
Normal Plasma Cholesterol in an 88-Year-Old Man Who Eats 25 Eggs a Day - argumentum
http://www.nejm.org/doi/full/10.1056/NEJM199103283241306
======
JPKab
Current state of nutritional science: Propose hypothesis of heart diseased
caused by high consumption of animal fats

Tell public to reduce animal fat consumption to reduce heart disease

Public reduces animal fat consumption

Heart disease rates continue to stay the same

Conduct studies to prove old hypothesis isn't wrong: Studies show that Atkins
style diets have closer to optimal HDL/LDL/Triglyceride blood levels than low
fat diets

Ignore study

Claim that it must be genetics that causes "some" people to not get heart
disease from high fat, low carb diets

Watch the documentary "Fathead" on Netflix. The movie can be a little annoying
in its political overtones, but the fact that the guy eats an extremely high
fat diet with low carb and sugar intakes and improves his cholesterol numbers
is interesting. Of course, it must be a genetic fluke, according to the low
fat promoters. Let's do the math, shall we:

Odds of a person having a genetic mutation where they are immune to
cholesterol when most people aren't: low

Odds of a person choosing to make a documentary: low

Odds of a person choosing to make a documentary about themselves going on an
extremely high fat diet for 30 days: extremely low

Odds that this same person just happens to be one of these people who is
genetically immune to cholesterol....... REALLY?

~~~
mberning
Actually 'Heart disease rates continue to stay the same' should be changed to
'increased'

In addition to heart disease there is a whole bevy of metabolic disorders that
are on the rise (type 2 diabetes, hypertension, PCOS, fatty liver, etc.)

In the 80s the government told us to reduce our fat and cholesterol intake,
and research shows that we did a bang up job of reducing it. But why are we
continuing to get sicker and fatter?

The nutritional recommendations of the US and most of the world has to be one
of the larges and most unethical experiments of all time.

~~~
michaelcampbell
While I'm not in any standing to argue with you here, I'm wondering if the
heart disease rise is with the same people that actually reduced fat intake.
It's one thing to say SOME reduced fat intake, and SOME increased heart
disease rates, but it's quite another to say those 2 sets of "SOME" are the
same, or even overlapping.

Have these studies actually shown that those that DO decrease fat intake show
no improvement in heart disease? (The answer may be "yes"; but I haven't heart
that stated here; only averages.)

~~~
mberning
In short, yes. There have been quite a few studies that show that low fat
diets have no bearing on developing heart disease.

But here is the rub. Most studies that show X,Y, and Z lead to heart disease
are observational epidemiological studies. This means that researchers collect
data from a number of disparate sources and attempt to make sense of it. The
problem is that it is very hard to tease out confounding variables.

So I don't put much stock in this type of study. They have their value, but I
wouldn't make any life decisions off of them. Their primary purpose is to help
formulate hypotheses that can be tested experimentally.

When it comes to experimental tests, the lipid hypothesis has been shown to be
wrong over and over. On the contrary, quite a bit of experimental data shows
that a grain based, low fat, high carbohydrate increases the markers for heart
disease.

~~~
michaelcampbell
Thanks. I understand that this sort of testing is damnedably difficult; at
least for the types of answers we crave; "This is good, that is bad".

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nessus42
I thought that it was debunked decades ago that dietary cholesterol
significantly increases bad serum cholesterol (i.e., LDL). Dr. Agatston, the
famous cardiologist who invented what is now the standard test for coronary
calcification, certainly claims that there is no reason to avoid eating eggs.
(I don't know what he'd say about 25 per day, but that can't be a very
balanced diet!)

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checoivan
There's a talk by Dr Donald W. Miller regarding how the original study
claiming low fat diets lowered cholesterol was wrong, yet it was taken as
basis for dietary guidelines by the USDA.

