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Coronary heart disease is a chronic inflammatory condition (bmj.com)
160 points by jamesknelson 10 months ago | hide | past | web | favorite | 144 comments

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.

Agree. To give context, this is an editorial in a sports medicine journal.

It's not a trial, meta-analysis, or even a systematic review.

No, but the first reference is to, "A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults."

Which you can find here: http://www.bmj.com/content/351/bmj.h3978

The reference concludes that trans fats are bad for you and that the evidence for saturated fats not being bad for you is not complete:

Conclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats.

Note "but the evidence is heterogeneous with methodological limitations" and "Trans fats are associated with all cause mortality, total CHD, and CHD mortality"

Dietary phytosterols lower cholesterol but do not reduce CVD or all cause mortality[0]. I don't remember the other names, but phytos are just one of many classes of agents that have been shown to reduce cholesterol without any other beneficial effect; IIRC, other than statins, there is only one other class of drugs that reduces cholesterol and reduces CVD.

LDL correlates trouble, but evidence that it is part of the problem when I last looked was not well supported (though it is generally accepted in the medical community)

[0] https://en.wikipedia.org/wiki/Phytosterol#Cholesterol_loweri...

>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.

They did a whole lot more than try to dismiss it. They said it was "inversely related". Here's a quote: "a recent systematic review concluded that LDL cholesterol is not associated with cardiovascular disease and is inversely associated with all-cause mortality"

This goes directly against everything the AHA says and what countless other sources are saying.

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

> The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support.

If this is the case, then it shouldn't be published in any reputable journal outside of a very clearly marked "opinion" or "editorial" column.

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.

As I recall, sugar is part of the Kreb's Cycle and is the brain's primary fuel. Nicotine is present in trace amounts in some plant matter, but is irrelevant for human physiology. Sure, sugar overconsumption in its raw form is probably bad for you, but it's not really on the same wavelength as smoking.

Glucose is part of the kreb's cycle; sucrose (table sugar) is made up of glucose and fructose. The metabolism of fructose is much more complicated, and ends up producing byproducts that can be linked back to metabolic syndrome. The discussions I've heard about sugar are really more focused on the toxicity associated with fructose and not that of glucose - I think some researchers would argue that fructose consumption is on par with nicotine with respect to ill health effects.

Nicotinic acetylcholine receptors are present throughout your body's nervous system and nicotine is an agonist for them. Thus nicotine is relevant for human physiology.

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.

I think there is value in traking the intake to your system, but is of course a chore. I used myfitnesspal for a year and its great to have a data driven approach, but is also exahusting.

Also traking your physical activity could be done with several combinations of devices and apps.

But also, very important, is to track your mood and overall feeling and wellness (or lack of). Again several apps are out there, but a old good pen and paper diary goes a long way.

Then, is a matter of correlate, and review back to when you were feeling better and try to replicate and optimize.

Of course this is nothing new, Tim Ferris and several other authors had dedicated a lot of ink to the subject of traking and self-improvement.

The other way to do it is hear your body, and do what you know it works. It's a lot more relaxed, but prone to biases.

This is not to say that any condition can be treated with lifestyle adjustments. I don't know about your condition and I am not giving any medical advice. But for sure I will try to see if any specific diet helps me to feel better if I were in your situation

if I where you I would have a look at this video playlist from Dr Greger, for what he says your condition can be very improved - https://www.youtube.com/playlist?list=PL5TLzNi5fYd8asBilI_Aj...

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.

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.

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.

Edit: changed my mind about posting, sorry about that.

> That diet may be just you body responding well to it.

I believe different. We are frugavores.

> Sugary stuff, forget it.

Indeed, bad for ever human. (I took it as processed sugary stuff, not fruit which is great for humans)

> Got fat when I became officially dad.

These things are unrelated, you're a man. Lol. Jokes aside, a frugavorous diet can melt your fat. And the health impact from bad diets can take years to show (like smoking or exposure to heavy metals).

