I am close with someone who has chronic high cholesterol, in addition to a 6-pack abs. She exercises 5x/week and eats .5kg of animal products/week at most, usually white meat. She just visited her heart Dr and was told that her cholesterol is too high and that she needs to cut out animal products entirely as a next step.
I am thinking...is this really the modern answer to someone's high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with?
It doesn't add up to me.
It's amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I'm excited to read and share this ongoing research. Thank you for posting this.
It may not. Her doctor could be erring on the side of caution. Also, cutting out animal products completely could demonstrate that her high cholesterol is due to something besides her diet which should open up referrals to a specialist and other kinds of testing.
In my experience, as a patient with some unknown problem, the less experienced a physician is, even if they are a specialist, the more likely they are to try to match up your issues with what they know and hand wave away any inconsistencies. When you get to an expert, if there are inconsistencies they will straight up say they don't know what's going on and will start looking into it (running tests, trying different meds, etc).
It could be entirely genetic. Worst case could be that some groups just tend to die earlier from these diseases... There could be some somewhat invasive medications to fix thigs. But they are likely very far away...
I have high cholesterol. Used to eat normally. Was on statins. Highest dose doctor would prescribe. Got muscle problems. Doctor took me off statin coz it might be the heart muscle at some point.
Unrelated to this I tried Keto a bit later. I did actual real keto with less than 20g of carbs. Probably higher on the protein side than normal but loooots of fat definitely and eggs and bacon and all the other cholesterol stuff.
All of my other bad blood values completely normalized. Cholesterol went down slightly but not much but LDL/HDL ration improved. I didn't get the test to check for size and makeup of the cholesterol molecules done (not covered/done here) but I bet you it would've confirmed that I had a lot of but mostly the fluffy type of cholesterol (the good type).
My LDL dropped by three quarters once I switched to a keto(ish) diet a decade ago and stayed down. My HDL remained stable, almost like the body manufactures it for cell walls or something...
Similar - my grandfather is my only grand parent with high cholesterol, he's now 93 and has out lived all my other grand parents and his sister. It's clear to me that there's a lot here that we still don't understand.
In my family all the cooking/frying is done with clarified butter. Butter, cheese, definitely no margarine/crisco, plant oil only for salads. So far no cardiovascular problems.
The interesting side effect to me here is using butter one might keep the cooking temperatures a little bit lower. Butter burns at a lower temp than many plant oils.
Not clarified butter; it's clarified so that it can be cooked at higher temps (it also keeps longer). Clarified butter has a higher smoke point than several plant oils.
What kind of exercise: cardio, yoga, resistance/weight training, other? There have been a number of studies showing that regular weight training improves cholesterol numbers (1,2) and I have seen it personally. Regular weight training causes cells to repair/recycle their cholesterol, removing it from the bloodstream. (Cardio may or may not do this as well but I'm a proponent of weight training as the foundation of health.)
Also: after reading the article, I think that cholesterol turnover rate is the key here. Cholesterol that is regularly used up and replaced does not have time to damage your vascular system like cholesterol that hangs around and hardens on your walls.
1) https://pubmed.ncbi.nlm.nih.gov/24174305/ -- Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations
2) https://pubmed.ncbi.nlm.nih.gov/33343671/ -- Regular training has a greater effect on aerobic capacity, fasting blood glucose and blood lipids in obese adolescent males compared to irregular training
I've always had high-ish cholesterol. I dramatically cut down on carbs and animal protein (no meat at all, but still some dairy and eggs) which resulted in only modest improvement to LDL.
I do cardio at least 3 times a week and train a form of calisthenics (push ups, pull ups, dips, etc) at least three days a week.
It doesn't really do much for the numbers. I think some people just draw the short straw on cholesterol.
The trick to it is that cholesterol is only one of many subtle risk factors in cardiovascular health. As this article suggests, it's obviously not the case that high cholesterol is universally associated with worse outcomes, and there's no guarantee that improving the test scores will provide any benefit for an otherwise healthy patient. Does the doctor look at the whole person and their exercise regimen and conclude it's not worth medicating for the cholesterol risk? Or do they consider that lowering cholesterol can improve risk even further and so recommend medication? There's actually a protocol here that includes cholesterol as only one factor.
Ideally, a model like the one in this article could help better understand who to actually treat. We know cholesterol is a reliable proxy for risk at population levels, but if it could be ruled out for individual parents that would be very helpful.
Could be also something like https://en.wikipedia.org/wiki/Familial_hypercholesterolemia where it's just due to genes and bad luck. You can do generic tests for it, but they're relatively expensive. Statins mostly help bring the numbers down.
Emphasis on mostly. Check my post above. It's genetic for me most probably (I'm the 4th generation w/ high cholesterol and we cover most of the combinations of vegan/carnivore/fat/thin). Statins have bad side effects that can kill you outright. To think I'd been on statins since 16 years old (for round about 25 years... )
In this case I meant mostly as in "out of things they do, the big effect is on the cholesterol numbers". We still don't really know if they help with heart diseases or not. As far as I understand it, that still relies on the unproven hypothesis that lowering cholesterol numbers does improve the outcomes.
