
Coronary heart disease is a chronic inflammatory condition - jamesknelson
http://bjsm.bmj.com/content/51/15/1111
======
carbocation
The reason this is published in an ancillary journal is that it is a polemic
that pushes an agenda beyond where the data support.

Much of what is written here is accepted widely: that many types of fats are
not really the issue driving heart disease; that fructose and other sugars are
problematic; that lifestyle interventions can have a real impact; that
stenting stable atherosclerosis has no benefit; and that atherothrombosis is
the killer.

The ongoing effort by these authors to dismiss the LDL hypothesis weakens this
paper. That LDL is a primary contributor to cardiovascular disease, myocardial
infarction, and death is supported by human genetic data and by hundreds of
thousands of individuals followed in clinical trials, as well as millions of
people in post marketing monitoring. The casual dismissal in this article by
referring to low quality, confounded evidence (observational studies) is not
responsible and it taints an otherwise useful summary.

~~~
omginternets
>The ongoing effort by these authors to dismiss the LDL hypothesis weakens
this paper.

I didn't get the sense that they were being dismissive, so much as pointing
out that the risk has been exaggerated.

~~~
carbocation
They are claiming that the risk has been exaggerated, but they are using low
quality evidence to support that claim. Higher quality evidence differs.

------
gassius
BOOM the smoking gun goes off.

As a nicotine addicted person, currently on recovery (but very aware of the
lifelong fight that it is for me), and as a LCHF dieter, to me the relation is
very clear. In my case, sugar has the same addictive effects than nicotine,
and apparently, it has as most or even worst malign effects.

This is not to say that everyone should follow a LCHF diet, or that it will
work for everyone. I do think that if you keep your carbs under 100g daily,
and they are low profile insulin type, you should be good and safe. But for
me, as an addicted person, if I deviate from 15g is very easy to get into a
slippery slope and the next thing I know I am eating donuts and flurries. If I
smoke a cigarette on a night out, the next thing I know I am smoking a pack
daily or more.

The thing is, as with tobacco before, the sugar industry (which is probably
the 90% of volume of the whole food industry world wide) has gone ways and
beyond to hook us to their products and to cover the negative effects. Too
many people is addicted to High Carbs without even knowing it.

I hope this studies get more and more attention in the mainstream media and
many more people could at least review their lifestyle with more information
and asses what is best for each of them.

~~~
brynx97
How does one review their lifestyle?

I was told I've got Rheumatoid Arthritis after extensive testing and doctor
visits with specialists over a few months. I'm shopping around ideas on how to
review and track my day to day life.

~~~
cies
I'd look at WFPB for food (I'm NOT a HFLC or keto promoter at all) and some
strength training (most bang of your hour of commitment -- see
reddit.com/r/bodyweightfitness) for starters. That will get most to a place of
general wellbeing (both in not toxifying your body and posture) in a few
months.

The basic idea I believe many of the "cronic", "infammetory", "auto-immune"
and/or "unfixable by MDs" diseases lies in a diet that is not for humans.
Hummans are frugavores (fruit eaters, that can only tolerate minescule, bug-
size, amounts of meat), like primates. Technically frugavores are a sub-
category of omnivores, but in practise there are a lot of differences
(dog/bear/swine = omnivore). Herbivores are different too: they graze and have
multiple stomachs. Understand that you are a frugavore, and live up to it, or
--as I understand it-- the "unfixable by MDs diseases" will get you. They
cannot fix it, because you need to stop something, not add a drug or cut-
out/radiate a piece of body.

You can look for natural remedies of RA. Flax seed powder (high in ALA-O3) and
high DHA-O3 algae extract oil capsules are great. So is turmeric.

More info see Dr Greger and Dr Bergman. They have videos on the topic of RA.
These guys base their advice on science.

Then there is the, not so well scientifically supported, next level (first eat
"clean" for a while) and that is detoxing. This basically starts by a colon
cleanse and "getting your kidneys to filter". Dr Robert Morse is your guy
here. This will involve some types of fasting for most people. Once your colon
and kidneys can properly eliminate waste, you lymph system will be able to
drain the acidic waste from you inflamed joints and your body will heal you
RA, naturally.

G'luck! You can fix this 100%. With the emphasis on _you_ , as your condition
is due to a lack of some pharmaceutical (patented medicine). It is MOST
probably due to your body's been obstructed in fixing itself somehow.

~~~
rhinoceraptor
Yep, there definitely aren’t any human populations such as the Masai or the
Inuit who live primarily on animal products. That would be completely crazy
and no one would survive such a diet.

~~~
cies
They have exactly the disease patterns that come with those diets. Clearly not
in the "blue zones" (= places with lots of centenarians) too.

I'm not talking about survival. Some people survive smoking for 50 years. I'm
talking about us being frugavores, and thus being most healthy on a
frugavorous diets like the primates.

