The PURE study was an epidemiological study and can only show associations, and not causation. Moreover, just like Dr. Ansel Keys, the study utilized a FFQ, a Food-Frequency Questioner, and also used the same multivariable Cox frailty model to calculate hazard ratios.
Association or correlation, is useful in two way:
- A correlation can be used to develop a hypothesis that can then be tested in a clinical trial to establish causality.
- The lack of a correlation can be used to demonstrate conclusively a lack of causality.
Simply put, a correlation does not prove causality but all causal relationship are also correlated.
The PURE HR for total mortality, from best to worst for total fats and types of fats are as follows:
- Total Fat 0.77
- Polyunsaturated 0.80
- Monounsaturated fat 0.81
- Saturated 0.86
The PURE study would indicate that the “healthy” (lowest HR) fat is polyunsaturated and not monounsaturated but by such a narrow margin that I would never hazard my reputation by making such a claim. Just eating more total fat is more beneficial then specifically targeting any specific category of fat.
PURE no more justifies making a recommendation to eat monounsaturated fats then did the Seven Countries Study justify the imposition of a low-fat dietary recommendation on the part of the U.S. government. I thought we where never going to make that horrifying mistake again.
Respectfully, do you know of any clinical trials that would support the statement that monounsaturated fats are the best fats? Show me the science!
Keto for Life!
Richard