Did the doc do any kind of test to determine current levels of plaque in the arteries? There's a test that's done via ultrasound (IIRC) on the carotid artery that can give a pretty good idea of current plaque levels.
My paternal grandfather and great grandfather both died of cardiac arrest in their 50s. My Dad has always had high cholesterol but went on drugs as soon as they were available - first Niacin, then statins. He's still doing great at 75 and very much thinks the pills are to thank.
It may be that she has insulin intolerance / resistance, it may be worth to check for it. I've heard a similar case, and after the insulin intolerance treatment was ongoing for a while, the cholesterol level dropped.
I think specifying meat vs other sources is more of an inaccuracy thing and can be corrected easily without involving interpretations.
"eats healthy" on the other hand is an exercise in assigning values to one way of eating over another. If you talk to a keto guy and you tell him you "eat healthy too" he might assume you're doing keto too. Talk to a vegan they probably think you're vegan as well etc. :)
I would actually argue that "stuffing my face" with 2 A&W lettuce wrapped uncle burgers (sandwich only, no combo) is healthier than having one regular mama burger with fries, lots of ketchup and a half litre of coke (or whatever sugary drink you prefer).
(This is the keto vs. regular diet example from before and showcases exactly what I was saying. You attribute value to one particular diet, while I might have another, ideal, healthy diet in my mind. After said 2 uncle burgers I don't have to eat again for a _very_ long time. On keto I've gone without eating for a day easy without feeling hundry, while I'd want an early dinner after the other option mentioned for lunch because my stomach is aching for more food)
What I have found and read recently-ish about as well is that dietery cholesterol will actually not have any bad effect on the cholesterol in your bloodstream. If I eat eggs and bacon my cholesterol basically stays the same as if I don't and my body just manufactures more of the bad stuff.
> In fact, cholesterol production is so important that your liver and intestines make about 80% of the cholesterol you need to stay healthy. Only about 20% comes from the foods you eat
This is not true for all people, sensitivity to dietary cholesterol intake is individually variable. My cholesterol responds very strongly to dietary cholesterol intake, when I do not eat eggs yolk, shrimp etc, my cholesterol is close to ideal. When I do eat them my numbers go extremely high and I am recommended to take a statin. I am in my 40s and this has been very consistent since I was in my 20s. If you read more studies related to this you will find that there are absolutely populations of dietary cholesterol responders and non-responders.
So much nutrition research is all correlation and no causation. Statements like this, which over-infer, kill me:
"There is little doubt that people with high cholesterol have an increased risk of disease."
It's just as valid to say that people with heart disease are more likely to have high cholesterol. When all you have is correlation, there is a heart disease group, and a high cholesterol group, and all you shown with correlation is that there is a third overlapping group of people with both. With only correlation, you don't know how/why, or even if, members of one group transform into the other. Which is partly the underpinning of the article.
It's possible that high cholesterol is a result of underlying heart disease (which the article says is possible), rather than a cause. But what shocks me is that people, even researchers, seem surprised to realize such possibilities.
We know that high cholesterol is a cause of heart disease rather than a mere correlation because people with genetic Hypercholesterolemia have a rate of heart disease 10-20x that of the general population, independent of other risk factors: https://www.acc.org/latest-in-cardiology/articles/2020/06/01...
By definition, Familial Hypercholesterolemia is a genetic defect of the receptor responsible for clearing cholesterol-containing droplets from the blood.
I understand that, but my point was that it's in principle possible that the exact effects of a particular genetic disease are hard to discover. Serum cholesterol is easy to measure, so it could be just the easiest to notice sign of a more complex metabolic modification induced by the specific genes. I doubt we are at a point where we can look at a gene and say exactly what it affects in the entire body.
That doesn't rebut my assertion or complaint at all, since you are referring to a specific type of genetic disorder.
The research in general on nutrition and hearth health is still mostly correlation. Definitely someone with a specific disorder could have a more obvious causal link with cholesterol and cardiac events, but I've read a bunch of different papers, many from respected institutions, and the conclusions usually are, IMHO (I studied physics), garbage.
No we actually understand the underlying mechanisms here, to a decent extent.
In case of people who have a high level LDL cholesterol, the phagocytes - the scavenger cells in blood consume more cholesterol particles in general. The result is cholesterol is more likely to stick to the walls of affected blood vessels.
This is one of the most thoroughly researched topics in medicine.
Does it mean high LDL will always result in a heart attack? No! Just like not every cigarette smoker dies of lung cancer.
The "thoroughness" of the research doesn't matter much when it's based upon a false assumption or two.
You describe one mechanism by which cholesterol could cause heart disease. As you say, there is lots of evidence that it happens -- in an unknown subset of the population, with defining characteristics that nobody's managed to figure out.
The science just isn't there. And the financial success of statins seems to really get in the way of people wanting to work it all out.
