypotheses, we ought to be extra demanding of quality evidence.
The weight of evidence for an extraordinary claim must be proportioned to its strangeness. –Pierre-Simon Laplace
I then wish to spend some time looking at what Prof. Jackson and other researchers like him may regard as the best evidence for their position that saturated fat is atherogenic. This is where I could use some help from readers who may know what, say, the top five studies might be. Please drop your thoughts in comments as we proceed — such comments will in part guide how I put together subsequent parts of this series.
Finally, we’ll take a look at the best contradictory evidence and try to draw some conclusions.
So, just who is professor Rod Jackson? Here’s his page at the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland.
Rod Jackson is Professor of Epidemiology and Head of Epidemiology & Biostatistics at the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland. He is also the director of EPIQ (www.epiq.co.nz), an in-house group undertaking teaching, research and consultancies in Evidence-based Practice (EP), health Informatics (I) and Quality improvement (Q), for healthcare services. He is medically trained, has a PhD in Epidemiology and is a member of the Australasian Faculty of Public Health Medicine. He has published approximately 200 peer-reviewed papers. His main research interest for the last 25 years has been the epidemiology of chronic diseases, particularly cardiovascular diseases. He is one of the architects of New Zealand risk-based clinical guidelines for managing CVD risk. He is currently involved in developing and implementing a web-based decision support system – PREDICT – to help primary care practitioners across the country systematically manage CVD and diabetes risk at the ‘moment of care’ for their practice populations.
Well, that’s quite a resume. From that I think we can trust that professor Jackson will have a very good familiarity with everything we ultimately touch on in this series.
And now, let’s take a look at some of the statements and claims made in the aforementioned exchange with Jimmy and David.
Saturated fat is the underlying cause of coronary heart disease – the single biggest killer in the western world. Fortunately most Americans are aware of this and over the last 40 years consumption of saturated fats, including butter, which is almost pure saturated fat, have fallen dramatically. Over the same period coronary heart disease deaths have fallen by almost 75%. No other common disease has fallen by so much so quickly. […]
The totality of the evidence on millions of people from basic biochemistry through metabolic ward studies, large scale cohort studies, randomised controls and finally the plummeting coronary heart disease death rates across the western world in line with major falls in saturated fat consumption and blood cholesterol levels, provides better evidence for the saturated fat – CHD relationship than anything else in medicine. I have spent over 25 years reviewing this evidence and it is important not to cherry pick the individual studies that suggest it is not true. There will always be some conflicting evidence – it is the nature of science – and the modern way to address this is to undertake systematic reviews of all the high quality evidence. […]
The advice people like me have been giving governments and the public about reducing their risk of heart disease over the last 25 years seems to have been extremely successful.
Then, there’s this this item: Professor calls for tax on ‘poison’ butter.
A top public health expert is calling for a health tax on butter, saying it’s "pure, natural poison" and as bad as cigarettes.
New Zealanders eat more butter per head than any other nationality and Auckland University epidemiologist Professor Rod Jackson says that’s why our cholesterol levels are also among the world’s highest.
"We have a health tax on alcohol and cigarettes and there should be a health tax on butter. It’s the most poisonous commonly consumed food in New Zealand. It’s about the purest form of saturated fat you can eat and it has no protein and no calcium. Butter has had all the good things taken out and just left the poison."
[…]
New Zealanders get about 20 per cent of their saturated fat intake (and therefore bad cholesterol) from butter. We average around 8kg a year – three times as much as Australians and 16 times more than the Japanese.
Jackson says while the dairy industry had done some "fabulous" things to produce low-fat alternatives, "its one major weakness is butter". "If only they could find a nice effective process for turning butter into biofuel."
So there you have it. Looks like I have my work cut out for me.
On one final note, I am going to insist this time around that all comments directed toward professor Jackson be respectful. Yes, that’s ironic, coming from me, but I wish for this series to not be tainted with irrelevancies, no matter their propensity to inspire and entertain.
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I applaud Dr. Jackson for at least engaging the conversation even if he isn’t budging from his dogged position.
