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Fat vs. carbs: What’s worse for your health? [pdf] (liliec.be)
35 points by yarapavan 34 days ago | hide | past | web | favorite | 14 comments

I'm almost 50, and my family has a history of heart disease. So a few years ago, I got serious about getting into better shape. Since then, I've lost almost 55lbs.

I dropped the first 30 over the course of roughly a year and a half 30 by doing vigorous cardio exercise (running) and not modifying my diet much at all. My bloodwork looked far better in terms of cholesterol.

In the last 6 months I've dropped another 25 by switching the cardio from running to rowing, adding weight training, and cutting most carbs from my diet. I'm not a fanatic.. I still have a glass or two of red wine every day. I still eat vegetables and fruit. But I avoid empty carbs as much as possible (chips, rice, bread, etc).

My experience with this, and what I've heard from friends who have done similar things, makes me think that the abundance of carbs in the modern diet is a huge problem.

It’s not just carbs, it’s “easy” carbs — highly processed and easy to digest, like flours. Carbs in their more natural state, such as oatmeal (and pasta can fit into this category as long as it’s not overdone) and whole grains (actual whole grains, not highly processed flour that is made from whole grains) really make a big difference. I think one of the biggest issues we have with nutrition is that we have reduced everything to a simple number, and have forgotten about the structure of the item and that it has to be digested. 100 calories from rice flour and 100 calories from steel cut oats are not the same.

> chips

Chips are about 20-40% fat by weight. Definitely something to avoid regardless of whether your diet is low carb or not.

how much do you typically row?

i feel i cant manage more than 20 min at consistent high effort :(

I do about one hour every other day at an average pace of ~29spm keeping my heart rate mostly in zones 4 & 5.

No question about it: It is BORING as hell. Much more boring than running. I just listen to podcasts and am very glad when it is done. The nice thing compared to running is that, in addition to being a full body workout, there are no excuses. No "its too hot" or its raining, or snowing, or whatever. The machine is always in my spare room waiting for me.

Related anecdote. A buddy of mine was dating a type1 diabetic, and he was amazed at all the advice she'd been told all her life. Basically that she should be eating mostly (fastish) carbs, counting them, and estimating how much insulin to use to keep her blood sugar down, then measure, and maybe use more insulin, or quickly eat a fast sugar to bring it back up. With type1 diabetes blood sugar control is a fine balance between losing a limb from long term too high sugar levels, and being literally too stupid to eat from too low sugar levels, and going into a coma.

He's got a background in signal processing, and control theory, and his first thought was that it's basically the exact opposite of how he'd manage a signal. Eating then estimating insulin to bring down sugar levels, was basically less effecting than taking a known amount of insulin and eating to bring up sugar levels. The main reason being that too much insulin is really dangerous, and blood sugar is tricky to measure and it can be really hard to tell if it's going up or it's going down with pin prick tests, even with multiple tests, since you may be in the part of the signal that's ringing after a big delta. He was even more convinced after a little research that fat and protein and soluble fiber will slow down sugar production, which meant it was even easier to slow down the rate of sugar change through diet changes, which would make ringing less of a problem, making measurements easier, and making smaller doses of more frequent insulin a viable strategy.

It took my friend months to convince his girlfriend to change her diet to lower her carb intake. But when he did it made a big impact on her overall health. The biggest change was when she stopped eating sorbet and started eating full fat ice cream at night to keep her blood sugar high enough to last until morning. It really helped prevent most of the night time blood sugar issues she was having to deal with. Her doctor even begrudgingly admitted that while "she was doing everything wrong", "all her numbers were better than normal", and she should "probably keep doing what she's doing".

Also fun fact, following my friend's advice really helped me and my wife deal with her gestational diabetes with both pregnancies. We were getting a lot of bad advice, and we experimented with lots of foods, and cutting carbs really helped her keep her blood sugar down. Oddly though, potatoes for her didn't seem to have effects on her blood sugar that its glycemic index would imply, preparation didn't seem to matter, she could eat a lot more potatoes than she should have been able to. I suspect she has some kind of genetic or gut flora predisposition with regards to potatoes.

There was this guy in Poland, an MD, who figured this exact thing in 60s. He essentially took and modified the damaged liver diet (rich in MCTs mostly) and have it in a series of trials, lightly controlled, vs a plain lower calorie diet, to a bunch of people in sanatoriums. He derived the diet from basic principles and then available dietary tables - being forced into service but the military he had to learn dietetics.

Extremely sick people who could barely walk. The results were pretty resounding, so good they made whole Polish Academy of Sciences at the time recoil and denounce him. He was thought to have committed fraud. They stopped denouncing him repeatedly only in some 2000s.

This was the more correct grandfather of better known Atkins diet. It has some uses. One of them is rapid weight loss, the other is diabetes, hepatitis recovery, a few connective tissue diseases and epilepsy refractory to treatment. It is driven by explicit testing for ketosis and microelement and vitamin tables. And the difference is it's an actual process not just one flat prescription.

Careful, this is with picked evidence. Use metastudies - they show effects are rather low if any once corrected for lifestyle factors...

I was suckered into the Greger's vegan diet for a year with no results, not even in bloodwork. (Even supplemented.)

Most importantly, we have not really plumbed the depths of ketogenic diets.

(Which is very different from eating a lot of meat - it's a lot of fats and generally MCT and middle chain saturated are the optimal.)

Any author or paper can be subject to bias, including meta-analysis.

I understand the discussion is about fats in general, but we have extremely reliable evidence that saturated fat causes heart disease, the #1 killer of men and women, our parents and grandparents. I'll quote HackerNews user cageface because s/he said it so well (https://news.ycombinator.com/item?id=16566968):

"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:"



> But more recently we discovered that smaller LDL particles cause more plaques than large LDLs. And while eating saturated fat raises large LDL levels, small LDLs are boosted most by refined carbohydrates.

Will refined foods ever get a bad rap? I suspect they are easy to monetize because they are efficient to create, store and transport and they can then be used as off-the-shelf ingredients. They will have commercial interests behind them, which means marketing slant.

Polyunsaturated oils = excessive free radicals under storage and heat of cooking

Saturated fats and the cholesterol of meats = atherosclerosis

Fried anything = acrylonitrile, carcinogenic

Monosaturated oils such as olive oil are the key, not to mention the beneficial compounds such as oleuropin unique to olive oil. Eat handfuls of raw walnuts daily. Walnuts actually have higher alpha-linolenic acid (ALA) than flax seed.

Moderate complex carbs.

Supplement with Bilberry extract, Chokeberry extract and Elderberry extract for powerful health promoting anthocyanins, teaspoons of each daily.

Just gave up most all forms of refined sugar, lost more weight, feel better. Swim 5,200 yds. minimum per week. Mildly ripped from swimming.

I am 65 yrs. male and 5'10", 164 lbs., vegetarian since 20 yrs., severe central sleep apnea (treated), but overall, never felt better in my life.

Link between saturated fats and atherosclerosis is tenuous at best.

It is now likely that not all of these days have the effect. Likewise only certain density lipids are dangerous.

Metabolism is a complex beast.

As I described above, I have to disagree: The link between saturated fat intake and blood LDL cholesterol is very well established by hundreds of controlled-feeding experiments. Here is a meta-analysis of 395 such experiments: https://www.ncbi.nlm.nih.gov/pubmed/9006469

Going from LDL cholesterol to atherosclerosis, the plaque that composes the arterial blockages is largely made of cholesterol-rich lipids. On a higher level, the use of statins to lower cholesterol is the #1 thing doctors do to try to reduce a person's risk of heart disease.

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