Tuesday, November 15, 2005

The Axis of Paradox

We are constantly being told to avoid "artery clogging" saturated fats, found in delicious foods like butter, eggs, cheese, pork and beef. It's for our health, they say. That's a problem for me, since I have a chest freezer full of beef and pork that I raised. I had steak (grassfed) and eggs (free range) for breakfast. But I'm not worried.

Most of you reading this have probably heard of the "French Paradox", which is the idea that it is paradoxical that the French eat a very high fat diet yet suffer from very low levels of heart disease (CHD). Jefferey Steingarten claims to have been the first one to have popularized this idea. But the French paradox is only a paradox if you believe that eating saturated fat plays a role in causing heart disease. I don't.

After the French paradox became widely known, researchers rushed out to explain why the French were so different from the rest of the world. Maybe they were protected from heart disease by the red wine they drank. Maybe it was the fruits and vegetables that they ate. And on and on.

Apparently no one ever actually bothered to check whether or not France was an outlier, a statistical anomaly. Until now. I looked, and it isn't. In fact, in Europe, the countries that eat the most fat from butter, cheese, pork and other animal sources have the lowest rates of heart disease. France is simply the most dramatic example of this. See for yourself:

How did I create this magical chart? Through tricky statistical manipulations? No, I'm not a statistician and I'm too lazy for that anyways. All I did was go to the British Heart Foundation's international statistics page, then got the FAO food disapearance data to see how much animal fat the people of each European country eat on average each day. I popped the two lists of numbers into Excel and got a scatter plot. You can easily replicate my little experiment given an hour or two.

The axis of paradox is composed of all European countries, whose dietary habits and health profiles stand in direct opposition to the idea that heart disease is primarily caused by the high consumption of saturated fat. On average, the people of Eastern Europe eat about 50 grams of fat from animal sources per day while the men suffer from 435 deaths from heart disease per 100,000 people per year. Their Western European contemporaries enjoy eating about 84 grams of animal fat per day while only losing about 170 men per 100,000 to heart disease each year.

If you'd like, you may bash my little study on the grounds that it's unscientific, but that's loser talk. If eating saturated fat is the primary cause of heart disease, how is it possible that French men have one NINTH the rate of heart disease mortality of Russians despite eating 125% more fat from animal sources? How is it possible that the people of Uzbekistan have four and a half times the rate of heart disease mortality of the Swiss despite eating only one fourth the amount of animal fats? Are the Swiss doctors 18 times better? I don't think so. How is it possible that Belgians have less than a fifth the heart disease mortality of the Ukrainians despite eating twice the fat from animal sources. I could go on, but you can see the chart and the following table - the table lists country, daily consumption of animal fat per capita, then heart disease death rate per 100,000 people among males aged 35-74.

Eastern Europe
CountryAnimal Fat ConsCHD Rate
Armenia 26.2 464
Bulgaria 49.5 296
Croatia 36.8 323
Czech Republic 61.3 294
Estonia 56.4 522
Georgia 27.1 507
Hungary 95.7 356
Kazakstan 44.2 703
Krgyzstan 37.1 439
Latvia 61.2 568
Lithuania 58.9 424
Poland 71.2 272
Romania 47.9 336
Russia 47.9 771
Slovakia 66.7 397
Slovenia 67.5 165
Tajikistan 10.7 331
Ukraine 45.1 839
Uzbekistan 25.8 540
Average 49.5 435

Western Europe
Country Animal Fat ConsCHD Rate
Austria 95.3 177
Belgium 88.5 146
Denmark 108.9 174
Finland 89.3 267
France 108.1 83
Germany 82.6 178
Greece 56.2 175
Ireland 81.8 277
Italy 71.7 117
Netherlands 84.2 151
Norway 89.1 183
Portugal 78.8 103
Spain 64.1 120
Sweden 74 185
Switzerland 96.8 120
UK 79.7 215
Average 84.3 167

And just for the record, the US daily consumption of animal fats was 71.6 grams per in 2002, and American men died of heart attacks at a rate of 230 people per 100,000 in 1999, the last years available for both statistics. You may notice that our animal fat consumption is exactly the same as Italy's, where they eat a "low-fat Mediterranean diet" yet our heart attack death rate is almost exactly double theirs. Whoopsie! And if you're wondering, they eat slightly more total fat than us too, 158 grams to 157.

Discussion and Conclusions

Even if you still want to cling idea that eating saturated fat causes heart disease, you have to admit that in Europe the consumption of saturated fat is AT BEST a secondary cause of heart disease. A more direct conclusion would be that saturated fat doesn't cause heart disease there. Keep in mind that although correlation does not imply causation, a lack of correlation casts serious doubts onto causation.

Eastern Europeans suffer from far less heart disease than Western Europeans despite eating far less saturated fat. There is not a single country in Europe in the top quartile of both saturated fat consumption and heart disease rates nor is there a country in the lowest quartile of both. Conversely, France, Belgium, The Netherlands and Switzerland are in the top quartile of saturated fat consumption but in the lowest quartile of heart disease deaths. Armenia, Georgia, Kazakstan, Krgyzstan, Russia, The Ukraine and Uzbekistan are in the lowest quartile of fat consumption but the highest quartile of heart disease.

