ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

A Popular Health Delusion: Prevention of Coronary Heart Disease by Diet Change

Updated on January 4, 2013
Public health advice is somewhat specious when it regards individual health choices, as it is based on population data and very low incidence numbers.
Public health advice is somewhat specious when it regards individual health choices, as it is based on population data and very low incidence numbers.

In this article, I address the opinion that we should have diets that are low-fat and have a low cholesterol intake. For the standpoint of prevention of coronary heart diseases, there is little data to support this type of diet, especially for those who are over 65 years of age. Scientific research doesn't support low-fat, low cholesterol diets. This common fallacy is exposed and a prominent critic of this dietary fad, Michael Fitzpatrick, is featured.

I don't want you to think that all dietary changes can't affect coronary heart diseases. I does seem that eating fruits and vegetables and taking antioxidants that are plant derived do have a positive effect. In other articles, I have covered quercetin, which is a flavonoid in the same class of chemicals that are found in chocolate. This class of chemicals have been found to help with preventing LDL oxidation which can lead to atherosclerosis. For more information on this read my articles on quercetin and chocolate regarding heart health.

Reduction of Cholesterol by Diet Delusion

I was reminded of the old book, Memoirs of Extraordinary Popular Delusions and the Madness of Crowds (by Charles McKay) as I was reading The Tyranny of Health Doctors and the Regulation of Lifestyle by Michael Fitzpatrick, M.D. Fitzpatrick covers various aspects of public health policy that have strongly influenced lifestyle choices for many people. Dr. Fitzpatrick calls into question the data which has been used to support these policies and the resulting propaganda which we hear almost daily.

Prevention of coronary heart disease (CHD) by diet change is a significant part of his book. In this section of his book, he covers the weakness of the data that is used to support public health policy for dietary changes. The author's primary focus regards the reduction of cholesterol. To sum it up, the data is not overwhelming convincing for dietary changes for the reduction of one's cholesterol. I discuss the available data and explain it in a way that anyone, even non-scientists, can understand the difference between relative risk and absolute risk, things that government policy makers haven't explained to the public.

The cholesterol molecule, important for many metabolic processes in the body.  It is made in the liver.  The liver produces less when there is cholesterol in the diet.
The cholesterol molecule, important for many metabolic processes in the body. It is made in the liver. The liver produces less when there is cholesterol in the diet. | Source
A sign that is enough to strike fear in the hearts of weak men and elephant ear lovers.  Laugh, please - at least there is good evidence that laughter benefits your health.....
A sign that is enough to strike fear in the hearts of weak men and elephant ear lovers. Laugh, please - at least there is good evidence that laughter benefits your health..... | Source

Effects of Dietary Changes on Cholesterol and CHD

Cholesterol is one of three factors which are associated with increased risk of CHD. The other two are saturated and unsaturated fat intake. Diets which attempt to modify blood (serum) cholesterol aim to reduce consumption of saturated fats and cholesterol.

According to a systematic analysis of many studies, there is a minimal reduction in serum cholesterol attained by dietary changes. (1) Diets included in the analysis were steps 1 and 2 of the American Heart Association's guidelines. Dietary changes with each of these resulted in a 3% and a 6% reduction of blood cholesterol, respectively. Public proponents of changes in diet ballyhoo pie-in-the-sky reductions of 10-15%.

There is an interesting theory as to why there is so little reduction of cholesterol through dietary intake. Le Fanu (2) postulates that these reductions are counteracted by production of additional cholesterol in the liver to maintain constant serum cholesterol levels. The liver accounts for most of our serum cholesterol, as it is needed for many processes in the body, including fortifying membrane structure, digestion of fats as a component of bile and production of vitamin D.

Relevant Books for Further Reading

The Tyranny of Health: Doctors and the Regulation of Lifestyle
The Tyranny of Health: Doctors and the Regulation of Lifestyle

Michael Fitzpatrick's book covers a lot more than just health policy regarding CHD. He discuss the relevance of different health scares and fads, the dubious value of screening tests and recommendations put forth by public health officials for 'healthy living' and relevant criticisms from dissenting academics.

 

Dr. Fitzpatrick's Comments About Dietary Change

Here is a quote from Dr. Fitzpatrick that bears on the effects of dietary changes and preventative measures for prolonging life:

"the concept of prevention is abused: death cannot be prevented, only postponed. Unfortunately, given the current state of medical science, death can generally be postponed only for a relatively short time by relatively intensive preventive measures."

The portion of the population affected by CHD the most are those who are greater than 65 years of age. Bonneux and Barendregt (4) found that, as a consequence of a 10% reduction of serum cholesterol, people who were 65 or older could expect to live an additional 2.5 to 5 months. Thus, the effect of diet changes to improve your life span is relatively small. And given the real reductions of 3-6%, as noted above, it is even smaller. With these numbers, dietary change would increase the life span by only 1-3 months.

Dr. Fitzpatrick also quips that “if dietary change is being recommended for everybody, then its benefit must be measured across the whole population. Faced with the choice between forgoing the pleasures of meat and cheese and prolonging a miserable fruit and fibre existence for a few more months, many people might opt to eat now and forfeit the few extra months.”

Eat more celery if you like, not because you should.
Eat more celery if you like, not because you should.

Consider Also the Statistics and What They Really Mean: Absolute Risk vs. Relative Risk

There is the problem with understanding the statistics of research data for most people (especially the media). They are usually expressed as numbers of people who die from CHD per 1000 in the population. As an example, if you were taking a pill daily for 10 years and it reduced your risk from 2/1000 to 1/1000, the scientists would report that there was a 50% reduction in the incidence of CHD deaths.

According to Vine and Hastings (5), most doctors would wholeheartedly agree to taking that pill if they were told that it would decrease CHD mortality 50%. However, when given the 2/1000 to 1/1000, they understand the insignificance of that 50% reduction. A 50% reduction of a very small possibility is a very, very small possibility. Thus it would be of "trivial clinical importance" to take this pill.

As the data points out, living another 1-3 months because of dietary changes is of trivial clinical importance and it should not impress any reasonable, thinking person to make severe changes in what they eat. As Fitzpatrick points out, " A man advised of his chances in these terms might well decide to live dangerously, but happily, on bacon and eggs, rather than marginally more safely on muesli and skimmed milk, with the added risk of dying miserable and flatulent."

Michael Fitzpatrick Discusses Government Involvement in Society

References

1. Tang, J.L., Armitage, J.M., Lancaster, T., Silagy, C.A., Fowler, G. H. and Neil, H.A.W. 1998. Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. British Medical Journal April 18; 316(7139): 1213–1220.

2. Le Fanu, James (2000). The rise and fall of modern medicine. New York, NY: Carroll & Graf.

3. Fitzpatrick, M. The Tyranny of Health Doctors and the Regulation of Lifestyle.

4. Bonneux, L., Barendregt, J.J. (1994) Ischaemic heart disease and cholesterol.
BMJ, 308: 1038.

5. Vine, D.L., Hastings, G.E. (1994) Absolute risk more informative than relative risk, BMJ: 308:1040.

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)