Does saturated fat really cause heart disease?

We’re not eating enough margarine and it really is starting to bother people who make it. According to Dairy Australia’s 2009 report, butter (and butter-like substances) have steadily increased from 30 percent of the spread market in 2001 to 43 percent in 2009. And the outlook to 2012 is even rosier with expected growth of almost 10 percent.

I blame MasterChef (and its ilk). You never see the latest quasi-celebrity cracking open a nice tub of marg do you? No, its great dollops of butter all the way. Of course it could just be that we’re getting wary of how many chemists were involved in creating the stuff we spread on our bread.

Goodman Fielder (the maker of Meadow Lea) has obviously decided not to take our growing disdain for manufactured spreads lying down. In the last few weeks a commercial has been airing featuring a smart young fellow by the name of Andrew Wilson chatting to us about the evils of eating butter.

Andrew ought to know what he’s talking about. He’s a cardiologist with the Department of Medicine, St Vincent's Hospital in Fitzroy, Melbourne. I know this because, not only does his mug appear regularly on the teev, he features on a website called Spread the Facts.

Andrew tells us that “as a cardiologist he understands what saturated fats can do to your child’s health,” and illustrates this with a graphic of a “child’s artery” filling with saturated fats from butter. He then goes on to suggest that we should switch to a margarine spread made with plant seeds (tight shot of plant seeds in doc’s hands), “because most contain at least 65% less saturated fat than butter.”

The website (and the ad) are bought to us by Goodman Fielder and both appear to be in some (nonspecific) way associated with the Australian Heart Foundation (if the constant use of their logo is anything to go by).

On my telly, whenever Andrew appears in an ad break, you can put money on the probability of an ad for Meadow Lea materialising an ad or two later in the break. The Meadow Lea ad features children gambolling in a field. Mother then enters and the voice-over points out that Meadow Lea is made from plant seeds (tight shot of mother’s hands holding plant seeds) which contains 65 percent less saturated fat than butter. Enough dots for you to join there?

All that authorititive advice (followed coincidentally by an ad for a product that fits the bill) should have any self-respecting parent hurtling towards the margarine section of the supermarket before Hermione and Jeremy’s arteries are irreversibly clogged.

The only problem with all of this is that the science doesn’t appear to match the advertising spin. A study to be published next month in the American Journal of Clinical Nutrition concludes that “there is no significant evidence that dietary saturated fat is associated with increased risk of [heart disease].” Huh? But didn’t Andrew show us pictures of children’s arteries being pumped full of saturated fat?

The study arrived at that conclusion after examining 21 previous studies of a total of 347,747 people. It was however supported by the National Dairy Council (who might like us to eat a little more butter).

Fortunately (for the suspiciously inclined), a comprehensive review (which has no dubious sources of funding) of the evidence was published in the British Medical Journal back in 2001.

The British review decided that despite decades of research (and thousands of people participating in randomized trials), there “is still only limited and inconclusive evidence” that the amount or type of fat you eat makes any difference to your chances of death by heart attack. Not exactly resounding support for the line being pushed by Andrew, the Heart Foundation and Goodman Fielder, now is it?

These results are quite a contrast to a review published by the American Heart Association (AHA) last August. That review summarised the available research on the relationship between sugar intake and cardiovascular health. It noted that “sugar intake appears to be associated with increased triglyceride levels, a known risk factor for coronary heart disease,” and concluded that the average American needed to dramatically reduce their sugar intake.

The AHA was so concerned they recommended that an adult male consume no more than 9 teaspoons (5 for women and 3 for kids) of added sugar a day (about the same as a can of soft drink or a large bowl of fruit muesli for the man). Even worse, alcohol had to be deducted from the allowance, so one full strength beer would reduce a man’s sugar quota to zero.

I can’t blame Goodman Fielder for having a go. They’re not a charity and they’ve got a product to sell in a market populated by mini-me MasterChefs. But why is a cardiologist fronting up and suggesting something that isn’t supported by the research? And why is the Heart Foundation in there helping them both out? Why aren’t the Australian Heart Foundation telling us what their American cousins know about sugar? Surely it’s not because no-one is paying them to - surely not?