O.M.G.
With all due respect, I simply cannot believe that he called the amazing 100% grass-fed (no other kind in NZ) butter from as ecologically clean a country as they get a “pure, natural poison”. This is going to be beautiful, thank you! As an aside, my wife’s from NZ, so we’ll be following this “discussion” very closely.
Looking forward to the series! One suggestion … can you make sure that the posts link to each other? I can imagine this will be very useful to point folks to over time, and it’d be great if we just can point to this post, and readers will be easily able to follow the whole argument.
You probably already had that in mind, but just wanted to be sure!
Not sure if you’ve seen this (you’ve may’ve pointed me to it in the first place – in which case I apologise)….
http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=heart.disease&conitem=a03ddd2eaab85110VgnVCM10000013281eac____
Good luck, this’ll be a good match…
Amanda:
That’s a dead link.
The link works for me. Title and summary:
“What if Bad Fat is Actually Good for You?
For decades, Americans have been told that saturated fat clogs arteries and causes heart disease. But there’s just one problem: No one’s ever proved it”
Reductions in CVD mortality could mean that we’ve gotten better at treating those who are sick. I’d instead want to know what’s happening with overall CVD rates of diagnosis during this time.
Todd:
stay tuned. That’s actually the biggest among two huge blind spots I’ve detected so far.
I did a quick search for those stats before I commented but couldn’t find it. I don’t have time to really dig right now. I’d also look for smoking rates during that time.
Yep. That’ll be in there too.
Richard, I think Prof. Jackson knows exactly what he is talking about when he says “deaths” as opposed to “CVD decease rates”. It’s not his “blind spot”, but a rather… how should I put it… “strange” way (for a specialist of his caliber) to confuse the issue. In my view, arguments of this sort just show that he doesn’t really want to have a sincere discussion on the subject, which is not surprising at all considering that his whole long career was and still IS dedicated to the Holy War against Saturated “Poison”.
@Richard
I think your effort while noble and well-intentioned, will likely be an exercise in futility. Reading Jackson’s phrasing of his response reminds me of what I encountered while taking a graduate degree in economics.
There were a number of fellow graduate students who were without a doubt more talented than me when it came to pure econometrics. That is to say, you could give them a slew of data to crunch and run all sorts of regressions on…but…when it came to stepping back and applying a rational, causal framework to the economic problem, one that might predict the data and prove useful in understanding the relationships, they were clueless on how to proceed. Not only were they clueless on how to proceed, but they were openly hostile.
They could “crunch” the data, but were unable to actually think for themselves, and therefore defended much conventional economic “wisdom” without even knowing why they were defending it.
This is what I see in SAD versus Paleo. The standard SAD approach has a bunch over-manipulate data on why X is ostensibly good/bad for us without a framework to hold it all together. Now I am not suggesting that data analysis is irrelevant, but that reasoning and logic should dictate what that analysis be.
This, in a nutshell, is what Good Calories, Bad Calories is all about: epistemology.
It is not coincidence that many of us Paleo types are highly educated and intelligent skeptics/non-conformists, often with a libertarian bent.
Patrik~
i’ve also noticed that paleo types seem to be a bit skeptical and libertarian.
…sounds like your fellow students were Keynesians… must have driven you nuts.
In New Zealand the leading cause of deaths was cancer 28.5% then ischaemic heart disease 20.8% and third CVD.
http://www.moh.govt.nz/moh.nsf/indexmh/mortality-demographic-data-2006
This journal writes that in NZ they have cut down consumption of saturated fat yet obesity and diabetes has increased.
“Such trends are encouraging but they are happening at a relatively slow rate, which, in association with recent rapid increases in mean population body weight and diabetes incidence rates, suggests that increasing levels of obesity and diabetes may potentially swamp the effects of any favourable trends in cholesterol levels. The proportion of obese New Zealand adults (BMI ≥ 30) doubled (from 11% to 21%) between 1989 and 20039 and the prevalence is continuing to increase. Rates of diabetes are similarly predicted to double by 2011.
http://www.nzma.org.nz/journal/118-1226/1750/
Perhaps the statins we have started dispensing like candy, with their anti-inflammatory properties, have something to do with the reduction. Of course those that use them are dying of other things and have an increase in all-cause death, but it certainly could help explain the CVD reduction.
