Day 033 - 10 Oct 94 - Page 10


     
     1        giving your evidence now, does it mean it plays a part in
     2        the cause of or something else?  Put it in other words for
     3        me.
     4        A.  The word "linked", as it is quite frequently used by
     5        researchers, it can mean many different things.  It
     6        primarily means associated, that two things go together,
     7        with an implication that there may be a role of cause,
     8        although that may not necessarily be a direct cause and
     9        effect relationship.  I do not think that "linked"
    10        necessarily means a direct cause and effect, but it means
    11        the two are associated.
    12
    13   MR. MORRIS:  If we move on to heart disease briefly because, if
    14        I am correct in saying, I do not think it is a great issue
    15        between the parties, just very briefly summarise the
    16        dietary implications for heart disease?
    17        A.  Yes.  Beginning in 1949 the Framingham Heart Study has
    18        been a continuous and ongoing study that has clearly shown
    19        that the higher one's serum cholesterol level, the greater
    20        the risk of heart disease.  Serum cholesterol levels are
    21        increased by diets that are high in saturated fat as well
    22        as in cholesterol.  Other factors such as soluble fibre
    23        can reduce cholesterol levels.
    24
    25        Foods that are high in fat and high in cholesterol, such
    26        as those served at McDonald's, tend to increase
    27        cholesterol levels and lead to a higher risk of developing
    28        heart disease, a higher likelihood of a death related to
    29        cardiac disease, and when the diet is changed to omit
    30        these foods and to avoid them, cholesterol levels can
    31        drop, and if the dietary changes go far enough existing
    32        heart disease can actually be reversed.  These findings
    33        are well documented and well accepted.  While they were
    34        controversial perhaps twenty years ago, they are no longer
    35        so today.
    36
    37   MR. JUSTICE BELL:  When you say "cholesterol levels can drop",
    38        you mean they do drop in a certain number of cases?
    39        A.  Yes, in most patients who -- in the vast majority of
    40        individuals who reduce their fat and cholesterol intake,
    41        their cholesterol levels will fall.
    42
    43   MR. MORRIS:  Can that be measured actually meal by meal?  If
    44        you have a high fat meal, does it increase your serum
    45        cholesterol?
    46        A.  One can see some effect of an individual meal, but
    47        what is more important is the overall effect of the diet.
    48
    49   Q.   So it is a cumulative effect?
    50        A.  Yes. 
    51 
    52   Q.   Obviously, is there any specific type of fat that is 
    53        particularly unhealthy in this respect?
    54        A.  Saturated fat is a particular concern because it
    55        stimulates the liver to manufacture more cholesterol.
    56        Saturated fat is particularly found in animal products,
    57        although it is also found in hydrogenated oils and
    58        tropical oils.
    59
    60   Q.   Just moving on to your page 3.  You have said that

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