You may think that it's unfair to compare heart disease rates between Eastern and Western Europe due to different socioeconomic factors in the two areas, but actually that is exactly the point. For too long, heart disease has been considered a "disease of affluence". Google it, you'll see. The idea is that as we become more affluent we get lazy and fat. We can afford more luxury items like steak and cheese. Then we die of heart attacks. This graph shows that that theory is exactly wrong, methinks. Furthermore, although there is no trend amongst Western European countries, among Eastern European countries there is a clear trend that the ones that eat the least animal fat have the most heart attacks.

There is no French Paradox. France follows the general European trend of wealthy countries eating more animal products and having less heart disease. If there is a paradox here, all of the European countries stand together, united and unyielding in the "Axis of Paradox".


Anonymous John Day-Richter said...

Fuckin' A! I eat tons of saturated fat in the form of six daily pounds of (non-government) cheese. Sure, it causes problems (particularly in the BM department), but I ain't got a lick of heart disease. Sometimes I can hear my heart pounding in my ears, but it's usually related to Bill O'Reilly's radio program.

3:58 PM  
Anonymous Jen S said...

1. The Japanese eat very little fat and suffer fewer heart attacks than the British or Americans.

2. The Mexicans eat a lot of fat and suffer fewer heart attacks than the British or Americans.

3. The Japanese drink very little red wine and suffer fewer heart attacks than the British or Americans.

4. The Italians drink excessive amounts of red wine and suffer fewer heart attacks than the British or Americans.

5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than the British or Americans.


Eat and drink what you like. Speaking English apparently is what kills you.

I copied this off a message board. Not quite as factual as your blog post but thought it was good.

6:38 PM  
Blogger Brad Marshall said...

Jen S,

Nice. Actually, the whole English speaking as a risk factor thing is kind of hard to miss if look at the stats. Hmmm.... future blog topic?


7:39 PM  
Anonymous Adam Fabian said...

I read Dr. Atkins New Diet Revolution; he makes a lot of points along these lines, like the "Eskimo Paradox" (where they live off of seal blubber for about 6 months out of the year and have almost no heart disease whatsoever.)

Try this correlation: refined carbohydrates and heart disease. Heart disease apparently goes through the roof about 20 years after the introduction of soda/soft drinks into a society.

12:05 AM  
Anonymous Anonymous said...

There is so much evidence to support that higher fat intake causes heart diseases. http://www.americanheart.org/presenter.jhtml?identifier=4582

But people will believe what they want to. A lot of fatty food pleases the sense of taste like nothing else, so people want to believe it won't harm them to eat it.

2:30 AM  
Anonymous John W said...

The cause of Coronary Heart Disease, like any real-world phenomenon, is a complex thing. Correlating intake of saturated fats with heart disease statistics leaves out lots of other dietary information, number of smokers vs non-smokers, rates of stress and poverty, bad luck and all the other stuff that must be taken into account to understand the story behind these stats.
But people prefer easy answers over complex explanations, which is understandable. That being the case "Moderation in all things" makes more sense than this hasty conclusion.

10:04 AM  
Blogger Brad Marshall said...

I have no real interest in fighting about this, I just think that people should know what the data is. I followed the link to the americanheart.org site. Typically, no data was given to support their position.

For more info in this vein, check out my entry at http://bradmarshall.blogspot.com/2005/12/is-wheat-killing-us-introduction-maybe.html and Malcolm Kendrick's http://www.thincs.org/Malcolm.French.htm


11:28 AM  
Blogger Brad Marshall said...

One other thing.

Please don't take this TOO seriously. I hope that you can read between the lines and see when I'm being facetious. Having said that, I truly don't believe that saturated fat causes heart disease, after spending way too much (although never really enough) time combing through the literature.


11:33 AM  
Anonymous Katrina said...

There's actually plenty of evidence saying that animal/dairy fats are vital to health. Quantity watch isnt so important as quality watch - they really need to be from grass-fed freerange (organic by default) animals.

If you've ever read about the Maasai tribe then you will see the same thing. Animal fats do not cause heart disease. The Maasai live on animal blood, fresh raw milk and meat. They have no heart disease on this diet. Of course, the PC nutritionists who prefer to believe the vegetable-oil industry-sponsored "research" prefer to think of this as yet another "paradox".

Animal fats contain plentiful fat-soluble vitamins including A and D as well as others, which in vegetarian or reduced animal fat diets are often severely lacking, especially in this day and age of sun scared people. Sure carrots have beta-carotene which can be converted into vitamin A in the body, with effort, but make sure too that you eat them with some fat to actually allow utilization.

Animal fats in their raw state also contain many vital enzymes, and assist digestion and assimilation, therefore as far as I have researched helping to avoid pathological disease (NB. heart disease!) of many kinds.

As many people in western societies would not willingly chow into a raw steak tartare, this is one of the very best reasons to NOT pasteurise milk. Pasteurisation of milk destroys the many enzymes in raw milk, as will cooking of food.

