The Saturated Fat Studies: Set Up to Fail

The Saturated Fat Studies: Set Up to Fail
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How might Big Butter design a study (like the Siri-Tarino and Chowdhury meta-analyses) to undermine global consensus guidelines to reduce saturated fat intake?

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Where did these consensus guidelines to dramatically lower saturated fat consumption come from? From literally hundreds of metabolic ward experiments, which means you don’t just ask people to change their diets, you essentially lock them in a room, for weeks if necessary, and have total control over their diet. You can then experimentally change their level of saturated fat intake however you want and see the corresponding change in their cholesterol levels. And the results are so consistent you can create an equation, the famous Hegsted Equation, where you can predict how much their cholesterol will go up based on how much saturated fat you have them eat. So if you want your LDL cholesterol to go up 50 points all you have to do is eat like 30% of your calories from saturated fat. When you plug in the numbers, the change in cholesterol shoots up, right as predicted. The experiments match the predictions. You can do it at home with one of those home cholesterol testing kits, eat a stick of butter every day and watch your cholesterol climb—it’s not rocket science. And look at this, this was 1965; we’ve known about this for 50 years that even if you keep calorie intake the same, increases in saturated fat intake are associated with highly significant increases in LDL bad cholesterol. Now your good cholesterol goes up a bit too, but that increase is smaller than the increase in bad, which would then translate into increased heart disease risk overall.

So if you feed vegetarians meat even just once a day, their cholesterol jumps nearly 20% within a month. To prevent heart disease, ideally we would need to get a total cholesterol under 150, which you can see these vegetarians were, but then even just once a day with the meat and their cholesterol shot up 19%. But the good news is that within just 2 weeks of returning to their meat-free diet, their cholesterol dropped back down into the safe range. Note that their HDL good cholesterol hardly moved at all, so their ratio went from low risk of heart attack to high risk in a matter of weeks with just one meat-containing meal a day. And indeed randomized clinical trials show that dietary saturated fat reduction doesn’t just appear to reduce cholesterol levels, but subsequent cardiovascular events like heart attacks as well.

So we have randomized clinical trials, controlled interventional experiments, our most robust forms of evidence—no wonder there’s a scientific consensus to decrease saturated fat intake. This is going to be a toughie for Big Cheese and Chicken. You’ll note, though, that the Y-axis here is not cholesterol, but change in cholesterol. That’s because everyone’s setpoint is different. Two people eating the same diet, the same amount of saturated fat, the same number of chicken nuggets a day can have very different cholesterol levels. One person can eat 10 chicken nuggets a day and have an LDL cholesterol of 90; another person eating 10 a day could start out with an LDL of 120. It depends on your genes. But while our genetics may be different, our biology is the same, meaning the rise and drop in cholesterol is the same for everyone. So if both folks cut out the nuggets, the 90 might drop to 85, whereas the 120 would be expected to drop to 115. Wherever we start, we can lower our cholesterol by eating less saturated fat, but if I just know what your saturated fat intake is—how many nuggets you eat–I can’t tell you what your starting cholesterol is. All I can say with certainty is that if you eat less, your cholesterol will likely improve.