The molecular mechanism by which cholesterol causes heart disease is well understood, and atherosclerosis has been experimentally induced in every species of mammal ever studied by either feeding the animals a high cholesterol diet or knocking out genes related to LDL metabolism, and these results are consistent between hundreds of studies performed over the past 100 years. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525717/
PROBLEM #1: High saturated fat diet correlated to high serum cholesterol
ANSWER #1: Serum cholesterol is transferred back-and-forth between the blood and cell membranes to maintain a constant cell rigidity; normal behavior
PROBLEM #2: High serum cholesterol correlated to cardiovascular disease
ANSWER #2: Chronic inflammation associated with metabolic disorders upsets the various regulatory systems
I find the second answer unsatisfactory. Any chronic condition that damages arteries leads to plaque and this, in my opinion, accounts for all the other associations. The arterial wall damage can be due to excess blood sugar, oxidation, or pathogens (SARS-CoV-2?). The damage causes an inflammatory response and extra serum cholesterol is needed to repair the damage (forms the plaque). The chronic plaque formation reduces the arterial cross-section and reduces elasticity which both increase blood pressure.
The underlying cause is arterial wall damage. This can be measured non-intrusively using the Ankle-Brachial Pressure Index:
PROBLEM #2: high serum cholesterol is correlated to cardiovascular disease, but eating high saturated fat-diets is not.
ANSWER #2: It appears that studies that assess the effect of a particular diet depends a lot upon the health of the individual prior to the study start; thus, using a random population results in non-significant results.
Note that I agree with you otherwise. I would suspect that a diet high in saturated fats without any supplemental unsaturated fats would result in cell walls becoming so stiff that removal of cholesterol can no longer benefit the cell walls; if this happens in arteries, you get hardened arteries that can lead to heart disease.
My key takeaway is that the ratio of saturated:unsaturated fat in the diet does control the concentration of serum cholesterol but any ratio between 1:0 and 0:1 (provided you get enough essential fats) is perfectly normal and does not impact health negatively either way. The function of serum cholesterol is maintaining cell rigidity throughout the body, not just in arteries. I have never heard this explanation before; it makes sense. This claim should be easy to verify experimentally.
The question then turns to the underlying cause of atherosclerosis. The arguments, to me, seem circular. Ultimately, the important question is how much of the plaque is due to a damaging agent like sugar and how much is due to a hyperactive inflammatory response. Measuring inflammation independent of arterial wall damage seems incomplete.
Speaking anecdotally, I put a few logical ideas together from different articles and got an answer that seems to work for me some years ago:
1. Simple carbs like sugar are metabolic stressors
2. Saturated fats, as well as other agents like caffeine can act to accelerate the metabolisation of sugar
3. If you consume a stressor with an accelerator, you are more likely to do damage than if they are spread out or diluted e.g. with fiber, so don't do that
4. (Something something exercise)
This hypothesis, while lacking in rigor, explains why I can have two burgers and be fine, but be miserable if I have a burger, fries and a coffee.
Problem #1 is not actually observed though. We know from many, many studies that dietary cholesterol is not directly correlated with serum cholesterol. The article even alludes to the point that the body regulates cholesterol on its own regardless of diet.
Cholesterol reduction is big business. Pfizer’s Lipitor alone raked in $125 billion between 1996 to 2012. This amount of money can be very corrupting. It’s almost impossible to find experts who are not influenced by money from industry.
If true then aspirins may be just as useful as statins while being cheaper and safer. (But you won't see anyone funding a clinical trial to prove this, any time soon!)
I find this article quite fascinating. It provides a bit of a glimpse into how science can work, and how difficult it is to gain valid knowledge on some topics. It's also a reminder that "science" isn't just a simple process that you follow to find the truth. Sometimes people ask the wrong question, or draw the wrong conclusion from experiments. It seems that research related to nutrition and health has a fair amount of this.
It reminds me of my own experience earlier this week where I needed to call a certain service. The API has 2 parameters. I thought that one was required and one was optional. But whenever I called the service with 1 parameter, it failed. Eventually I thought "maybe both parameters are required" and called the service with 2 parameters, and it worked. So I concluded "both parameters are required". But later I discovered that the service was just flaky and it was a coincidence that it started working just at the moment when I added the second parameter. After that experience it's difficult to know what to trust, when everything could be due to randomness and unreliability.
We have known for many decades that it is oxidized blood cholesterol that correlates with heart disease. Fred Kummerow showed this back in the '50s, 60+ years ago. But you can't get a blood test for oxidized cholesterol.
Fred Kummerow spent his whole working life getting trans fats out of the US food pipeline. He proved trans fat was poison in 1957, and finally in 2009, under compulsion of a lawsuit, the FDA declared it toxic. Then, they issued no regulations restricting their use until forced by another lawsuit, in 2014. Then, they gave vendors 3 more years to put poison in stuff being sold as if it were food. In 2018 it was supposed to be illegal to sell trans fats as food, but a number of companies still do, under waivers.
He died in 2017, at age 102. He spent the final two years of his life working on Parkinson's, which had taken his wife, since trans fats had (he thought) finally been outlawed. He was a great hero of experimentally-grounded health science.
India and Brazil are still struggling to get it outlawed. The big corporations have resisted because selling poison as if it were food remains profitable.
We are still confused about fats. But a takeaway should be that nobody has ever found any evidence of harm from eating saturated fat, or benefit from eating unsaturated fat, despite decades trying.
