Today’s PrimalMed Prescription…Step away from the Seed Oils!
A President’s Day story about IKE, and thoughts about our ENDOTHELIUM!
Today is President’s Day and as I sit down with my morning coffee, my thoughts turn NOT to Washington, Lincoln, and the bevy of mattress sales, but rather good ol’ IKE, and the saga of how his heart attack shook the nation and helped foster 50 years of dietary guidelines that in fact may have been contributory to the metabolic chronic diseases afflicting us today.
Let’s start with a Chest CT scan. Radiologist starts with a CT scan, makes sense, right? The other day I was at my workstation, reading Low-Dose Chest CT exams, which screen for lung cancer. In 2013, The US Preventative Services Task Force (USPSTF) recommended annual Low Dose screening for lung cancer for smokers and in 2021, updated their guidance to include adults between the ages of 50 and 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. In my neck of the woods, there’s a lot of smokers and ex-smokers, so I read these screening CT scans quite frequently.
The other day, I was reading a stack of screeners one day and there were no nodules to be found. No lung cancers. We know that inhaling smoke is a direct toxin to the lung tissue and driver of malignancy. BUT, most people who smoke do not get cancer at all. I’m looking at case after case after case. These people have smoked 1-2 packs per day for 20-30 years! Can you imagine? Brown teeth and stained nails and craggy wrinkled skin yes but no lung cancer.
You know what I do see? Look at the top image of the heart. Coronaries made of stone! Different windows are used to highlight the heart and lungs. The lungs were clear but man, those coronary arteries were rocks. I’d bet a nickel that this guy has cardiovascular disease. If he’s been smoking for 30 years, I’d bet not a nickel, but a whole dollar that, based on statistics, this guy will drop dead of a heart attack before he ever gets a lung cancer.
Maybe we can save lives by commenting on the presence of coronary artery disease on the CT reports. We look for one thing, but find another, and that too has positive and perhaps better patient outcomes. Medical history is filled with examples of how we develop a drug for one purpose and behold, discover unintended uses. Behold the unexpected. Rogaine was intended to treat hypertension, but people started discovering hair growth. Viagra was initially developed to treat hypertension as well, and the downstream effects on men were positively uplifting!
Latest example is how diabetics treated with GLP-1 agonists like Ozempic started dropping weight like crazy, and now Ozempic and Wegovy are all the rage among non-obese non-diabetic Hollywood A-listers looking for a quick fix. Marketing works! I can’t get this song out of my head. O-O-O-Ozempic!
OK, back to Ike. In 1955, the President had a heart attack. What started out as a lovely round of golf, quickly went south. Ike, the former 5 star general and Supreme Commander of the Allied forces and now leader of the free world was felled by a coronary!
Heart disease was rising in the US throughout the mid 20th century but when Ike had his coronary event, the stock market sank, panic ensued, and experts were called in to step up and lead the fight against heart disease. Ike was a 4 pack per day smoker but had been advised to quit in 1949. But alas, the damage was done, and his first heart attack occurred on that sunny autumn day. After a lengthy convalescence, Ike was back and won a second term in 1956 but he soon went back to his old ways. It is thought that Eisenhower suffered at least seven myocardial infarctions and 14 cardiac arrests before he died in 1969 at age 78. Ike was old school. If you’re gonna play, go hard!
What was causing this epidemic of heart disease, striking middle-aged men at an increasing rate, since say 1900 and escalating in the 50’s? Was it genetics? Was it obesity? Was it smoking? Was it diet? Was it some sort of combination? No easy answer, but autopsies of heart attack victims did show fat and cholesterol in the arteries so THAT must have been the CAUSE!
Enter, the “diet-heart hypothesis.” Long story short, this hypothesis was championed by Ancel Keys, a prominent physician at that time. The theory seemed to make sense. You eat cholesterol and fat, the fat goes into the arteries, clogs the arteries and you get a heart attack. Plaques, upon inspection at autopsy, did contain LDL cholesterol. But perhaps the LDL wasn’t the cause. Perhaps it was there to help repair underlying inflammation?
Animal fats like butter and cholesterol in eggs did raise a type of cholesterol known as LDL, so the thought was to drive down LDL and limit dietary saturated fat. The narrative was to replace the saturated fat that we had used for centuries (with little if any heart disease) and replace them with factory made artificial polyunsaturated fats, also known as Seed Oils. And seed oils such as Soybean oil and Canola Oil (let’s call them PUFAs, or polyunsaturated fatty acids for short), did lower LDL.