Try taking probiotics for the sugar cravings. After I started taking them desserts started tasting uncomfortably sweet and I stopped getting a high from sugar.

You might add to try different strains. I found that certain strains actually increased my "sweet-tooth". It took a few tried to find the right one for me. I believe it has to do with each persons existing bacteria in their gut and finding the probiotics that don't upset the balance in the wrong direction.

Which probiotics are you taking? There is a huge variety and not all are created equal (or even similar).

> Too many people is addicted to High Carbs without even knowing it.

Not to mention, and probably worse, refined sugar. It is basically crack cocaine.

> refined sugar. It is basically crack cocaine.

To put this into context. I've been on refined sugar for about 50 years now. The health effects are - I have 2 fillings and and a BMI somewhat above the recommended.

It's basically not crack cocaine.

An interesting thing about sugar: though a key part of certain delicious recipes (e.g. cake, ice cream) a cup full of pure granulated sugar does not appeal.

Science right there.

What is it about nutrition that makes people resort to ridiculous hyperbole like this? No, sugar is not like crack cocaine, and red meat is not like cigarettes.

> What is it about nutrition that makes people resort to ridiculous hyperbole like this?

A 2017 study published in the British Journal of Sports Medicine.


Agree with the sentiment, but there is a valid point to be made about the addictive qualities of sugar vs cocaine.


To downvoters: let me know you think about the following study published in the British Journal of Sports Medicine: http://bjsm.bmj.com/content/early/2017/08/23/bjsports-2017-0...

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/

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".

> 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".

I completely agree, and it also appears to change every other decade.

Suddenly, drinking coffee became healthy, eggs stopped being unhealthy and drinking a glass of wine a day became a major risk for CVD.

Engineers are spoiled when it comes disentangeling relationships between causes and effects because our systems are relatively simple compared to the huge and complicated mess that is human (or, indeed, any) biology.

I wonder if there are categories of people that respond in similar ways when they are in the same category, but the response would vary from one category to another. For example, people with low blood pressure would not benefit from a low sodium diet. Yet we are all told "reduce your salt intake".

Those are nits compared to the vast amount of nutrition advice which has remained stable.

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

Luckily, fasting does. Whatever your metabolic and inflammation markers are, they will all trend worse after energy input.

If your waking day is 16 hours long, reducing your "feeding window" by even four hours increases your time spent in "low inflammation mode" by 50%.

Looking for a drug or a novel intervention is silly when you haven't picked even the lowest hanging fruit. It's like installing a fancy air filter in your car but neglecting to even change the oil.

Additional low-hanging fruit is Omega-3 supplementation. For those interested cntl-f my username and see my other comment on this page.

There is actually some suggestion that the way the statins work is as anti-inflammatories [0]. Of course there is the wonder drug aspirin as well.

0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394171/

I think there is a drug on the market that was approved because it lowered cholesterol the same amount as statins. But when studied on how well it reduced heart attacks was shown to be worthless.

Yes there have been a few of these that have fallen over in large scale phase III trials where they reduced cholesterol, but didn’t reduce the death rate. Shows how little we understand even some of the most studied pharmaceuticals and disease areas.

>wonder drug aspirin as

unfortunately if you're asthmatic there is a decent chance you are allergic to aspirin

My guess is that we're simply overstimulating ourselves -- with food, caffeine, alcohol, drugs, sex, etc. In part to support our increased mental activity (work, video games, social media, etc). This would explain weight gain, increased inflammation and tendency to form clots (sympathetic nervous system arousal increases blood clotting, presumably for 'fight or flight' purposes). Hence the benefits of periodic fasting, observing the Sabbath, etc, -- to truly relax and allow the parasympathetic nervous system to kick back in. Hitherto our ideas of what is relaxing have been faulty e.g. watching TV

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.

> 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.

Wow... Someone dismisses veganism as "unproven dogma" then promotes in it's place, of all things, the "Paleo diet" without a shread of irony.