Robert Lustig is right that fructose (half of common sugar) is responsible for a variety of ills: exactly the ones Americans die of, by the millions. There is a lot of Lustig material on youtube, all of it excellent, all thoroughly grounded in rigorous experimental science. We need more Robert Lustigs.
The normal metabolic route is that excess fructose, beyond what the liver can afford to process immediately or store itself, is carried wrapped in cholesterol to fat cells to be stored.
If you take statins, excess fructose gets dumped into your bloodstream not wrapped in cholesterol, which is much worse. It causes oxidation of blood lipids, which have long been known to cause heart and circulatory problems.
Can you share a good article about the misconceptions of cholesterol and the dangers of statins? I've been looking for a decent source. I have a family member on a statin now.
Sadly, no. Statins have been successful at preventing Nth heart attacks, N>1, with some evidence of preventing first heart attacks in people badly at risk, i.e. already with heart disease. It is far from clear how that works.
Vendors have eagerly sought for any hint of evidence of preventing heart disease, or anything else, for decades, and have come up empty. That does not stop physicians from prescribing statins for slightly elevated cholesterol. Pharmaceutical companies love drugs like statins that don't cure anything, so you have to take them every month, forever. They have proven very skilled at manipulating the opinions of medical doctors, e.g. scandalously in the case recent case of opioids.
Making your liver ignore signals to produce the cholesterol your body needs to function is a very bad idea, on par with irradiating your thymus gland when it becomes enlarged (which was done, and recently! Your thymus gland is part of your immune system, enlarged when it is working.)
Cholesterol is is not the problem. HDL and LDL differences not withstanding.
Cholesterol is used by the body to patch damaged arterial walls which can cause clogging if the there is excessive damage to the arteries.
The problem is high sugar levels in the blood by eating high sugar content foods and high glycemic index foods like highly processed carbohydrates which turn to sugar quickly raising blood suggar levels.
High sugar levels cause damage to the arterial walls and bodies response is to patch the damage.
Other issues interfere with the ability of lipids entering the wall properly in the repair process and cause the atherosclerosis exaserbated by ldl presence also caused by high sugar levels amongst others
studies show saturated fats increase LDL cholesterol
A => B
People who get heart disease are more likely to have high LDL cholesterol
C => B
> Researchers have thus drawn a logical conclusion: a lot of saturated fat in the diet produces more cholesterol, which in turn increases the risk of heart disease.
A => B /\ B => C
> But this has been surprisingly difficult to prove.
The author wrote "People who get heart disease are more likely to have high LDL cholesterol". Had she written "People who have high LDL cholesterol are more likely to get heart disease" then the argument would have been valid.
I have an auto-immune disease. The medication prescribed has the side effect of making my "bad" LDL cholesterol skyrocket. I tried everything from diet, to exercise to bring it back down but nothing worked. I'm now on a Statin medication which solved the issue but I'm not thrilled about yet another medication.
Before my disease I ate like an average American (sugar, meat, dairy etc.) and my LDL cholesterol was high. I was diagnosed, changed my diet and my LDL dropped to healthy levels. Later I started a new medication (JAK inhibitor) and it jumped back up, but my diet did not change.
I read this article twice and have no idea how it applies to my situation.
I'm no doctor, so take what I'm about to say with a ton of salt. Your doctor might disapprove, but salt ain't so bad in reality.
High LDL or high cholesterol doesn't mean anything, per se. The HDL:LDL ratio is a little more important but not so much. Triglycerides and glucose levels are a much bigger indicator of health. Inflammation is the biggest indicator, but AFAIK we do not have ways to measure it directly.
HDL, LDL, cholesterol, triglycerides are fats, but are often not directly correlated with dietary fat. There is more and more evidence triglycerides increases as sugar and refined carbs increase in your diet. This is the biggest misconception in dietary history and we're 20 years away from science and doctors to integrate this new piece of information.
I think it was a mistake to focus public health discussions around the finer details of work in progress research.
The ambiguities and unknowns have opened the door for fitness gurus and health product grifters to turn this into a sort of holy war. It’s sad to see how many people have been convinced they are “healthy” because they follow a couple out of context fragments of the overall health picture.
I know too many people who think they are doing everything right because they avoid gluten, or don’t eat dairy products, or minimize saturated fat. Yet they go on to consume excessive amounts of sugar, or drink copious amounts of alcohol, or eat 4000+ calories per day of their chosen healthy foods.
Correct me if I'm wrong, but wasn't one of the founding / influencial "cholesterol is bad" studies found to be bad science, and that ultimately it was the result of "financing" by Big Sugar? They were Harvard profs / researchers I believe.
The point being, much of collective knowledge on this subject is based on misleading / false assumptions. That is, you're going to struggle to find results that align with conventional wisdom because that wisdom is flawed.
So the new model seems to be suggesting that high LDLs are not a cause for heart disease, but rather a symptom. Have other studies tying high LDLs to heart disease taken this into account, or did their main findings just show a correlation with high LDLs and heart disease?
This is why I have three things I never trust the experts in.
- How to be healthy
- How to educate
- How to raise kids
It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out, and this time we know we are right because we have fancier gadgets and more citations in our name.
