Fat and Protein Good, Carbz Bad, for Cardiovascular Disease?

Written by Tommy Wood MD, PhD

Oct. 4, 2016

A new study came out last week that seems to support the carbohydrate-insulin hypothesis of cardiovascular disease (CVD) at a population level. It may well do, but it’s also worth digging a little deeper.

See Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries

This was an “ecological study” that looked at how 42 countries in Europe eat (i.e. overall consumption of common foods as a population) compared to that country’s incidence of CVD (including high blood pressure and high blood glucose). It’s all averages and public data that we have to trust, but it’s still very interesting.

From the abstract, the main reported conclusions included that: “The most significant dietary correlate of low CVD risk was high total fat and animal protein consumption… The major correlate of high CVD risk was the proportion of energy from carbohydrates and alcohol, or from potato and cereal carbohydrates.”

Basically, countries that eat more fat and animal protein have lower CVD, and those that eat more carbz and drink more calories from alcohol have higher CVD rates (wine and beer were mildly protective but distilled beverages increased risk). Low carb win!

Unsurprisingly, higher animal protein and fat intake was associated with “raised” cholesterol levels (defined as >5mmol/L or 193mg/dL). Importantly, higher cholesterol was associated with lower CVD risk in both men and women.

Fig. 7.   Correlation between the mean daily consumption of total fat and animal protein and the actual total CVD mortality in women (r=−0.81; p<0.001).
This is a very similar conclusion to the MONICA study that did something similar in the 90’s and early 2000’s. However, what most people missed when reporting on the MONICA analysis is that the countries with the lowest saturated fat intake (and high rates of heart disease) were Bosnia & Herzegovinia, Georgia, Azerbaijan, Tajikstan, Moldova, Croatia, Armenia. This was compared to those with high saturated fat intake and relatively low heart disease (Austria, Finland, Belgium, Iceland, Netherlands, Switzerland, France). It doesn’t take much lateral thought to realise that saturated fat intake is probably not the biggest factor here.
Here, the new study comes to the rescue. One of the biggest predictors of CVD was health expenditure (i.e. how much is spent per person on health care), with richer countries having less CVD on average. This would also be reflected in how people eat: saturated fat and animal protein are expensive; potatoes and vodka are cheap. If you live in a poorer Eastern Bloc country, your risk of CVD is therefore higher.
Despite this, the patterns of food intake and CVD risk seem to hold. However, you’ll see from the graph above that the wealthier countries in Europe are clustered together in the top left hand portion of the graph (high fat and animal protein intake, lower CVD risk), so extrapolating this data to recommendations for individuals would be very tricky.
There are a few interesting associations that the authors found that are worth reading through the paper to investigate. For instance, smoking was correlated to reduced CVD risk in women (higher CVD risk in men), higher BMI was correlated with lower CVD risk in men (higher risk in women), and higher sunflower oil intake associated with greater risk of death from stroke (perhaps this is less surprising, but sunflower oil is also cheap and tended to be eaten with a side of potatoes).
Most importantly, hidden at the end of the paper was an analysis for cancer: “In sharp contrast to CVDs, cancer correlates with the consumption of animal food (particularly animal fat), alcohol, a high dietary protein quality, high cholesterol levels, high health expenditure, and above average height.” Surprisingly, nobody mentioned that.
As well as the potential risk of high animal protein intake on IGF-1, mTOR, and other factors that can promote cancer growth, it’s also worth noting that the countries with the highest health expenditure are probably the most technologically advanced. This means more social isolation, a greater exposure to environmental toxicity, less habitual movement, and a greater circadian mismatch.
Focusing on one thing (i.e. carb intake) to reduce the risk of CVD shouldn’t mean not thinking about all the other things that make us healthy!

Dr. Tommy Wood is a British Medical Doctor, Chief Medical Officer at Nourish Balance Thrive and visiting scientist at the University of Washington. Tommy recently curated and featured as an expert at the Keto Summit where he gave three classes on getting started with, losing weight on, and athletic performance for a ketogenic diet. His final interview is titled “What to Do When Your Keto Diet Isn’t Working: Underlying Issues and Overlooked Tweaks.” Watch the Keto Summit whenever you want (for life) with the all-access pass complete with audio and full transcripts.

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