How sick do we have to get?

A study published this week says that we are 87 percent more likely to contract pancreatic cancer if we have two cans of soft drink a week (about 10 grams of sugar a day on average). But the current Australian healthy eating guidelines say it’s perfectly fine to slurp up more than ten times that much sugar. Is there a problem here?

In the study, 60,524 Singapore Chinese were followed for 14 years (not literally, they were surveyed on their dietary habits). Their names were cross-matched with health records. Those that drank two or more soft drinks a week were much more likely to be among the 140 that had contracted pancreatic cancer in the intervening years.

Clearly the study doesn’t prove anything. You could drive a truck through it with questions like “What else did they eat?” “Did they smoke as well?” and so on. But it’s not the only recent study coming up with similar results.

A 2006 study published by the Karolinska Institute in Sweden also decided soft drinkers were in significant jeopardy, and had warnings for anyone eating sugar at all. The Swedish study began in 1997 when scientists ran a dietary survey of almost 80,000 healthy people, who were subsequently monitored until June 2005. According to the cancer registry, 131 people from this group had developed cancer of the pancreas.

The researchers were able to demonstrate that the risk of developing pancreatic cancer was directly related to the amount of sugar in the diet. The people who said that they drank soft drinks twice a day or more were 90 per cent more likely to develop pancreatic cancer than those who never drank them.

It won’t shock you to discover soft drinks are not health food, but the study went on to report that people who added sugar to food or drinks (like tea and coffee) at least five times a day were at 70 per cent greater risk than those who did not. People who ate fruit jams at least once a day also ran a higher risk – they developed the disease 50 per cent more often than those who never ate them.

As far as our bodies are concerned, a soft drink is a combination of just three things, water, glucose and fructose (the two halves of sugar). If water or glucose is the problem then we should all give up now. Water is critical to survival (if you like living more than three days) and if we were cars then glucose would be our petrol. A 2002 a study tried to tease out which food element had the greatest association with pancreatic cancer, and fructose got first prize.

The study conducted by the US National Cancer Institute identified 180 cases of pancreatic cancer from among 88,802 women who were monitored for 18 years as part of the Nurses’ Health Study. Women who were overweight and sedentary and had a high fructose intake were shown to have a 317 percent greater chance of developing pancreatic cancer.

Big Sugar’s response to the most recent study was as predictable as death and taxes. Richard Adamson, a consultant to the American Beverage Association (ABA) said in a statement “... soft drinks do not cause cancer ... You can be a healthy person and enjoy soft drinks. The key to a healthy lifestyle is balance -- eating a variety of foods and beverages in moderation along with getting regular physical activity.”

Well, he would say that wouldn’t he. You canna blame a man for trying (it on). After all, the ABA is in the business of selling soft drinks. The fact that he could have been reading from the current Dietary Guidelines for Australian Adults is of much more concern.

The Australian guidelines say “Consume only moderate amounts of sugars and foods containing added sugars.” They go on to explain that what that means is up to 20 percent of energy intake. For an adult male eating a 2,200 calorie diet, that is 110 grams of sugar (about three cans of soft drink) a day.

In Australia, pancreatic cancer is the fifth most lethal cancer for both men and women. Every year it kills almost twice as many Australians as Melanoma and the numbers are steadily increasing. It is also the least treatable cancer. More than 95 percent of sufferers are dead within five years of diagnosis (compared with just 7 percent for Melanoma).

None of the studies on sugar and pancreatic cancer are conclusive on their own. But taken together, there is cause for serious concern. Sugar consumption is clearly implicated in a disease which (every year) kills almost one and a half times the number of Australians as die on the nation’s highways. And yet the people we rely on for nutrition advice tell us that it’s perfectly fine to consume sugar at ten times the level which was a problem in the most recent study.

It’s time to wake up, smell the (unsweetened) coffee and act on sugar before we sentence even more Australians to death by pancreatic cancer.

Where’s the F word … err fructose … in healthy children debate?