From Frued to the Food Pyramid it seems that the experts always have just finally figured it out.
> - How to be healthy - How to educate - How to raise kids
I think it's interesting that all of three of these hinge on the same problem: human variability. I strongly suspect that humans are much more variable internally than conventional science and journalism accounts for.
The scientific method uses statistics which is important for showing aggregate effects but can also obscure variability. And journalists have an incentive to offer simplified guidance that is as widely applicable as possible.
The end result of a lot of information like "Do X" when what it should really be is "If you are like Y do X, if you are like W do Z."
This is a pattern I think of as "the missing parameter" that I see just about everywhere people give advice once I started looking for it. Examples:
- "(Static/dynamic) types don't help programming." For what kinds of programs? Developed by whom? At what scale and timeframe?
- "You (should/should not) use a schemaless database." How big is your dataset? What is the relative fraction of reads/writes? What kind of data? How many users? How much money do you have? What are your failure modes?
- "People should move (to/out) of cities." Which cities? What is the city's transit like? Which people? What activities do they prefer? Do they have kids? What's their economic status? Age? How important is it to be near a hospital?
- "You should eat less salt." For people of what age? Activity level? Diet?
- "Teach by example not generalities." Teach what material? To whom? How important is their understanding? How long should they retain it?
- "Children should go outdoors on their own more." What age? What personality do they have? Where do they live?
Whenever I see people arguing about some generality, what is often happening is that each party has implicitly filled in those parameters with different values, so they are all correct but talking past each other. When I see this happening now, I try to take a step back and figure out what implicit parameters they are assuming and see if there's a higher-level parameterized stance that unifies their arguments.
I'm always confused when I read/hear people say things like this. Do people think there is a skyscraper downtown with a giant sign on it that says Expert HQ on it or something where they release their findings from?
I understand that science is multi-facted discipline and there are a lot of people who have dedicated their lives to their craft and discovering truth because of their desire to solve human suffering and figure out how the world works.
I also think there are a bunch of "scientists" that like the veneer that comes with the title like to spend their time talking on TV, going to parties, chairing committees and stealing credit from people doing work. They are aided and abetted in this endevour by the popular media and politicians who just want to slap out some new "discovery" to get clicks.
The first group is anxious for their work to be peer reviewed, tries to explain things simply, and will do what they do even if there was no reward and no one appreciated their work. They have qualifications.
The second group uses jargon to try and confuse people, hate when people call them on things, use their influence to restrict funding to others and publicly deride their opponents who disagree with them. They have credentials.
Unfortunately, society generally listens to the 2nd group over the first group because they often tell them what they want to hear.
Doctors learn the results of science, but generally aren’t scientists. People doing science outreach are generally in that same category where their knowledgeable, but speak outside their specialty. Simply because being able to do original research today means a very narrow focus.
Beyond that, the best available information isn’t always that clear. Low salt diets for example where prompted based on very limited information that suggested they where slightly more likely to be useful than pointless. Unfortunately, we rarely have unambiguous data which gives clear guidance. Vitamin C for example is mandatory, but you can have zero vitamin C for 2 weeks without issue or quickly excrete excess. For more subtle interactions it’s just difficult to figure out what’s going on.
I think a lot of people think that sociopaths and narcissists have a tendency to rise to power in politics, business and media over time, as well as have a tendency to lie and cheat to the general population to advance their agenda. "Science" is one of the topics that the average person reveres but doesn't really understand, and so is readily weaponized for less than altruistic reasons.
As a recent relevant example with the pandemic, there was a widespread effort by the media
and politicians to discredit various well understood, several decade old drugs known to effectively regulate inflammatory problems. The primary objection was an appeal to "science" claiming that the drugs were untested for their effectiveness specifically against covid, and sensational claims that they are dangerous. Meanwhile, you have pharmaceutical companies injecting mRNA purposefully designed to essentially cause a temporary auto-immune disease into anyone they can, enjoying the fact that they were able to skip a decade of best practices for vetting new treatments. It just seems like maybe there's some unscientific human bias in there...
> It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out
I think you're being unfair. Most of the time, it's not a major 180, it tends to be smaller course corrections, refinements over current understanding of data, and the discovery of even more correlated complexities.
The issue is people want simple answers, easy to follow guidelines, and guaranteed results. The science just isn't at the point where it can deliver those. So people make up best guesses for them each decade based on where the science is at that point.
Generally common sense, good wisdom, and my own understanding of the situation as well as my personal investigation.
Like everything I need to know about nutrition is "eat food, but not too much, try and get a variety, generally plants are better for you than sugar, fast regularly and get exercise."
I've personally be satisfied with what I'll call "informed" common sense. An example from health is the documentary "In Defense of Food" where the journalist uses a little science and history to create the heuristic: "Eat food, mostly plants, not too much." None of those insights are really surprising, the only exception maybe being the "mostly plants part".
A downside of depending on complicated theories from experts is that it makes a "priesthood" of people telling you what to think all the time. I think there are enough examples from health, environmental, and privacy policy making to demonstrate that the "priests" don't always have the public's best interests in mind.