All,
I hope everyone recognizes the weight of what Richard and his colleagues are proposing. Changing the mind, in a documented way via blogging, of even a single big time proponent of the Diet-Heart hypothesis has enormous ramifications as far as the precedent that it builds on. And this guy doesn’t just seem to be a proponent. He sounds like the George Bray of the southern hemisphere.
You are doing honorable work here Richard. If you bring him around to the truth, and then someone shares this with a doctor friend of theirs, and it continues, you will have started something amazing.
I know people’s minds have been changed before, but to be able to read a public transcript of the experience is potentially revolutionary.
Good luck to you, and any help that we can give, I’m sure we’ll pull together to provide.
Regards,
Bryce
Patrik is right, while the science is of great importance, this is largely a philosophical battle. Most pressing, especially when they are talking about taxing “poison” butter in New Zealand, of all places, is the need to defend the choice of what to eat on the basis of individual rights.
That’s why I’m so heartened to see this kind of philosophical defense from folks like Dr. Kurt Harris at PaleoNu.com and Dr. Monica over at FA-RM.org, in addition to similar support from our good host Mr. Richard.
So, the battle is on many fronts and I applaud your efforts here. That would be great to sway someone away from the Dark Side. But, no matter what the science suggests, ultimately people must be free to choose to do with their bodies as they wish, so long as doing so does not infringe on the rights of others to do the same.
My, what a tasty subject. NZ butter is divine, but my recollection of our short visit to NZ is that like the British, New Zeelanders love sweets and biscuits.
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I am a New Zealander myself, this guy makes me cringe. I’m sorry he is representing my country to people who might not have had experience with the happy and relaxed people and lifestyle we have first hand.
I see the good doctor keeps telling Jimmy that anecdotal evidence is not evidence, yet he provides none of his own and merely says “I’ve seen things, and I’m a doctor, so I know’. The appeal to authority does not work with me – any authority who thinks they know better about what is good for me can go [expletive deleted] themselves. I don’t need evidence. All I know is that on the recommended healthy diet, I was a physical and emotional mess and that since cutting out grains and eating plenty of ‘poisonous’ saturated fats I’m feeling the best I have ever felt in my life. EVER. My quality of life is so much better now, if I drop dead at 50 from CVD, so be it. I would rather live a short, good life than a long painful one. So pass the poison.
However, New Zealand eats the most butter per capita per world? We beat the French on the butter score? HELLS YEAH! Go Kiwi!! If only I could convince New Zealand to give up it’s bakery/coffee and a cake/sticky bun habit…
Oh, and Anna – yes – we LOVE our biscuits (cookies). The biscuit aisle in the average NZ supermarket runs the length of the shop. It would not phase Americans, but it freaks out every other nationality in the world. But then again, the meat coolers run the entire length of the store plus some, so we’re not entirely nuts 🙂
… not to mention the pavlovas. 😉
My mum makes the best pavlovas in the world! 🙂
What I’m most curious about is how saturated fat affects the body differently when in a high-insulin, high-inflammation, oncoming metabolic syndrome state vs. a low-insulin, low-inflammation state. Putting a lot of butter on a piece of bread along with a bowl full of “fruit loops and skim milk” (aka sugar) may in fact make your problems worse than going without the butter. But putting a dollop of sour cream (with the same SFA’s) on your usual steak and eggs, or salmon and eggs breakfast as a part of a low-carb lifestyle is a completely different context for the intake of those saturated fats.
Remember, the carb hypothesis states that insulin is the central issue of weight gain and the illnesses of civilization. In that theory, saturated fat is not intrinsically good or bad, it’s that your body does harmful or helpful things with fats (and proteins) based on your insulin levels.