"Paleo diet," as a concept, is uh... not based in reality. I honestly don't mean to be mean when I say that, there just isn't any other way to put it.

First, to recreate a "Paleolithic diet" we'd have to know exactly what Paleolithic humans ate, in which proportions, and we really don't. The evidence we have is incomplete. It's extremely doubtful humans in different groups in different geographic locations all ate the same thing - it's more likely humans adapted to their environment as that is exactly what humans tend to do.

It's not possible to eat a Paleo diet today, as the plants and animals that existed in paleolithic times no longer exist today. Natural and artificial selection has changed our food supply so drastically that the foods available today are almost completely unrecognizable compared to their Paleolithic ancestors.

(Ignoring for a second that humans have evolved since Paleolithic times as well. Also ignoring for a second the diseases of aging might not have appeared much in Paleolithic humans, to our knowledge, because there wasn't a whole lot of aging going on during that time...)

If you feel better following a fad diet, that's perfectly fine, just don't pretend it's any less "unproven dogma" than any other diet. The "Paleo diet" is based on a bad understanding of science, history, and anthropology.

> It's not possible to eat a Paleo diet today, as the plants and animals that existed in paleolithic times no longer exist today. Natural and artificial selection has changed our food supply so drastically that the foods available today are almost completely unrecognizable compared to their Paleolithic ancestors.

A modern day Paleo diet is merely about eating as closely to natural foods as possible, eating those foods optimal for our individual health, and cutting out all processed junk foods.

Simple. It is certainly based in reality, much more so than the dogma of Veganism.

But how do you know which foods are optimal for our individual health? Finding that out is the whole point of nutrition science!

I was deliberately vague, because this is an individual thing. I was never dismissing nutrition science...

I swear some people just downvote without even trying to understand what I'm trying to convey... then again, maybe I could have explained a little better.

Words have meaning, "Paleo diet" doesn't mean "whatever is healthy or 'natural.'"

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.

>Paleo man just didn't have access to three giant portions of meat a day.

Paleo man definitely had access to multiple giant portions of meat a day -- just not every day.

After you kill the auroch, all that meat has to go somewhere.

Or mammoth. Or whale.

Paleo man also ate the whole thing, not just the muscle meat. Some days, you might just have a giant bowlful of fat. Other days, you're eating paste made from acorns that have been leaching out their bitter compounds under a waterfall for a week.

Depending on where you lived, your tribe might have had access to many portions of meat every day for weeks, and then nothing but low-nutrition or semi-poisonous plants for months. It was a great incentive to develop either food preservation technology, agriculture, or a nomadic lifestyle. Which is to say: follow the meat, keep the meat from rotting until the herd passes through again, or eat more nutritious plants.

So there wasn't any one archetypal paleo diet. Paleo man had to adapt to his environment or die. The "paleo" idea is to reject foods that did not exist 10000 years ago, because supposedly human physiology hasn't evolved to deal with them yet. You invent a caricature of a cave man in your head and let him tell you what's food and what isn't.

~I don't recommend it. When I tried it, my cave man slipped on a wet rock while hunting, got a bad compound fracture, and died from an infection a week later, because antibiotics hadn't been discovered yet. My cave woman was out collecting sour berries and army worms, fell into a creek, and drowned. Then my cave baby was raised by wolves. I couldn't find the wolf milk and regurgitated caribou section in the supermarket, so I had to abandon the diet.~

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

It's difficult to know what the diet in the Paleolithic was but there is, I think, a component of the diet that we can be pretty sure about: occasional hungry. How we use that knowledge it's a different issue.

> 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.

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.

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.

>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.

All one has to do is lookup bioavailable sources of iron.


Yups. True paleo looked a lot more like the WFPB diet what it now widely and scientifically proven to be the best for human health.

>Avoid processed sugars and oils and eat mostly (or entirely) plants. //

I'll bet if you look at foods in a supermarket the main changes in ingredients will be more processed sugars and oils. This seems to happen in the UK when companies are taken over by USAmerican companies.