[http://www.youtube.com/watch?v=vRe9z32NZHY&feature=my_li...](http://www.youtube.com/watch?v=vRe9z32NZHY&feature=my_liked_videos&list=LLN_Fq2wUXnfoM2G8S5qOkFw)

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yannk
First oddity that jumped on my face is: why 25? 24 seems to be a much better
number.

~~~
ams6110
Packaging eggs by the dozen is largely a consumer retail thing. Restaurants
and commercial packing is more typically on a 5x5 square. Maybe he was getting
his eggs from a wholesale supplier... at that rate of consumption it might
make sense.

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BadassFractal
Nutritional science is indeed a nightmare to deal with, especially to discuss.

People still won't believe me when I tell them that they should at the very
least try reducing their carb intake. It's surely possible that Good Calories
Bad Calories, and the various Intermittent Fasting / Primal proponents are
there are full of crap and don't know what they're talking about, but it has
at the very least worked for me.

I went from 25+% fat a couple of years ago to about 8% now, shooting for 6-7%
soon, and I'm barely at the gym a couple of days a week (I do lift heavy
though). There's nothing quite like being really happy with one's shape after
years of being really uncomfortable.

~~~
soperj
I have a carb heavy diet, and always have, but play alot of sports, and have
always hovered in the 10% fat and below range.

~~~
ams6110
Not all carbs are created equal. Whole grains, while IMO not great for you,
are probably a lot better than a 40oz Mountain Dew.

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Lazare
This is a surprise?

The idea that eating food that _contains_ cholesterol magically increases the
cholesterol levels in your blood never made any real sense, and has been
debunked repeatedly.

(What does increase blood cholesterol? Fructose, mostly. If you're trying to
control your cholesterol the maple syrup on your pancakes and - especially -
that big glass of orange juice are killer. The eggs, by contrast, are good for
you.)

~~~
Raphael
You have to admit it's counter-intuitive. Cholesterol in, low bad cholesterol
levels; sugar in, high bad cholesterol levels.

~~~
Lazare
It depends on whether your mental model is "stuff goes into the stomach and
then magically ends up in the body intact" or "stuff goes into the stomach,
gets broken down, and then synthesized into what the body needs".

The first model implies, for example, that dietary fat is _uniquely_ fattening
and that, conversely, a low-fat diet is an easy way to reduce or eliminate
your body fat. I believe we can mark this model down as "trivially
disprovable". :) (It also implies that eating sugar should have some impact;
sugar deposits forming around the body...again, nothing of the sort happens.)

And yet, belief in the first model persists. I don't think either model is
inherently more intuitive, given our current understanding. People will
believe whatever the popular wisdom is as it shows up in USDA guidelines,
highschool texrbooks, etc. The question is, why does the obviously wrong model
persist in popular wisdom?

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bbayer
Couple of years ago I have lived in Korea for one month. Their daily food
doesn't include produced salt, sugar and carbs. If you want salt you have to
eat ocean algae. If you want sugar grab some fruit juice. Do you need carb, go
get a steamed rice. Also they consume lots of gabbage usually in Kimchy form
which I believe helps to decrease LDL levels. I know because after returned
back my LDL levels were in normal levels. Normally I am suffering from high
LDL.

In my experiments (on my own) I can say that walnut and stinging nettle also
helps to lower bad cholesterol. (btw I don't have medical profession, don't
get this as advice.)

I saw lots of people who eats animal fat all the time and have low levels of
LDL. Even though I did diet, I couldn't maintain LDL in normal levels. I have
to use medication. I believe it is highly related with genetic factors and
somehow some people's body couldn't handle things as expected. A bug that we
cannot fix. The only way is monkey patching.

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argumentum
The line below made me check if the article was published on the first day of
april.

""" The patient stated, "Eating these eggs ruins my life, but I can't help
it."

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mdellabitta
Did anybody else see 'Pink Flamingos'?

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ktizo
I'm glad they didn't try to see what would happen if he stopped eating eggs.
At the age of 88, and given that he has done this solidly for so very long,
they could accidentally kill him by putting him on a more average diet.

What would be extremely interesting is studying any genetic factors and
whether they could have possibly even drove him to eat this amount of eggs
just to keep his cholesterol levels high, and also, conversely, whether there
is any biochemical adaptation, especially anything that is unusual for his
genetic makeup, that helps him retain this level of cholesterol consumption
without getting ill, that could have resulted from long term exposure to his
diet or other environmental factors.