It sounds like Dr. Jackson may have already made an important move and taken the initiative in the discussion by changing the context of the argument away from insulin and inflammation over to saturated fat. If you wish to make a compelling case in this argument, you can’t let him distract from the real argument behind the carb hypothesis.
A little word about epistemology here.
Many people appear fond of repeating the line that “Anecdotes don’t equal evidence.” They appear to extend this to personal experience. Thus, if you lose weight and have health improvements on a paleo diet, you are advised that this doesn’t count as “evidence” by the authorities who get to decide what counts as evidence.
If you think it through a bit, it seems the railing against anecdotes becomes the advice: Do not believe what you see with your own eyes, or experience in your own life. Instead, believe what the authorities have authorized you to believe, based on the evidence the authorities have decided is real evidence.
Although clothed in scientific garb, it sounds a lot like religion.
And the authorities think their ‘evidence’ gives them the right to regulate the lives of people who prefer to ignore their authority.
As for the atherogenic potential of saturated fats, how come the Masai did not have atherosclerosis (confirmed by autopsy) or heart disease on their diet providing 60% of calories from butter fat? AJCN 24, Nov 1971, pp 1291-93.
Or how about the Fulani, pastoralists getting nearly 50% of energy from dairy and palm fats, with 25% o energy from saturated fats: “Despite a diet high in saturated fat, Fulani adults have a lipid profile indicative of a low risk of cardiovascular disease. This finding is likely due to their high activity level and their low total energy intake. Am J Clin Nutr 2001;74:730–6.”
I agree with Ross, the effects of saturated fat are relative to context. I hope that someday people in nutrition could embrace the scientific perspectives of evolution and relativity…instead of the good/bad thinking of, again, religion.
Human body fat is about 45% saturated. So I guess the body is designed to store emergency fuel that is simultaneously a poison?
BTW nature already found a way to convert butter (fatty acids) to biofuel. Its called a mitochondria.
Don
Although clothed in scientific garb, it sounds a lot like religion.
@Don
I couldn’t agree more. So much of what we take for granted as “science” is not much more than shamanism or cult of a high priest.
I remember hearing someone say that doctors and scientists like to use the term ‘anecdote’ for a data point they don’t want to deal with.
Seems about right to me.
Dave
Prof. Jackson is talking through a hole in his……..
To call butter a ‘poison’ is a complete pile of trollop. Butter contains Vit A, D,E, & K not to mention selenium, iodine, butryic acid and CLA. Does he care? no, because the medical profession’s ‘cure’ for something missing from the diet is a pill.
I say here and now, you can lead him to the evidence, but you won’t sway him toward it. For him to accept the evidence would place him as a hypocrite and he’d not want that given that he appeared on a quiz style national tv show in September as the authority of heart health. He’s on a crusade (excerpt taken from the blurb of the TV channel that hosted the quiz show) ‘ He is committed to changing the world and in his eyes New Zealand is a great place to lead the charge towards a healthier world. ‘
from another Kiwi!
btw, Just found your site 2 weeks ago and it’s a fantastic resource and am looking forward to following this to it’s conclusion.
New Zealand butter is possibly the best quality you can get. I’m Australian and always prefer NZ dairy to anything else. The entire NZ dairy system is based on pasture-fed cattle. See here:
“…the New Zealand cow is almost exclusively fed on pasture and on conserved feed such as silage made from surplus pasture in the spring months. Few New Zealand dairy farmers use grain-based supplements, which introduce a higher cost structure into dairying.”
..and…
“In England, a kilogram of grain might cost 12p, while the farmer receives 22p per kilogram of milk; in New Zealand the price of suitable feed grain is 30c per kg or more, while the farm receives only 30c per kg of milk, i.e. grain feeding is not economic.”
Hi Shmaltzy,
If you live in Sydney or I think Queensland too, you can find the best all natural, pastured butter i have ever had. It’s not even pasteurized.. look to the markets.
Hi Glenn. I have heard of this amazing, pastured, unpasteurized butter of which you speak. But unfortunately we don’t seem to have it down here in Melbourne. I visit the farmers markets regularly, but no luck. I have heard and read of it being available only up in Sydney and QLD.