Food has definitely gotten worse but the nutritional recommendations haven't really changed much.

Is dairy still in? I think it used to be, but is on the way out in most places due to the mountain of evidence proving it makes us sick.

Processed meat is since a few years on the carcinogens lists (next to asbestos and smoking). But strange enough still on the hospital menus (also consumed by cancer patients)!

It takes a while I guess... Sadly.

> carcinogens lists (next to asbestos and smoking).

The quality of the evidence that processed red meat causes cancer is now as good as the evidence that smoking causes cancer.

The strength of the effect is very very different. Smoking causes a lot of cancer. Red meat causes very little cancer.

It's completely incorrect to suggest red meat is equivalent to smoking for cancer.

There may be some tiny amount of truth to this. Red meats contain more L-Glutamine which is required for muscle growth. It is the most abundant amino acid in our body. That said, taking more of it will also feed tumors by increasing the production of HGH. An extreme example of this is performance athletes that take human growth hormone. Those with tumors meet their demise rather quickly because their body did not have time to terminate the cells, or could not keep up with the growth rate. This is of course an extreme example. Red meats only contain enough L-Glutamine to increase your HGH on a much smaller scale.

> It's completely incorrect to suggest red meat is equivalent to smoking for cancer.

Did I? Please read again. Just saying it's on the same list.


> Red meat causes very little cancer.

Could you please quantify how little cancer? Prolly not. This is difficult stuff. We do not know dosages, etc.

BTW, I was talking about "processed meat" (like hotdogs, bacon and nuggets), you now talk about red meat. Red meat is not on the cancer list (yet).

If you down voted me, please reconsider. Because I'm right.

You can pry my cheese from my cold, dead hands. Most hardish cheeses are low in lactose and high in all kinds of good stuff. And fat.

Anecdotally, the best I’ve felt is eating only ribeyes and nothing else. 2 pounds for dinner and only water in the 23 hour interim. I’m apparently sensitive to a lot of vegetables that make me feel awful.

You will eventually get scurvy if you don’t get any vitamin C in your diet. I also hate to think what a zero fiber diet will do to your intestines.

As much as I love a ribeye and as amazing as that sounds, I bet it got pretty boring pretty quickly. Not to mention expensive.

Specific anti inflammatories actually do work: a landmark trial from last year showed that canakinumab (an IL1 antagonist) reduces recurrent adverse cardiac events.


Is there a natural form of that drug or has it been modified from its original form?

This particular drug is a human monoclonal antibody, so it's different from many of the small molecule drugs that are derived from natural compounds.

I read somewhere that anti-inflammatory drugs neutralize the effect of Vitamin K2 in the blood. So they treat the symptoms, like making your blood less thick or expanding your arteries, but during all that time your arteries still aren't healing and you keep accumulating LDL cholesterol and calcium. So in the long term, you're probably actually making things worse, because you're not allowing Vitamin K2 to act against the calcium in your blood.

You should be able to experiment with this by taking a CAC test every year or two.

The problem with nutrition is there are two types of valid studies. The first concludes "despite our best efforts we were unable to get the subjects to eat their assigned diet". The second doesn't apply to you because you are not confined (either to a hospital bed or in prison).

The above is overly cynical and not completely true, but it is a good guide to the types of science that can be done in nutrition.

Prescription drugs? Or all drugs? e.g. CBD?

Except we also know that you should be eating strict vegan, paleo, or keto, and for God's sake man, don't touch sugar or cow's milk.

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...

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/), 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.

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.

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

Also working on substitution in the diet of Omega-6s to Omega-3s. It's actually very difficult, as almost everything is swamped with O-6s. I've literally given up on Mayo for sandwiches, just using high O-6 olive oil for now.

I've provisionally concluded that this is because of shelf life -- the O-6s have good shelf life, but the O-3s do not, so essentially need to be made fresh or kept in special containers, cooled, etc.

I feel like supplements can be good as a supplement, but I'm looking to improve my eating system. Any suggestions welcome!