I'm glad to see new approaches to this problem being discussed, because even after researching about lipids for quite awhile, I was unable to come to a full conclusion on them myself. There's so many confounding variables, and attempting to control for all of them just isn't really feasible in an RCT (not to mention most studies are correlational and nowhere near an RCT to begin with).
I think it's likely the case that sometimes high LDL is good, and sometimes it is bad, and this may depend on many other factors related to yourself and your diet. But disentangling these cases is very difficult, and the food supply of nations has changed so much that we keep seeing very misleading correlations. These misleading correlations are why we sometimes hop onto bandwagons like 'fat is bad for you', 'high salt is bad for you', or 'animal products/red meat are bad for you', and then after more research and RCTs, we realize that this is not the case (if the press would stop reporting correlations to everyone as important research that you need to act on right now, that would certainly be nice).
I'm looking forward to more progress here, but until then I don't mind eating saturated fats myself, although I do avoid certain sources of them, such as in fried oils high in linoleic acid. I also don't focus a ton on LDL precisely, but rather some other related measures (different types of cholesterol, low inflammation, and coronary calcium scans if possible)
I believe the focus on LDL as 'bad' has been misguided. It's an improvement from 'all cholesterol is bad', but we just don't understand very much about how it all works, and so as we discover more, we slowly refine our understanding.
A lot of the theory about why LDL is 'bad' is based on the fact that arterial damage is repaired with the stuff, causing plaque. There's no evidence that LDL is causing the damage, just that it has a role in how it's fixed (in an ultimately detrimental way).
It'll be interesting to see how this theory stands up. It seems like they're on the right path, tying together several things that seem to be problems.
The homeoviscous adaptation to dietary lipids (HADL) model explains controversies over saturated fat, cholesterol, and cardiovascular disease risk
"Corresponding with the model, we suggest alternative contributing factors to the association between elevated LDL cholesterol concentrations and ASCVD, involving dietary factors beyond SFAs, such as an increased endotoxin load from diet–gut microbiome interactions and subsequent chronic low-grade inflammation that interferes with fine-tuned signaling pathways."
> When we eat more polyunsaturated fat, the cells incorporate more polyunsaturated fat into the cell membrane, making it more fluid.
That seems like an absolutely wild idea to me. So the cell just grabs whatever lipids arrive from the diet and turns them into phospholipids and puts them in the membrane? I know nothing about this process, but my biochemist's intuition tells me to be skeptical. Is there research on this?
I can't help but think that there is active effort to halt our understanding of nutrition. I mean, if we still can't say at least that saturated fat is causally related to heart disease, then this whole field is in a very bad place. My hypothesis though, is that this finding has already been established but people keep coming back to this subject to try to adjust it to their lifestyle choices.
Your hypothesis is incorrect, or at least not justified by the data. The whole field of human nutrition actually is in a very bad place. Most of what we think we know comes from low quality observational studies which don't rate well on the evidence based medicine scale.
By all means let's continue research. But people generally shouldn't rely upon most of it when making dietary choices. A better approach is to conduct your own n=1 informal experiments and determine empirically what works best for you.
But you see, I don't agree that these conclusions are based on low quality data. These conclusions are not merely based on observational studies, as you pointed. This question is being asked for more than 70 years and a lot of different types of designs have been tried: putting people on strictly monitored diets and seeing what happens to their biomarkers, finding people with weird mutations that lower their LDL cholesterol, etc. By the way, the only type of data that disagrees with the expert's conclusion are, you guessed it, observational data. And that is simply because there are so much individual variation that these studies end up always underpowered. If you track the same individual and changes his/her diet, the conclusion is inescapable: saturated fat increases LDL cholesterol. And LDL cholesterol is causally linked to heart disease.
I don't mean to say that this narrative can't be pushed back, but these articles comes from the [wrong] premise that these findings are not solid. They are. It's the same as trying to advance the idea that trans fat is not dangerous to someone's health: you surely could try, but the prior should be low. That's is why I advanced the hypothesis that people are craving for these types of news that validate their lifestyles: they don't seem to be properly calculating their priors and are dismissing too quickly solid evidence.
They have been trying to establish a causal connection between saturated fat and heart disease for many decades, with no success at all. The failure, despite such effort, is its own evidence. Similarly, others have tried for decades to find evidence for a benefit to taking statins when you haven't had a heart attack, and have again always failed.
There are pretty good reasons to think eating lots of meat is bad for your heart, which they have always blamed on the saturated fat. Now they have having to backtrack, and try to discover what else it is in meat that causes trouble.
It's an interesting hypothesis. But it seems contradicted by Mendelian randomization studies, which find that LDL cholesterol levels to be causally associated with heart disease.
Not sure how "new" this model is, it's just not well-known in the mainstream. Dr. Rhona Patrick has been explaining this very clearly for years. Go watch any of her podcasts with Joe Rogan.
This is parallel to the question of vitamin D and COVID. There's a strong correlation between vitamin D deficiency and COVID mortality, yet taking vitamin D doesn't help. Conjecturally, it's the genetic cause of vitamin D deficiency that increases COVID mortality.