------
adrianN
It is strange that anti-inflammatory drugs don't reduce risk.

Which fats are pro- or anti-inflammatory also seems to be an area of active
research:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/)

Nutrition is pretty terrible. It seems to me that laymen have zero chance of
getting useful advice out of the research, other than "Eat a varied diet, move
regularly".

~~~
cageface
There are billion dollar industries out there doing their best to confuse you
about this. Established wisdom out there hasn't really changed that much in
the last few decades. Avoid processed sugars and oils and eat mostly (or
entirely) plants.

~~~
Valmar
> Established wisdom

> eat mostly (or entirely) plants

So, Veganism is "established wisdom". More like unproven dogma...

A paleo diet is far more supportive of overall health. What that looks like
for the individual is really down to them discovering what their body prefers,
in terms of nutrients, carbs, fats and protein.

A paleo diet can be mostly veges, mostly meat, and anywhere in between.

~~~
cageface
A true paleo diet is mostly plant based anyway. Paleo man just didn't have
access to three giant portions of meat a day. Only modern industrial
agriculture has made that possible.

The modern "paleo" diet loaded with animal fat and protein is a modern
invention that serves mostly to help people rationalize their taste
preferences.

~~~
Valmar
> A true paleo diet is mostly plant based anyway. Paleo man just didn't have
> access to three giant portions of meat a day. Only modern industrial
> agriculture has made that possible.

Not true ~ there is no "true" paleo diet ~ it varies vastly from culture to
culture. Look at the Eskimos ~ their traditional diet was mostly animal, high
in nutrients, protein, fat, and sugar in the form of glycogen, and very little
in the way of plants. Then in other tribal cultures, they may subsist mostly
on plant foods.

There's no One, True Diet. Veganism is actually rather unhealthy, because it
excludes foods which contain highly bioavailable forms of nutrients not found
in plant foods ~ Omega 3s, iron, etc.

An animal-based diet isn't unhealthy ~ it can be the most nutritious of all.
Organ meats are extremely nutritious.

An animal-based diet isn't the problem ~ modern human societies run by greedy
corporations and governments are, because they have created and supported the
problems of animal abuse, because it is profitable.

> The modern "paleo" diet loaded with animal fat and protein is a modern
> invention that serves mostly to help people rationalize their taste
> preferences.

Bullshit. Paleo isn't all about fat and protein. That's _keto_. Paleo can be
full of healthy carbs.

~~~
cageface
It's not possible to feed 8 billion people a diet rich in animal products
without all the abuses and cruelties of modern animal agriculture. Those
techniques weren't invented because people enjoy abusing animals. They were
developed because environmentally sustainable and more humane methods simply
can't scale to meet demand.

And the "paleo" diet most people eat is really just a rebranding of what
people used to call the Atkins diet.

~~~
rmrm
While this is often cited as being true, and I used to believe it myself, as
I've investigated alternative forms of agriculture and animal husbandry - I've
begun to feel less and less that this is true. There are integrated farms that
are highly, highly productive.

I feel the root cause of much of these issues is the practice of corporate
farms to wall things off into atomic monocultures, and to separate animal
husbandry from farming. I believe this is easier, for many reasons, but not
more productive. It may be more economical, based on externalized pollution
costs, and subsidized energy costs. I.E it has more to do with our arrangement
of politics, rather than underlying fundamentals.

------
billmalarky
For those interested in supplementing Omega-3 oil in their diet (which should
probably be everyone), don't get Omega-3 off the rack at the store. Most
Omega-3 supplements (even at GNC/Vitamin Shoppe/etc) consist of a small amount
of Omega-3, and a lot of filler "fish oil" which does nothing for you.
Furthermore, in order to get the levels of Omega-3 you need to really see
benefits (roughly 500mg DHA and 500mg EPA per day, 1000mg DHA/1000mg EPA if
you have heart disease - but ask your doctor) you would need to consume so
much of this filler you will really start to see side effects (fishy breath,
gastrointestinal distress, etc).

Here's an example of what you will see at the store:
[https://www.amazon.com/Nature-Made-Burpless-
Omega-3-Softgels...](https://www.amazon.com/Nature-Made-Burpless-
Omega-3-Softgels/dp/B00MGNMMHI/ref=sr_1_7_s_it?s=hpc&ie=UTF8&qid=1520870949&sr=1-7&keywords=omega%2B3%2Bfish%2Boil&dpID=51eg6Tzy3DL&preST=_SY300_QL70_&dpSrc=srch&th=1)

Notice there's 1000mg of fish oil there, but only 300 mg Omega-3 (only 250mg
of which is actually DHA/EPA) and they don't even give you the ratio of DHA to
EPA in that 250mg - you need an even split to see best benefits as they work
together.