~~~
abecedarius
The paper did discuss adaptations, though in my skim I saw no sign of anything
genetically unusual behind them -- afaik they left that open.

~~~
ars
I wonder if he has any children, or close relatives.

~~~
soperj
has a (alive)sister -as per the article

~~~
ars
I read the article - the whole thing. But I guess I missed that.

They should test her to see if the adaptation is genetic, and does it affect
her as well.

~~~
abecedarius
Even bacteria adapt to their diet, so I'd guess that at most his genes got him
to _want_ two dozen eggs a day. (I'm not a doctor or a biologist.)

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killyourheros
Google 'keto'.

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autarch
Cue the endless comments from unqualified nerds who are convinced they and
they alone know everything about nutrition science, and that all the commonly
accepted facts are totally wrong. Complete with links to random Youtube videos
of some dude who proves them right.

~~~
tzs
Actually, they are not disagreeing with nutrition science. They are
disagreeing with nutritionalism. And they are right (although some of the
specific links might be replacing one kind of nutrisionalism with another).

Here's the difference. Nutrition science _IS_ science. It's results come from
controlled, replicable experiments, checked via peer review and analyzed
correctly for significance.

Nutritionism is the belief that food is just the sum of independent nutrients
and other substances, and once we know what nutrients we need we and which
substances are bad, we can rearrange and pick and choose to get an ideal diet,
coupled with the belief that we know enough from nutrition science to actually
understand enough of nutrients and other food substances to actually do this.

Nutritionism _IS_ _NOT_ science. It is to nutritional science what pop
psychology is to neurobiology.

Here are some examples (based on real things, but I do not have specific
references handy so I'm going to keep the details generic). Suppose nutrition
science finds that substance X is vital to health, and that carrots are high
in substance X, and that people who eat a couple servings of carrots a week
get enough substance X.

Synthesizing substance X (or extracting it from carrots) and adding it to to
some other food, and then telling people that they can use that other food as
a source of substance X is nutritionalism, not nutrition science. Or making X
pills for people and telling them these can supply the X they are not getting
from their diet is nutritionist, not nutrition science.

This is because it is possible that in order for our digestive system to
actually extract and absorb substance X, it needs something else (substance Y)
which is found in carrots, but is not found in those supplements or in the
food that the synthetic X is added to--and so people getting X in the
supplement or additive form are not actually making it available to their
bodies.

The X supplements do not move from nutritionalism until scientists actually do
the experiments and show that we can incorporate X in that form, or gain
sufficient understanding of the mechanism by which X is absorbed to be able to
say it will work in supplement form.

Another example: for almost everything we are told we must eat more of (fish,
carbohydrates) or less of (red meat, carbohydrates, fats, cholesterol), there
exists some culture for which (1) their traditional diet goes massively
against that advice, and (2) people who eat that diet are healthy.

That's because the advice we get in these areas is NOT based on nutrition
science. It is based on nutritionalism. The science that says that, say, red
meat is bad for you ACTUALLY says that in particular studies of particular
populations, red meat was bad. For people that strongly match the
characteristics of the populations in those studies (e.g., whose complete diet
is similar to the complete diet of the participants, and who live similar
lifestyles) the conclusion that they should avoid red meat is probably pretty
accurate. Since there are other populations in which red meat consumption does
not appear to lead to those bad health effects, however, the proper conclusion
is that the dire effects of red meat cannot be generalized outside of
populations like the study populations.

Your best bet if you want to avoid nutritionalism is to try to stick to proven
traditional diets. If the people of some region or culture have been eating a
certain way for hundreds of years, and are in good health, that's pretty damn
good evidence that their diet as a whole works. If someone's theory says that
they should be in poor health because their diet includes too much X, or
doesn't have enough Y, then that someone's theory is incomplete or wrong. In
science, when results and theory disagree, results win.