A really great resource on all of this non-industry biased stuff is the Weston A Price foundation.

Sure, you need to read and critically evaluate a lot of material (and not just contradictory study summaries, but the actual studies) to really find out the truth for yourself, but hey, wasnt the popular opinion from all 'authorities' once that the world was flat!!!

Good luck in your discoveries.

- Katrina

7:09 PM  
Anonymous Joseph Marcello said...

Brad -

Am genuinely interested in sorting out the truths and myths of hunter-gatherer as opposed vegetarian, vegan China Study lifestyles.

Do you discuss this directly anywhere?


Joseph marcello

7:09 PM  
Anonymous Anonymous said...

Heart disease mortality is heavily influenced by the availability of Western medicine...

9:55 PM  
Blogger Candy Minx said...

Wow how wonderful all the different responses to this category.

Hormones are linked to heart disease. Fat is actually normal and good for you. I would stay clear of that crap margerine and cheez whiz. Eat the good stuff, less processed fat. I even take a shot glass of flax seed oil.

I have never been as overweight as when I went on a low fat diet. As soon as I returned to my high fat protein diet I lost 20 pounds! Go figure, heh heh.

Hormones are tricky. when we eat simple carbs like bread, rice, potatoes, cake, noodles, they turn to sugar in our tummies in about 15 minutes. Too fast, then our body demands we produce insulin wuickly. We all know that diabetess and insulin compromises the heart.

Steak and salad also turn to sugar, as does all food, but it take slonger so your body doesn't feel it has to pump insulin to save you.

I am ahunter-gatherer and it is my passion to save us from the tyranny of the farm mind set.

Down with farming, food grows for free! Primates don't need farms!

Much love and peace and I dig your baby blog.


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Anonymous Anonymous said...

Very interesting! I can add data on both sides as you said, it is a very complex issue.

Look up the 7 Country Study for info on saturated fat and cholesterol levels, as it is pretty convincing that they are related.

Jeff Volek's lab has produced some data showing that saturated fat in a very low carb diet does not seem to matter.

Also check out the abstract below.
Keep up the good work.
Mike N
J Hum Hypertens. 2003 Sep;17(9):623-30.Click here to read Links
Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study.

* Zhou BF,
* Stamler J,
* Dennis B,
* Moag-Stahlberg A,
* Okuda N,
* Robertson C,
* Zhao L,
* Chan Q,
* Elliott P;
* INTERMAP Research Group.

Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

The purpose of the study was to compare nutrient intakes among Chinese, Japanese, UK, and US INTERMAP samples, and assess possible relationships of dietary patterns to differential patterns of cardiovascular diseases between East Asian and Western countries. Based on a common Protocol and Manuals of Operations, high-quality dietary data were collected by four standardized 24-h dietary recalls and two 24-h urine collections from 17 population samples in China (three samples), Japan (four samples), UK (two samples), and USA (eight samples). There were about 260 men and women aged 40-59 years per sample--total N=4680. Quality of dietary interview and data entry were monitored and enhanced by extensive systematic ongoing quality control procedures at local, country, and international level. Four databases on nutrient composition of foods from the four countries were updated and enhanced (76 nutrients for all four countries) by the Nutrition Coordinating Center, University of Minnesota, in cooperation with Country Nutritionists. The mean body mass index was much higher for Western than East Asian samples. Macronutrient intakes differed markedly across these samples, with Western diet higher in total fat, saturated and trans fatty acids, and Keys dietary lipid score, lower in total carbohydrate and starch, higher in sugars. Based on extensive published data, it is a reasonable inference that this pattern relates to higher average levels of serum total cholesterol and higher mortality from coronary heart disease in Western than East Asian populations. The rural Chinese diet was lower in protein, especially animal protein, in calcium, phosphorus, selenium, and vitamin A. Dietary sodium was higher, potassium lower, hence Na/K ratio was higher in the Asian diet, especially for Chinese samples. This pattern is known to relate to risks of adverse blood pressure level and stroke. At the end of the 20th century, East Asian and Western diets remain significantly different in macro- and micronutrient composition. Both dietary patterns have aspects that can be regarded, respectively, as adverse and protective in relation to the major adult cardiovascular diseases. In both Asian and Western countries, public efforts should be targeted at overcoming adverse aspects and maintaining protective patterns for prevention and control of cardiovascular diseases.

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Ever heard of the idea that the French have a high fat diet, yet have very low levels of heart disease? That’s called the French Paradox and in his first post, Brad refutes the idea.

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Healthline recently put together an infograph showcasing heart disease statistics and facts to help someone understand their risk for a heart attack or other heart-related issues. You can see the infograhic here: http://www.healthline.com/health/heart-disease-infographic

I am writing to you to see if you can help spread awareness about heart disease by sharing this with your followers or including it as a resource on your page: http://bradmarshall.blogspot.com/2005/11/axis-of-paradox-we-are-constantly.html

Please let me know if you would be interested in helping to raise awareness about heart disease.

Thank you for your time reviewing. Please let me know if there are any questions I can answer.

Warm regards,
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p: 415-281-3124 f: 415-281-3199

Healthline • The Power of Intelligent Health
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