THE Malaysia Lipid Study (MLS), an observational evaluation of dietary practices and metabolic outcomes among Malaysians, supports the hypothesis that a high-fat diet may not be a cause of heart disease.

Published in the Scientific Reports journal on September 20, the findings are interesting as they reopen the diet/lipids-heart disease debate and tell of the shortcomings of our Love MY Palm Oil campaign – and how the campaign can capitalise on the new knowledge.

The Karupaiah et al (2019) cross-sectional study on the impact of dietary patterns on cardiovascular disease biomarkers in Malaysia examined the outcomes of 577 Malaysians grouped into combinations of LFLC, LFHC, HFLC and HFHC (LF = low fat, LC = low carbohydrate, HF = high fat, HC = high carbohydrate). It observed that high fat and high carbohydrate consumption was not associated with a negative cardiovascular impact.

The MLS findings corroborate those of other studies. The meta-analyses of Siri-Tarino et al (2010) and Chowdhury et al (2014) found no significant relationship between total saturated fat and the risk of coronary heart disease (CHD). Harcombe et al (2015) concluded that the dietary advice to reduce saturated fat consumption should not have been introduced, and required a review.

Harcombe and colleagues pointed out that governments’ advice to their citizens to avoid fatty foods had been based on the “consensus of opinion”, not the best scientific evidence. When the dietary advice for low fat and low saturated fat consumption started being given in the 1980s, there were already randomised controlled trial (accepted as the gold standard in evidence-based medicine) results showing no significant difference in CHD and all-causes mortality between the intervention group, where dietary fat and cholesterol were lowered, and control group. Previously, government officials had succumbed to the interests of corporates and industries that benefited from the low fat, low cholesterol narrative.

Saturated fatty acids are synthesised in the body for energy and physiological functions. The concern about saturated fatty acids as a causative factor of heart disease has been overstated. Because of the positive linear relationship between total saturated fat intake and low-density lipoprotein cholesterol (LDL-C), various authorities have recommended that saturated fat be limited to less than 10% of calories. Furthermore, the thesis for LDL-C as a cause of atherosclerotic cardiovascular disease (ASCVD) has shifted today, from the 1970s, to LDL particle size.

It is assumed that small and dense particles of LDL are better able to penetrate the intima of the artery walls, and therefore, cause ASCVD. The mechanism of how LDL-C causes ASCVD has yet to be explained.

The following questions pertaining to cholesterol and atherosclerosis remain unanswered:

* Why do cholesterol deposits form in the arteries and not veins, while the same cholesterol level circulates in the arteries and veins?

* Why is coronary sclerosis the most frequent form of atherosclerosis? In the 98km-long human vascular system, cholesterol deposits are predominantly found in the coronary arteries.

* Why is atherosclerosis characteristic of humans, while being practically unknown in the animal world except for a few species that are not able to produce Vitamin C internally (e.g. primates and guinea pigs)?

Today – and more than three decades have passed – the cholesterol “war” continues. Driven by corporate and industrial interests, proponents of the lipid-cholesterol theory have clung on to the argument that LDL-C is the culprit behind atherosclerosis and heart disease, while critics of the theory, with observations of best practice results and the paradox of the high prevalence of ASCVD mortality despite lowering LDL-C with statins, remain sceptics.

Meanwhile, here in Malaysia, we are caught in the conundrum of promoting palm oil as a healthy edible oil, but one laden with saturated fat, which is commonly perceived as a contributor to heart disease. With the latest findings by MLS, perhaps, the Love MY Palm Oil campaign, which has so far been less than convincing, and has avoided mentioning saturated fat, instead focusing on the oil’s high Vitamins E and A content, should go all out.

Without a doubt, our palm oil, rich in mixed tocotrienols (Vitamin E) and beta-carotene (Vitamin A), as well as saturated fatty acids, is superior to the temperate canola, corn and soybean oils. – October 3, 2019.

* Captain Dr Wong Ang Peng is a researcher with an interest in economics, politics, and health issues. He has a burning desire to do anything within his means to promote national harmony. Captain Wong is also a member of the National Patriots Association.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.