I think it's cost more than shelf stability. Canola oil actually has the best n-6:n-3 ratio (2:1) of the common vegetable oils [1], and you can buy (or make!) canola oil mayonnaise easily. Beef fat has much better ratios when grass fed than grain fed as well [2]!

[1]: http://www.susanallport.com/images/Dietfatchart_8_.jpg [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/table/T...

Yikes! Canola oil is near the top of my Avoid List.

I've seen various ratios, but even with that, the processing involves high heat and hexane, both of which can substantially alter the molecules, and it's high in polyunsaturated fats, so goes rancid easily, destroying the n-3s, but it's hard to detect because of the processing...

What about the findings that people with prostate cancer show elevated DHA/EPA levels in the blood? Correlation isn't causation, but causation hasn't been ruled out. I have stayed away from Omega-3 supplementation since reading that study, as inconclusive as it was.

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:




This video sums up the issues well:


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.


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.

Losing weight, no matter how you do it, will lower your cholesterol and improve your overall health. And reducing your overall calorie intake also has a lot of benefits. That’s why people can report good results from a lot of different kinds of diets.

But the causal link between saturated fat consumption and blood cholesterol levels is very well established. See my earlier comments for links. There are a lot of people out there with very questionable agendas out there trying to confuse people on this issue.

"Cholesterol levels" is a blunt term to use, there are HDL, LDL (with different particle sizes) etc. Correlation != causation

"The total body of evidence suggests that attention should be shifted from the harmful effects of dietary SAFA per se, to the prevention of the accumulation of SAFA in body lipids. This shift would emphasise the importance of reducing dietary CHO, especially CHO with a high glycaemic index, rather than reducing dietary SAFA"



"A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD"



"High intake of cholesterol results in less atherogenic low-density lipoprotein particles in men and women independent of response classification"



"A high-fat, high–saturated fat diet is associated with diminished coronary artery disease progression in women with the metabolic syndrome."



n=1 https://denversdietdoctor.com/lchf-15-years-coronary-artery-...

> 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.

Yes, saturated fat can raise cholesterol (in some people).

> And the correlation between high cholesterol levels and CVD has been known for decades.

Correlation is not enough!

By the same logic:

Building fire stations (eating saturated fat) leads to more firefighters (cholesterol). Firefighters are highly correlated with burning buildings (CVD). So firefighters cause CVD? The body is way to complex for such a simple statement.

There are also literally hundreds of studies that show the opposite.

There are also literally hundreds of studies that show the opposite.

Can you cite some? Actual feeding experiments and not self-reported diets?

One of the best points of evidence is the Minnesota Coronary Experiment, that was always used for your line of advice and recently turned around.



You can easily find more yourself.

Your statements show some logic. Can you back them up with any actual studies? In my experience that's where these arguments usually start failing.

A high cholesterol level can mean your body already had high levels of inflammation, so it produces more cholesterol to "fix it". But a side-effect of that is that it clogs your arteries. And it's worse when you have a Vitamin K2-deficient diet, which means calcium is slowly accumulated into your tissues and arteries.

Heart attack is caused by the "plaque" that "breaks off". So I'm thinking it wouldn't be a plaque with just the cholesterol alone. It needs the calcium to really turn dangerous.

I think everyone needs to do a CAC test. But it seems most doctors believe only the US president and astronauts are good enough for it.

This documentary on it is a good one:


Not disagreeing, but want to add that heart attacks are usually a result of an inflammatory process within coronary artery walls (as opposed to plaque building up on the outside of the wall). Inflammation in the artery wall leads to plaque buildup (to repair it). If that plaque breaks through the artery wall (the intima) into the bloodstream, a clot forms leading to a heart attack.

https://www.youtube.com/watch?v=cwri-0rTweI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209544/

Is there anything that can be used to safely reverse the hardening / plaque buildup? I have been using 2-Hydroxypropyl-beta-Cyclodextrin in attempt to reverse damage to the outside of the arteries and will see with time if it helps. I would like to find something that can slowly and somewhat safely soften and dissolve the plaque in the arteries over a long period of time.