Governments are often criticised for not putting in the hard yards when it comes to forward planning. They start building desalination plants after we run out of water. They start adding lanes to freeways after traffic is at a standstill. They build more power stations after the black-outs start.

But there’s no way you could accuse Paul Lucas (Queensland’s Health Minister) of such poor planning. He’s already building the infrastructure necessary to treat the victims of childhood obesity in 2014.

Back in 2007, the Queensland government implemented a series of initiatives aimed at reducing childhood obesity by 33 % by 2020. Smart Choices would force children to eat healthy food at school and Smart Moves would force children to exercise for at least half an hour during school time.

The policies are very similar to programs for healthy eating and exercise implemented as part of the UK’s Healthy Schools initiative. Those programs were kicked off in 1999 because surveys in 1995 had shown that a quarter of British kids were overweight or obese. In Queensland we took until 2006 to reach that particular milestone, hence the delay (I guess).

The British programs have met with resounding failure. Now almost a third of English kids are overweight or obese. And the prediction is that the numbers will be truly diabolical by 2050.

The presumption underlying the Smart Moves program is that sport prevents obesity in children. But an extended study of the UK program to be released this week suggests that is likely to be nonsense.

After a decade long study of children in the UK, the researchers have concluded that increased physical activity is unlikely to reduce a child’s weight. For years nutritionists have told us that kids are fat because they don’t exercise. But the study concludes that the opposite is in fact the case.

Overweight children eat more and exercise less because they are fat, not the other way round. When you think about it that has a certain logic to it. We are perfectly happy to accept that when children grow taller they demand more food, so why wouldn’t we accept that when they grow fatter they do the same.

We are also happy to accept that a pregnant woman puts on weight (and eats more) because she’s preggers. And just like a pregnant woman, an overweight child, exercises less because it is much harder to move when you are carrying extra weight. Less exercise is a side effect of weight gain not the cause of it.

Growing taller happens because of the work of growth hormones in the child’s body. Pregnancy happens ... well, you know why ... and also involves hormones. Growing fatter also happens because of the work of hormones.

Appetite control hormones precisely regulate the amount of additional weight gained, but sugar (or more precisely, the fructose half sugar) has been shown to disrupt the operations of those hormones. But fructose limitation is not on the menu for the Queensland government any more than it is in Ole Blighty.

Just like its British equivalent, Queensland’s healthy eating in schools program focuses on the anti-fat dogma trotted out by nutritionists for the last five decades. It has little concern for sugar unless it has been added. Soft drinks are coded ‘red’ because of the added sugar and can only be consumed twice per term (maximum). But juices with identical (or higher) sugar content are coded ‘amber’ and can be consumed every day.

I asked Paul Lucas about that contradiction in July last year. In my request I supplied him with references to many of the recent studies on the damage done by the fructose half of sugar. Paul finally got around to having a minion reply to me in the New Year.

The minion agreed that diets high in added (his emphasis) fructose were indeed undesirable because fructose promotes weight increase, chronic disease and increased circulating fatty acids. But he points out that fruit juice is high in naturally occurring (my emphasis) fructose not added fructose. As such there is no need to change the policy.

Ah, I see. So somehow the very act of adding fructose to water rather than removing the fruit from the fructose and water (juice) must magically transmogrify the fructose from a healthy substance to a dangerous substance. I’m glad that’s been cleared up.

As much as Paul is having his minion trot out the party line, it would seem that he has one eye on the ‘success’ of the British programs. On Sunday he announced that in 2014 Queensland will have its very own childhood obesity treatment clinic. When Smart Moves and Smart Choices produce the inevitable increase in childhood obesity, Paul will be there ready with the ambulance parked at the bottom of the chronic disease cliff face.

How many children need to be sacrificed to nutritional dogma before the science on fructose crosses into the political domain. Do all our kids need to be overweight or suffering from diabetes before we acknowledge that the ‘fat makes you fat and exercise makes you thin’ advice is just plain wrong? Or can we start doing something about it now? Maybe, just maybe, if we did, by the time that brand new clinic is open for business, they won’t be needed.

Also published in Crikey