I had been taking Clemastine and vitamin D. I asked a former student now a doctor at the center of the COVID response whether these would interfere with my vaccine. She said to stop Clemastine on the off chance that one study was on to something, but there was no reason to take or stop taking vitamin D.
The science in this area is actually pretty low quality from a strict evidence-based medicine standpoint. It mostly consists of poorly controlled observational studies, which are only one step above the woo woo fad diets. We still don't have a solid theoretical framework for how all the pieces fit together.
We (and by we I mean the government) just need to bite the bullet and and pay for a multi billion dollar study where we pay tens of thousands of people to control* and monitor what they eat, exercise, etc for 20 years and just figure this out. None of this “well we had 20 grad students journal what they did for 6 months and this is the result” low quality studies.
*Morally correct and ethically of course. I’m not saying we force people into large hamster cages.
Unfortunately such a study still wouldn't produce valid results. The problem is that study subjects don't report accurate data. They lie because they're ashamed of their choices, or they forget, or they just don't know how to accurately count what they eat.
Consider a hypothetical study subject who goes to watch the game at his local bar, drinks 7 beers, eats a plate of hot wings, and then stops at Taco Bell for nachos on the way home. When he wakes up the next morning what do you suppose he'll enter on the form?
No, it's what some interpret the science to mean. It's not like the Carnivore Code is just a nonsense fad diet. It's a book describing the science behind it. You may or may not agree with its conclusions, of course.
And I'm not even suggesting to start eating a carnivore diet. I don't. I just think it's worth reading for some valuable insights.
Additionally, I would argue that the science on seed oils points to them being bad for our health. If you watch that video, the conclusions are all based on research.
There's no such thing as "the science", as if there's only a single conclusion that can be derived from experiments. That's not how science works.
If the epic, explosive scale of obesity, diabetes and heart disease under the modern government recommended high-carbohydrate, low-fat diet doesn't give you pause, then.... I just don't know what to say.
It makes you wonder what would happen if they recommended the opposite for a generation, what would happen. Would recommending a ketoish diet improve health outcomes? Or does the recommendation mean almost nothing and people will just eat whatever is sold by big food.
Yes, the recommendations appear to mean almost nothing. Americans didn't even reduce the amount of fat consumed since the government started recommending that they eat less fat. They just haven't increased it as much as they increased the amount of carbs consumed. https://www.washingtonpost.com/lifestyle/food/did-the-govern...
> The idea that animal products are unhealthy seems to be misguided
From my personal sifting through research, it seems there's a lot of correlation with different diets which shows people with more health problems often have an animal based diet and people with less health problems often have a more pesceterian diet.
What is absolutely not clear is any of the cause/effect. It's also unknown of the nuances.
For example, what else correlates with those? It often is true that people with pesceterian diets are from specific isolated genetic lineages. It is also often true that when they're not, they tend to be individuals that pay much more attention to their overall health, making sure they don't eat too much, eat high quality produce (organic, wild caught, etc), exercise more, and often are more financially wealthy.
Personally I agree with you, but I also agree with the opposite:
> The idea that vegetables/fruits/nuts/seafood products are unhealthy seems to be misguided
Historically, we've always consumed all these things. Meat, seafood, vegetables, fruits, nuts, grains, seeds, human lineage ate all of this for a very long time. Why would any of it be bad for us?
More recently as I've been thinking about this, I'm wondering if it's more related to our modern production of those things, and our changing consumption habits.
Take meat for example, the meat we eat today is very low quality. The animals are themselves unhealthy, fed garbage food, and have a lifestyle unlike their natural one. Can we compare the effect of eating unhealthy meat to healthy meat? We know grass fed beef has way more nutrition than non grass fed beef for example, so there's clearly major differences between eating one or the other.
Now take vegetables, we've not been hard pressing canola into an oil extract and consuming it in high quantity before. This is a modern change.
In fact, I don't even think canola is a plant we would have eaten the seeds off in the past.
So my current thoughts are that low grade produce and processed foods might have a lot more to do with it. And all of the "diets" no matter if you think they are a fad or which affinity you have will emphasize this point: Avoid processed foods and try to get the highest quality ingredients.
In the past, we'd probably eat an animal that had eaten canola itself and processed it for us, and we'd get the canola nutrients through eating the animal.
But also, we wouldn't be eating animal all the time at the quantities we do now. Because winter, and hunting is hard, and lack of preservatives. But also because once we became sedentary, meat was expensive and most people could afford very little of it.
And like I said when we did, it would be this very high quality meat. Very different from what we eat today.
We also wouldn't be consuming all these processed vegetables byproducts, like oils. Appart from those that were very easy to extract, like Olive oils. Everything else that requires modern industrialization to extract it was probably consumed in much less processed forms, such as eating the seeds themselves, or grinding a much smaller amount and getting much smaller amount of oil out of them.
Modernity has brought major changes in that all foods are now of a lower quality, and come in a much more processed form. It made a lot of foods more accessible which mean eating as much as we do is also a modern change. And it allowed us to modify the proportions of what we'd eat, like way more sugar and salt, way less veggies and fruits. In my opinion these are the more consistent factors. So from my readings, I currently conclude the best course of action for your average healthy person is to eat less food overall, eat unprocessed foods of the highest quality (organic, grass fed, wild caught, etc.), In mostly equal quantity of each kind (based on calories), like consume the same calories of meat, fish, veggies, fruits and grains.