I don't know that there are medical studies showing positive results for any single factor. I've seen videos making the case for vitamin K2 and D3, as well as metformin. You will need to do your homework on this, ideally with a doctor.


Thankyou. I already take extra D3 and K2. I had never heard of metformin.

I have had really bad luck finding a doctor that will discuss natural solutions. A nurse friend was suggesting I find a functional medicine doctor or lab scientist.

Metformin requires a prescription, by the way.

If you mix a high carbs intake with a high (saturated) fat intake, you cholesterol will rise, and you probably will develop a coronary disease.

The thing in those studies, and many others, is how they handle the carbs intake. I would like very much to read about metabolic ward studies in the following terms

Baseline Macros and Overall Isocaloric Intake Baseline blood levels (Cholesterol, Insuline, Lipid curve, triglycerides, etc) Baseline BMI or any measure that could gave information of the subject energy reservoir.

Macros and Overall Isocaloric Intake during study and duration

Resulting blood levels after study and BMI.

If anyone can provide links would love to read that

Isocaloric studies have been done. I don’t have links handy but if you search a bit I’m sure you can find them.

Ray Cronise has done some interesting work on the body’s metabolic priorities:


In short, you’re basically right that eating fat along with carbs or protein will cause your body to store the fat and burn the other fuels it has available instead because storing fat is cheap.

Correlations are non-transitive. You'd have to study:

saturated fat intake <-> CVD

Why would they not be transitive in this case? The mechanisms are well understood.

All the "blue zone" diets are low in animal protein and saturated fat:


Eat mostly plants, especially beans. And eat meat rarely, in small portions of 3 to 4 ounces. Blue Zoners eat portions this size just five times a month, on average.

The mechanisms of cholesterol -> heart disease are not well understood. Cholesterol is a natural component of the blood - if it's too low or high it implies you are ill. The levels being off correlate with heart disease but I don't think there's a simple high cholesterol directly causes deposits causation.

What would bother me is the idea of two stories

Story one:

High cholesterol --> higher rates of plaque deposition -> heart disease.

Story two:

Inflammation --> plaque deposition that is highly sensitive to cholesterol levels --> heart disease.

No Inflammation --> no plaque deposition --> no heart disease.

If story one is true, inflammation is unimportant. If story two is true then inflammation is what's important and going after cholesterol levels is treating a secondary cause instead of the primary cause. One gets fooled by the dose/disease relationship in the context of inflammation.

Not sure what you're asking? You've shown two correlations and you can't make the conclusion the way you did based on those two correlations. It's just how statistics works in our complex world. Perhaps if you can prove that only cholesterol affects CVD and nothing else. Good luck with that.

You'd need to study the relationship directly. Otherwise, your ignoring the whole range of effects that eating saturated fat may have that would counteract CVD. You're just picking one effect (cholesterol) and making invalid transition from that to correlation between saturated fat and CVD.

What was the exercise level of the participants in a metabolic ward study? What's the pre screening for inflammation and associated risk issues?

Your rebuttal is good in as much as it points to study but surely the reappraisal of these more modern meta analyses carry some weight or are you refuting by appeal to authority?

The guardian article says the peer review had misgivings so obviously the epidemiological aspects of this are up in the air. I'm not on statins but I wouldn't stop if I was. I might however take heart that moderate exercise and med diet appears to have upsides?

The main point here is that observational studies are much less reliable than mechanistic studies involving direct feeding & measurement. The genetic variability of baseline cholesterol levels is so high that it can drown out the effect of diet in cross-sectional observational studies. Meta-analyses of observational studies are the easiest kind of nutrition study to skew in the direction of the conclusions you want.