Ive seen it on sale at the farmers market at the abbotsford convent/collingwood childrens farm, , but adevertised as bath milk of course.
I find it interesting that Prof Rod is very vocal about butter but is absolutely silent about the role of homogenised milk in the development of arteriosclerosis and artherosclerosis. Isn’t it strange that homogenised milk, with its ability to pass unmetabolised fat cells directly into the bloodstream, causing damage to the artery wall to which the body responds by “patching” the damage with calcified plaque.
He calls butter poison but, not only doesn’t he turn his sights on a genuine heart harmful food but is totally silent about it.
It is also interesting that whilst Professor Jackson recommends not to “cherry pick” research that reinforces the opposite to his recommendations, surely he is doing the same – cherry picking only what agrees with his theories and discarding the rest. You will notice that our august Heart Foundation does the same thing. They are strongly very much against any diet that leaves out, or limits, whole food groups and yet their own diet recommended diet severely limits saturated fats.
That is a fascinating hypothesis of athersclerosis. It seems to be Kurt Oster’s hypothesis about xanthine oxidase (XO) making it through the gut in the smaller lipid particles in homogenized milk. There are a few problems with Oster’s theory, basically that nobody has been able to reproduce his results since 1971. The increases in serum XO levels after drinking homogenized milk or cream are observed after any fatty meal, whether or not there is any XO in the food at all. Second, there is substantial evidence that XO levels in the blood and lymph are tightly regulated and that a dietary source would simply temporarily reduce endogenous production (much like cholesterol). Third, XO seems to exhibit both oxidizing catalyst and anti-oxidant properties, and seems to be a part of a signal pathway, so it’s presence in our bodies should not be particularly alarming. And finally, we are learning a lot more about how athersclerotic plaques form, and except for it’s variable contribution to inflammatory processes in and around blood and lymph, XO is not particularly worrying.
Now, if you’re referring to a different hypothesis by which the smaller lipid particles of homogenized milk might be a cause of athersclerosis, I’d love to learn more. Google doesn’t have anything about it on the first few pages of my searces.
If your Vitamin D3 levels are up, your HDL levels are up (and consist of larger particle sized), your triglycerides are down, and your LDL also consists of larger particles, you’re pretty good. To achieve that, stay away from sugars, grains, and starches, and take 4k-10k UI Vitamin D3/day and 1-2g nicotinic acid/day.
[…] Part I of this series I introduced you to Professor Rod Jackson, who has quite a strong view of the dangers of saturated fat from animal sources in the human diet. […]
[…] the saturated fat-cholesterol-heart disease link or "causal chain" might use (here's Part I). In the process of doing my homework for that post I came across something I think fits in here […]
Richard, you might be interested in this new global PR assault on butter, by one of the leading margarine companies. They claim that butter should be banned!
blogsthatmakemethink.blogspot.com
Funny. You comment came on the heels of another with this link:
http://www.dailymail.co.uk/health/article-1244048/Ban-butter-save-thousands-lives-says-heart-surgeon.html
They’ll lose. Guaranteed. My only aim is to make them look like idiots, murderers and maimers in the process.
I haven’t looked closely at that link, but he’ll have his name on this blog within a day or so.
[…] I begin, I'll simply point you to part one of the series and you'll find the links to all the other parts […]
[…] this Part IV of the series (Part I; Part II; Part III), I have decided to do go about this in a different way than I'd indicated […]
[…] Free The Animal […]
With all due respect, I simply cannot believe that he called the amazing 100% grass-fed (no other kind in NZ) butter from as ecologically clean a country as they get a “pure, natural poison”. This is going to be beautiful, thank you! As an aside, my wife’s from NZ, so we’ll be following this “discussion” very closely.
Perhaps the statins we have started dispensing like candy, with their anti-inflammatory properties, have something to do with the reduction. Of course those that use them are dying of other things and have an increase in all-cause death, but it certainly could help explain the CVD reduction.