When polyunsaturated fats, like those found in seed oils, were found to lower serum cholesterol levels, researchers, and policy makers assumed that lower cholesterol levels would lead to better health outcomes. No brainer, right?
What could possibly go wrong? Well, since 1961, smoking has decreased but the use of PUFA’s has skyrocketed. “Heart-healthy” corn oil, and factory processed soybean and canola oil for all! Goodbye to butter, hello to Mazola!
The story continues. Studies in the 1960’s and 70’s did show that replacing saturated fats with processed seed oils did lower LDL (complex chemistry at the level of the liver) but did NOT improve health outcomes or all-cause mortality. Science moves slow, and the hypothesis from 1961 (that seed oils high in a type of fat called Omega-6 or linoleic acid could decrease cardiac deaths by lowering LDL cholesterol) was disproven in the Minnesota Coronary Experiment, which concluded in 1972 but not reported until 1989. Consider the unexpected. However, ditching dogma in the face of evolving new data can be a bitter pill to swallow. https://www.bmj.com/content/353/bmj.i1246
For the inquisitive, read the works of Nina Teicholz, a NY Times reporter and author on this fascinating tale.
https://thebigfatsurprise.com/
In medicine, we often look for one thing, and find another. We hunt for lung cancers on CT but find more cardiovascular disease, which may save even more lives!
WARNING - NERD ALERT: Chemistry deep dive ahead. Skip to the TL;DR and I will not be insulted!
Back to seed oils. It seems that the fatty acid in seed oils, Linoleic Acid or Omega-6 can easily become oxidized or unstable due to the presence of double bonds in the chemical structure (it all comes down to CHEMISTRY).
We all need some Omega-6 our diet. It is considered an essential fatty acid. (We can’t make it, we need to eat it.) But ultra-processed and heated oils (think french fries and baked goods) in excess can be oxidized and cause an inflammatory response at the level of the inside of our arteries. This is called endothelial damage. Small oxidized LDL particles arise not from eating a healthy real food diet including saturated fats, and fruit oils such as olive and avocado oil, but rather a diet filled with inflammatory ultra-processed frankenfoods containing seed oils such as heated soybean, sunflower, and canola oil.
If you eat chemicals, you’re gonna pay the price. (See past posts by the PrimalRD including her most recent on ultra-processed banned foods).
When the endothelium has been damaged (from smoking, excessive stress and oxidized rancid fats) then and only then can cardiovascular disease commence. It is only the small particle oxidized LDL that can contribute to the atherogenic process. The degraded particles from oxidized seed oils include aldehydes, which is the same toxin from cigarette smoke! The metabolites (Oxidized Linoleic Acid Metabolites) from the heated and processed seed oils can therefore create a direct damaging effect on the endothelium and drive the onset of cardiovascular disease. Chemistry lesson over.
TL;DR. Enjoy President’s Day. If you need a new mattress, go shopping this week.
Remember that scientific and dietary dogma is always changing. At the end of the day, it is ENDOTHELIAL damage that does us in. Smoking is BAD. No doubt about that. But I submit that excessive intake of oxidized heated PUFAs and fake fats are a very relevant and just as important as a cause of cardiovascular disease. We look for one thing and sometimes find another. IKE smoked like a chimney, and I suspect the endothelial damage from the toxic carcinogenic smoke, and not the eggs and butter did him in. The narrative and advice to go heavy on the extra corn and soybean oil didn’t help.
The narrative to switch to processed seed oils may very well have been a contributing factor to the rise not only in cardiovascular disease, but obesity and a fair amount of the health issues we as population face today. More on seed oils and obesity and radiology in future musings!
At the end of the day, it’s all about CHEMISTRY!
Captain Obvious says “Don’t smoke and stay away from the fries! “We DO NOT want our coronaries to Turn to Stone!
Thanks to all for reading todays musing on Metabolic Health as seen through the lens of a curious radiologist. Share this post with friends and family and have them subscribe for free!
Thanks for reading Nancy! Ya never know what you’re gonna learn! Hope you enjoyed the historical references as well!
Very interesting Dr Metzger! I always learn something new from you…