What's worse, "studies" like these are used as excuse for people to adopt diets very high in saturated fat and animal protein which are not only disastrous for the environment and animal welfare, but have also been shown to be the absolutely worst diets in terms of overall mortality risk:



> mechanistic studies involving direct feeding & measurement

I believe that's the fancy terminology for "We fed people with substance X and blood marker Y went up", correct me if I'm wrong. How is that in any way reliable unless it's proven that elevated blood marker Y causes CVD? It's only reliable if you want to prove that food X causes elevated Y.

Also, I find it amusing that you're deriding observational studies, yet the study you're quoting is observational. And a big problem with a study like this is that it wouldn't discern between a high-protein diet consisting of bacon/sausages and one consisting of grass-fed beef. Processed meat contains all kind of shit, it's a major staple in people's diets and it's not surprising to me at all if people eating that have more health problems.

Observational studies are inferior, it's true, but how do you propose to measure long term mortality rates in a direct feeding study?

Of course the elephant in the room is that it's ecologically impossible to feed the Earth's population a diet high in animal protein so even if you have convinced yourself it's healthier it's really not an option for the long term.

One would also hope that the monstrous cruelty of industrial animal agriculture would factor into your considerations at least a little bit.

> how do you propose to measure long term mortality rates in a direct feeding study?

Simple, lock lots of people in a building, feed them the same thing for 50 years and then measure :) That's impossible, of course, which is why I try to take all these studies, no matter what the type, no matter which side of the argument they are on, with a monstrous grain of salt. When trying to find the perfect diet, I think it's better to look into the diet of our ancestors and to refer to the works of Dr. Weston Price and Vilhjalmur Stefansson. What they did might not be considered technically "science" because it's not peer-reviewed, doesn't have confidence intervals, mortality rates and whatnot but I consider it much more valuable as they spent years on the field studying people's diets and their health, not sitting in a comfy chair measuring blood cholesterol levels.

Inuit lived practically on very fatty meat only. One can only imagine their LDL. Why weren't they dropping dead of cancer, diabetes and heart attacks at 30 years of age? Dr. Price says that in all his travels he didn't come upon a group that thrived on plant food only. If I remember correctly there was a community in the Swiss Alps that lived exclusively on wholegrain rye bread, cheese + some meat once a week and they were very healthy. That's was the diet closest to vegan that he described. Of course, these days with all the nutrition science advancements, with the addition of supplements, it's may be possible to thrive as vegan but I'm not willing to be the guinea pig.

And yes, I'm well aware that feeding everyone animal protein is not sustainable in any way but that doesn't have much to do with the discussion whether animal protein is bad for your health or not. Given the problems with modern agriculture, it's questionable whether the Earth can sustain 9 billion vegans in the long term either.

I try to take into account the cruelty of industrial farming when choosing my food, at least to certain extent. However, you need to note that the very fact of my existence means hundreds/thousands of critters are being killed. From ecological point of view, the best option would be for me to kill myself, not become a vegan. I just have to draw the line somewhere.

Th Inuit actually do have a fairly high rate of CVD. The idea that they live long healthy lives on an all meat diet is wrong:


IMO all creatures have a right to fight for their survival, including killing and eating meat if necessary. But humans don’t have to so why should we?

Well, I didn't say the Inuit live long lives. In fact I haven't been able to find data how long do they live when in their natural environment on traditional diets. But I suspect they don't live that long as it's a harsh environment. It's probably the same effect as animals in the wild vs in the zoo.

I checked all the studies in your link and didn't see anything to contradict the notion that they had healthy enough lives. First study is behind a paywall so it's hard to comment but the most damning thing in the abstract is "The mortality from all cardiovascular diseases combined is not lower among the Inuit than in white comparison populations". Shouldn't it be significantly higher when you consider the copious amounts of "unhealthy" food they consume (allegedly 5-10 pounds of meat per day).

The paleopathology study involves a grand total of 3 mummies, that all died from trauma, 1 of which was 53 year old woman with signs of atherosclerosis but otherwise no evident heart problems, 1 apparently healthy young woman and 1 woman with severe heart and other health issues, some of which the researcher suggests are the result of a bacterial infection.