What you need to look for is pharmaceutical grade Omega-3, which is basically
just concentrated so you don't get the filler oils. I'm a huge evangelist for
OmegaVia ([https://omegavia.com/](https://omegavia.com/)), since they also use
a enteric coating on the pills so they do not dissolve until they hit your
small intestine. As a result there are zero fish breath/burp side effects.
Give it a try, it's a game changer.

~~~
pascalxus
If you're following a healthy diet (that's all our ancestors had access to),
you don't need to supplement with omega-3. The problem isn't that people
aren't getting enough omega-3, the problem is their getting waaaayyy too much
omega-6, mostly from oils that have very high concentrations of that. It's
this imbalance that causes inflammation.

~~~
redblacktree
Sure, but I don't see that changing for me anytime soon. As second-best, I
take an Omega 3 supplement.

------
cageface
Literally hundreds of metabolic ward studies (the gold standard in nutrition)
have demonstrated a direct, causal relationship between saturated fat intake
and blood cholesterol levels. And the correlation between high cholesterol
levels and CVD has been known for decades. Don't be fooled by observational
studies which fail to disentangle the highly variable baseline individual
cholesterol levels from the effects of fat in the diet.

Here is a review of 395 direct feeding experiments, which are much more
appropriate for measuring the effects of diet:

[https://www.ncbi.nlm.nih.gov/pubmed/9006469](https://www.ncbi.nlm.nih.gov/pubmed/9006469)

[http://circ.ahajournals.org/content/circulationaha/108/22/27...](http://circ.ahajournals.org/content/circulationaha/108/22/2757.full.pdf)

[https://www.theguardian.com/science/sifting-the-
evidence/201...](https://www.theguardian.com/science/sifting-the-
evidence/2016/jun/13/dont-throw-away-your-statins-yet-ldl-cholesterol-is-
still-probably-bad-for-you)

This video sums up the issues well:

[https://nutritionfacts.org/video/the-saturated-fat-
studies-s...](https://nutritionfacts.org/video/the-saturated-fat-studies-set-
up-to-fail/)

~~~
QuantumAphid
Here's a related theory: People who consume a significant amount of fat tend
to become overweight/obese because they _also_ overconsume carbohydrates (and
protein), which spikes blood insulin and causes the dietary fat to be stored
as adipose tissue. People with a lot of adipose tissue have higher levels of
cholesterol, a hormone manufactured by the body to manage its fat stores
(among many other things).

So in this scenario, is it eating saturated dietary fat which causes unhealthy
levels of cholesterol in the blood?

Or is it because the person's diet has caused them to become overweight/obese
and therefore the body's cholesterol levels have increased as a result?

In my own experience, I lost 20% of my body weight (57 lbs) by eating a high
fat low-carb diet, supplemented by intermittent fasting. I was on statins
(cholesterol medication) and an ARB (for hypertension), and was able to stop
taking these meds 18 months after losing the weight.

There are lots of reasons to avoid saturated oils/fat. I think it's misleading
and overly simplistic to say or imply that dietary fat leads to high
cholesterol.

[https://peterattiamd.com/the-straight-dope-on-cholesterol-
pa...](https://peterattiamd.com/the-straight-dope-on-cholesterol-part-i/)

~~~
epalmer
I have lost ~50 lbs on a keto diet. I test for ketones almost daily and only
fall out of keto 1 out of 10 days or so.

My blood chemistry is better than it ever has been. My A1C is great. My LDL
and VLDL are very low. I eat saturated fat and olive oil. I eat fish 2 or more
times a week. Some white fish (cod) but mostly salmon and a little tuna. I
have more weight to lose, maybe another 40 lbs. I was trending towards
metabolic syndrome before keto. I exercise for 40 to 50 mins a day, 5 days a
week. Strength training walking and more.

Since going keto (2 years ago) I have had no colds, no ear infections, no
sinus infections. I have had the flu once. That is it. I used to get a lot of
ear infections and colds and more. Several times a year.

I have heart disease. I had 4-way bypass more than 10 years ago. I take a
statin and aspirin.

I am under two doctors care, a primary and a cardiologist. They support my
keto diet. My primary says my systemic level of infection is very low
resulting in less sickness.

I am a sample size of one so take that for what it is worth.

------
vanderZwan
> _Saturated fat does not clog the arteries: coronary heart disease is a
> chronic inflammatory condition, the risk of which can be effectively reduced
> from healthy lifestyle interventions_

Doesn't saturated fat _trigger inflammation?_ Because if I remember that
correctly, then this is a "guns don't kill people, bullets do" argument.

Similarly, doesn't it also cause arterial stiffening? It is not the same
process as arterial clogging but definitely makes it worse and is part of
heart disease.

