Functional Medicine meeting summary 9-29-2015

We had a fun meeting last night, discussing whether dietary cholesterol and saturated fats contribute to heart disease.  We were all generally in agreement that the current research supports the concept that while saturated fat is not as evil as once believed, it would be better not to have too much animal fat in the diet and it is best replaced with healthier fats, like nuts, avocados, and olive oil. On the other hand, a few eggs per week and some grass fed butter can be part of a healthy diet, if consumed in moderation.  Recent studies point to the fact that when subjects are instructed to reduce saturated fats in their diets, they tend to substitute carbs, and often refined carbs. They end up no better or even worse off. But if they replace the saturated fats with polyunsaturated oil, monounsaturated oil, and omega 3 fats, they reduce their risk for cardiovascular disease. It was nice to have Dr. Howard Elkin, an integrative cardiologist, to provide us with his informed insights. Interestingly, we never got to discuss coconut and palm oil, the two vegetable sources of saturated fat. That can be a topic for a future discussion.

We welcome new attendees, Dr. Howard Elkin, cardiologist, Dr. Eric Dahlstrom, DC, LAc, and Lauren Cornell, RD, along with previous attendees, Dorothy Bernet, RD, Dr. Olga Popel, rheumatologist, and Dr. Denise Weisner, LAc. Thanks also to Metagenics for some fabulous sushi dinner and to Adam Banning for sharing some interesting information with us.  I will be sending out an email next week on the topic for our next discussion group Thursday, October 22 at 6 pm. The topic will be GI related and I will be asking for a few attendees to present a case study.
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Functional Medicine meeting announcement 9-29-2015

I hope that you can join our next exciting discussion of functional medicine on Tues Sept 29 at 6 pm with some healthy food sponsored by Metagenics. Please let me know via email or phone if you will be able to attend.

The topic for the next Functional Medicine Discussion Group is: Does dietary cholesterol and saturated fat intake contribute to cardiovascular disease?

For many years we advised our patients to avoid saturated fat and cholesterol in their diet, since they were linked with increased LDL cholesterol, which would increase cardiovascular disease risk. This would mean avoiding butter, cheese, egg yolks, red meat, poultry skin, whole fat dairy, etc.  In recent years, studies have not found as clear a link between dietary cholesterol or saturated fat intake with heart disease.  For example, the study by Mozaffarian in 2004 (1)  found no relation between saturated fat intake and heart disease in postmenopausal women. Similarly, a meta-analysis published in 2010 by Siri-Tarino found that the intake of saturated fat was not associated with an increased risk of heard CHD, stroke, or CVD.(2)

Jonny Bowden and Stephen Sinatra in The Great Cholesterol Myth (2012) pointed out the problems with the Diet-Heart Hypothesis first p8ut forth by Ancel Keys back in the 1950s, who claimed to have found a clear link between dietary fat intake and heart disease after examining epidemiological data from various countries around the world. Looking at the chart below, it’s hard to see how you could draw a straight line connecting the dots:

Inline image
http://rawfoodsos.files.wordpress.com/2011/12/yerushalmy_hilleboe_22_countries.jpg

Nina Teicholz in The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet published in 2014 made this case in even more exhausting detail that saturated fat intake was not the cause of heart disease.  The problem she argued is the carbohydrate and trans fat intake.  Teicholz and other practitioners who promote the Paleo or Primal nutrition approaches often argue that saturated fats do not contribute to cardiovascular disease and it is fine to eat plenty of eggs, butter, cheese, red meat, bacon, coconut oil, etc., though it is often recommended that we choose meat that has been grass fed and not farmed and butter that is from grass fed cows.  They recommend avoiding commercial seed oils (vegetable oils) other than olive oil.

Is this position correct?  Do we simply tell our patients to consume as much saturated fat and cholesterol as they like and not worry about it, even those with elevated LDL or coronary artery disease?  Recently, several papers have been published that review the evidence linking dietary cholesterol and saturated fat with cardiovascular disease risk.  Dr. Mozaffarian concludes that a review of the evidence demonstrates that consuming polyunsaturated fatty acids (vegetable oils) in place of saturated fats significantly reduces coronary heart disease. (paper attached)  The review by Berger et al. on dietary cholesterol concludes that intervention studies did show a relationship between dietary cholesterol and increased total cholesterol, LDL, and HDL levels, but only when high levels of dietary cholesterol were used (500-1400 mg/day).  Dr. Eckel in his accompanying editorial suggests “when ordering an omelet, why not order an egg white omelet with plenty of vegetables, lean meat, and spices, rather than one with 600 mg cholesterol?”

Please look at the attached papers before the next discussion group on September 29

References:
1. Mozaffarian D, et al. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal wome. Am J Clin Nutr 2004; 80: 1175-1184
2. Siri-Taurino PW, Sun Qi, Hu FB, et al. Meta-anlysis of propective cohort studies evaluating the association of saturated fat with cdardiovascular disease. Am J Clin Nutr 2010; 91:535-46.
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Functional Medicine meeting summary 8-27-2015

We had a nice discussion last night on the alkaline ash theory of osteoporosis and we all agreed that the research does not support recommending an alkaline diet for promoting  bone health.  We were treated to some sushi by Metagenics.  After I was informed that September 22 was the start of a Jewish holiday, we decided to change the date of the next Functional Medicine discussion group to Tuesday September 29.  I will send another email with the topic and some articles to look at prior to the next discussion. I hope that you can join us.

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