The Canadian Eskimos study mostly talks about ailments related to their way of life - worn teeth (which were still in excellent condition!!), snow blindness and the like. No mention of degenerative diseases. In fact you'll see a comparison between "traditional" Eskimos and "civilized" ones. If you intended to prove how unhealthy the traditional diet is, this study says just the opposite.

>the correlation between high cholesterol levels and CVD has been known for decades

Exactly, correlation.

> 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"

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


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.

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

Let's not omit sugar and refined carbohydrates (high-GI foods) from the inflammation equation...

I'd be interested to see the actual study. That article is very hand wavy about it.

Wouldn't that suppose that you're not doing progressive damage by slowly clogging arteries over long periods of time and that eating saturated fat is something you can cycle/regulate? Still being bad for you is one thing, but the manner in which it is bad for you seems like it would have some wider implications.

Perhaps, but that is not the language used in the headline nor in the article:

> It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat.

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....

It may be of interest.

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

This talks about a Mediterranean Diet quite a bit, but what, exactly is such a 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.

As a hopefully interesting aside: rodent studies that work with diabetes usually have mice or rats that are pre-disposed to T2D, but they kick it off by a few weeks on what is known in the literature as the "American Diet". It's higher in fat and carbs, and while the "standard diet" is brown, grainy, and pretty solid, the higher fat diet is slick, crumbly, and either bright pink or the same color as congealed fat.

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

>Important to note that list doesn't include Pasta and Pizza

Which list?

Pasta is an essential item of Mediterranean Diet and Pizza or bread are the same thing, the discussion is more about making them with "whole grain" or "white, refined" flour.

Today common flours tend to be much more refined than traditional ones, so "real world" Mediterranean Diet (i.e. what actually people eat daily in Mediterranean countries following the tradition) misses some ingredients of the "whole grain" flours, and the use sparingly warning in the "Harvard Food pyramid":


is only for those items made of "white" flour.

It says "in the 1940's and '50's" though to be fair at the time people in the Med just didn't have much to eat at all (because of the war).

As a Greek person, I'm a bit surprised that pulses are rarely mentioned in what is supposed to be "my" diet. We eat lots of beans, chick peas and lentils in Greece- "fasolada", a soup of dried beans, is our national dish.

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

>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.

I feel like the word "Mediterranean diet" is something I've never seen defined to my satisfaction. I know it includes lots of vegetables and olive oil, and not much meat. I have yet to see anything prescriptive. As in, here's a diet plan with recipes and calorie counts, follow this, from any highly respected medical source.

Do people fry food in olive oil along the Mediterranean or is it only eaten fresh? In fact, I'm not even certain that I can buy olive oil anywhere locally, but rather everything labeled olive oil may be something else.

Great question, and no good answer exists. That why it should be avoided in such studies.

There is, however, the traditional Okinawa diet. This is much better defined (a much small geographic region), and know to be one of the healthiest in the world. There's this book Blue Zones, that talks about this.

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

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.

"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.

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

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. :)

Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. Same for the saturated fats in meat (not even to speak of dairy), which are rarely found in plants. Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation.

Looking for a "good for health" diet: see WFPB.

> Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame.

> Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation.

These claims don't even seem remotely scientific, lol.

> Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame.


There are so many studies on this.

> Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation.

Your right here. You may call rotting on all things passing our colon. But rotting meat is just a little more "dangerous" I guess. Again, your right: no science to back up this claim I could find.

Our small intestine is long, compared to the colon, precisely because we've evolved on meat-based diet. By the time the "meat" reaches the colon, there is barely anything left because the nutrients are absorbed by the small intestine.

As opposed to our cousins the apes, who have larger colon and shorter small intestine because they evolved on a plant-based diet.

But what if we human/compare ape guts with true omni guts (bear/wolf/swine), or true carnivore (cats) mammals?

Would you say this kind of chart is not true?


Just being inquisitive here... I want to learn.

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