Again, I may be misremembering this - I could be confusing fat and meat, for
example. Either way it boils down to "eat mostly plants"

~~~
cageface
You're correct. Both saturated fat and animal protein are inflammatory, which
certainly contributes to their effect on CVD.

[http://www.arthritis.org/living-with-arthritis/arthritis-
die...](http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-
to-avoid-limit/food-ingredients-and-inflammation-3.php)

~~~
vanderZwan
Every time food is discussed on this site, someone downvotes everyone who says
excessive meat is unhealthy. I don't know who it is but it's pretty sad.

~~~
verylittlemeat
Talking about nutrition on the internet is nearly impossible because diets
encourage cult followings and attitudes.

Benford's law strikes again: Passion is inversely proportional to the amount
of real information available

------
toddh
Dr. Malcolm Kendrick has a good over 40 part series on What causes heart
disease? [https://drmalcolmkendrick.org/2016/01/18/what-causes-
heart-d...](https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-
disease/).

It may be of interest.

------
watertom
I’m with Linus Pauling, and his belief that an L-Ascorbic Acid deficiency is
the cause of heart disease.

------
jbb67
This talks about a Mediterranean Diet quite a bit, but what, exactly is such a
diet?

~~~
Someone
[https://en.wikipedia.org/wiki/Mediterranean_diet](https://en.wikipedia.org/wiki/Mediterranean_diet):

 _The Mediterranean diet is a diet inspired by the eating habits of Greece,
Southern Italy, and Spain in the 1940s and 1950s. The principal aspects of
this diet include proportionally high consumption of olive oil, legumes,
unrefined cereals, fruits, and vegetables, moderate to high consumption of
fish, moderate consumption of dairy products (mostly as cheese and yogurt),
moderate wine consumption, and low consumption of non-fish meat products._

~~~
tonyedgecombe
Important to note that list doesn't include Pasta and Pizza :)

~~~
jbb67
I guess this is my problem, I understand the principle of Mediterranean diet,
I just don't know _specifically_ what food to make.,

~~~
jaclaz
>I guess this is my problem, I understand the principle of Mediterranean diet,
I just don't know _specifically_ what food to make.,

What do you mean?

Do you need a (say) weekly example?

Mind you this would greatly depend on where you live, and which products you
can find (and the actual quality/originality of those products).

Personally I am an advocate of the Mediterranean Diet (not really as "coded"
by the various scientists, but more like traditional eating), but you need to
have "real", "good" ingredients not the kind of stuff that you can normally
buy at a supermarket - say - in the UK (with no offence intended to the
British or to their supermarkets, of course, only an example) if you want to
have the "right" experience, at least regarding taste, but I suspect that also
the (supposed) health benefits come from fresh, genuine ingredients.

And I would add - OT but connected to other recent discussions on HN about
Vitamin D and sun - that most probably part of the generic Mediterranean good
health might come from eating "right" while living in the "right" climate.

------
vfc1
A plant-based diet can be very anti-inflamatory, and its reported to revert
heart disease in some cases -
[https://www.youtube.com/watch?v=tk0iC4TOE0E](https://www.youtube.com/watch?v=tk0iC4TOE0E)

~~~
Valmar
What about a diet with completely unprocessed meats and plants? Basically, a
diet entirely devoid of processed foods?

I bet that would be equally anti-inflammatory, and be good for heart health.

~~~
Broken_Hippo
"Basically, a diet entirely devoid of processed foods?"

Processing isn't all bad. In fact, the most basic processing brought great
gains to humanity: Cooking. It made meat less dangerous to eat and frees up
nutrients in some vegetables. Sometimes, processing is what allows us to eat a
food (acorns, for example) or lets us get through the winter (drying,
fermenting, and whatnot).

Similarly, freezing foods isn't such a bad thing. Be it freezing fruits and
vegetables or freezing leftover home made soup. You don't need lots of
preservatives nor special ingredients to do this either at home nor with
commercially prepared foods.

Milk products are keen to be processed as well. Cheeses, yogurts, and so on
aren't bad things to eat. Pasteurization keeps milk available longer.

Processed doesn't mean bad, its just a few of the things we've come up with
aren't so wonderful.

~~~
corpMaverick
It begs the question. What do people mean what they say processed foods ?
Other than what you have already mentioned. (cooking, freezing and
pasteurization .

~~~
Broken_Hippo
I'm pretty sure folks generally mean highly processed foods - high fructose
corn syrup, for example, and some modern vegetable fats. This is pretty vague,
of course. And sometimes folks include older methods such as making sausages
and bacon to it. They could mean something like mycoprotein (quorn branded
meat replacements) or pea protein based meat replacements (Beyond meat, for
example), though those hardly seem to be in the same sort of category even
though they seem pretty processed.

The question is why I bring up the processing that we make good use of,
actually. :)