> Historically, we've always consumed all these things. Meat, seafood, vegetables, fruits, nuts, grains, seeds, human lineage ate all of this for a very long time. Why would any of it be bad for us?
Because evolution trends toward living long enough to reproduce. People often die of heart disease once they're old enough they weren't having kids (although exceptions certainly exist).
Evolution doesn't give a fuck if fruit suddenly becomes poisonous to you on the day you turn 65. Youve passed on your genes, your survival is now irrelevant.
So the things that will help us live a long time are not driven by evolution. "We've always eaten it" is a terrible argument because it should be followed by "but the average lifespan was like 40 up until a few decades ago".
> Because evolution trends toward living long enough to reproduce.
I'm not sure it's that simple. Given that humans tended to live in tribes, it was in the tribe's best interest if people were healthy and vital beyond reproduction, for hunting, protection, care of young, passing on wisdom, etc.
> People often die of heart disease once they're old enough they weren't having kids (although exceptions certainly exist).
There are cultures where heart disease is nearly unheard of. So I don't think this explanation is very satisfying.
You're right, the evolutionary argument is just one dimension.
I don't think it's irrelevant, because logically we should have evolved to process what we eat so it doesn't kill us. But evolution could have settled on a compromise between availability to the food and some "good enough" health and lifespan like you say, live at least 40 years, healthy enough to have and raise offsprings.
It just seems a good starting point to start refining from.
I've alluded to other dimensions, like how it seems plant and seafood heavy diets correlate to longer healthier lifes and meat heavy ones don't. But I also wanted to point at the uncertainty exactly in those. We don't really have data of people on very good meat quality diets versus your typical large scale meat production. So it can be premeditated to just blame meat.
Similarly more modern forms of vegetable based byproducts also have studies showing correlation with inflammation and other issues. And again I think it be premeditated to just blame vegetables.
In the end, when I consider multiple dimensions that I've read about, the diet most consistently appearing "healthier" in the average is what I said. A varied source of nutritions from different foods, all of high quality, with no excess in any one of them over the others, with overall eating less of it all, with minimal processed food consumption. For which I was just showing that even the evolutionary dimension corroborates.
Another way to look at it, we don't know enough about any single food and their risk, so a diversified portfolio is the best strategy to mitigate the risks, similar to financial investments.
> Historically, we've always consumed all these things. Meat, seafood, vegetables, fruits, nuts, grains, seeds, human lineage ate all of this for a very long time. Why would any of it be bad for us?
In terms of fruit, it would have been seasonal, and it would have been good for us to put on weight when we got the chance. So some fruit is probably fine, but I suspect people eat too much of it.
There's also a theory that we only resorted to seeds if we couldn't get anything better. Which would explain some of the research that shows seed oils tell fat cells to stay "open" and keep growing. It was a signal that we were on hard times, and needed the extra energy stored.
For vegetables, I guess it comes down to "which ones". I guess the same would probably be true of fruits and nuts, too.
> And like I said when we did, it would be this very high quality meat. Very different from what we eat today.
And we would have eaten nose-to-tail, meaning we'd have eaten the liver, spleen, heart, etc.
> Modernity has brought major changes in that all foods are now of a lower quality, and come in a much more processed form.
Yeah, I think that's where our biggest problems are likely coming from. It looks a lot like the seed oils might be the worst offenders.
> So from my readings, I currently conclude the best course of action for your average healthy person is to eat less food overall, eat unprocessed foods of the highest quality (organic, grass fed, wild caught, etc.), In mostly equal quantity of each kind (based on calories), like consume the same calories of meat, fish, veggies, fruits and grains.
I'm not sure about equal quantities, but I'm also not sure what the right quantities are either. I'm not convinced we should be eating grains at all, and we should probably be careful about fruits. Maybe only eat them when they're in season? I dunno.
Fish is tricky, just because you have to be careful of mercury, even if they're wild caught. So I guess just try to find the types with the lowest mercury levels?
In terms of vegetables, it can also be tricky. Nearly all plants have some kind of toxins to protect themselves (they obviously can't run or fight back with teeth and claws). Our livers have mechanisms to deal with toxins, of course, but which ones we can handle and how much is not clear (to me). I guess it might be one of those cases where you have to experiment and figure out what seems to work for you, at least until we have better understandings of them.
NICE no longer specifies target cholesterol levels for people with diabetes. Your doctors will use a calculator, called QRISK2, to work out your risk of heart disease using a number of factors such as age, BMI, gender, blood pressure levels, cholesterol levels and which type of diabetes you have.
If you want a general guide of how healthy your cholesterol levels are, find out your total cholesterol-to-HDL ratio
To find this, take your total cholesterol figure and divide it by your HDL figure. A result of less than four is healthy
I am thinking...is this really the modern answer to someone's high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with? It doesn't add up to me.
It's amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I'm excited to read and share this ongoing research. Thank you for posting this.