But because of this extreme “interindividual variation,” this wide variability in baseline cholesterol levels for any given saturated fat intake, if you take a cross-section of the population, you can find no statistical correlation between saturated fat intake and cholesterol levels, because it’s not like everyone who eats a certain set amount of saturated fat is going to have over a certain cholesterol. So there’s like three ways you could study diet and cholesterol levels: controlled feeding experiments, free-living dietary change experiments, or cross-sectional observational studies of large populations. As we saw, there is a clear and strong relationship between change in diet and change in serum cholesterol in the interventional designs, but because of that interindividual variability, in cross-sectional designs, you can get zero correlation. In fact, if you do the math, that’s what you’d expect you’d get. In statistical parlance, one would say that a cross-sectional study doesn’t have the power for detecting such a relationship. Thus because of that variability, these kinds of observational studies would seem an inappropriate method to study this particular relationship. So since diet and serum cholesterol have a zero correlation cross-sectionally, an observational study of the relationship between diet and coronary artery disease incidence will suffer from the same difficulties. So again, if you do the math, observational studies would unavoidably show nearly no correlation between saturated fat and heart disease. These prospective studies can be valuable for other diseases, but the appropriate design demonstrating or refuting the role of diet and coronary heart disease is a dietary change experiment. And those dietary change experiments have been done; they implicate saturated fat, hence the lower saturated guidelines from basically every major medical authority. In fact, if we lower saturated fat enough, we may even be able to reverse heart disease, opening up arteries without drugs, without surgery. But wait a second. Let’s put our Big Cheese and Chicken hat back on. Observational studies would show no correlation, mathematically could show no correlation. We’ve known since 1979 that observational studies simply don’t have the power to show the relationship. Bingo!

All we need now is a friendly researcher. How about Ronald M. Krauss? Funded by the National Dairy Council since 1989, also the National Cattlemen’s Beef Association, as well as the Atkins Foundation—perfect. Then you just combine together all the observational studies that don’t have the power to provide significant evidence and what do you know, no significant evidence was found.

This 2010 meta-analysis was basically just repackaged for 2014, using the same and similar studies. As the chair of Harvard’s nutrition department put it, their conclusions regarding the type of fat being unimportant are seriously misleading and should be disregarded, going as far as suggesting the paper be retracted, even after the authors corrected a half dozen different errors.

But it’s not like they falsified or fabricated data—they didn’t have to. They knew beforehand the limitations of observational studies; they knew they’d get the “right” result, and so they published it, helping to “neutralize the negative impact of milkfat by regulators and medical professionals.” And it’s working, brags the dairy industry: "Perceptions about saturated fat in the scientific community are changing. This is a welcome message to consumers, who may be tired of hearing what they shouldn’t eat." They don’t need to convince consumers, just confuse them. Confusion may easily be misused by the food industry to promote their interests.

It’s like that infamous tobacco industry memo that read “doubt is our product.” “Doubt is our product since it’s the best means of competing with the body of fact that exists in the mind of the general public.” They don’t have to convince the public that smoking is healthy to get people to keep consuming their products. They just need to establish a controversy. Some science says its bad, some says it’s not bad. Conflicting messages in nutrition cause people to become so frustrated and confused they may just throw their hands up in the air and eat whatever they want, which is exactly what saturated fat suppliers want–but at what cost to the public’s health?

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Sara Marchetto who is graciously volunteering her talents. If you’d like to help as well, please go to our Volunteer Opportunities page.

Where did these consensus guidelines to dramatically lower saturated fat consumption come from? From literally hundreds of metabolic ward experiments, which means you don’t just ask people to change their diets, you essentially lock them in a room, for weeks if necessary, and have total control over their diet. You can then experimentally change their level of saturated fat intake however you want and see the corresponding change in their cholesterol levels. And the results are so consistent you can create an equation, the famous Hegsted Equation, where you can predict how much their cholesterol will go up based on how much saturated fat you have them eat. So if you want your LDL cholesterol to go up 50 points all you have to do is eat like 30% of your calories from saturated fat. When you plug in the numbers, the change in cholesterol shoots up, right as predicted. The experiments match the predictions. You can do it at home with one of those home cholesterol testing kits, eat a stick of butter every day and watch your cholesterol climb—it’s not rocket science. And look at this, this was 1965; we’ve known about this for 50 years that even if you keep calorie intake the same, increases in saturated fat intake are associated with highly significant increases in LDL bad cholesterol. Now your good cholesterol goes up a bit too, but that increase is smaller than the increase in bad, which would then translate into increased heart disease risk overall.

So if you feed vegetarians meat even just once a day, their cholesterol jumps nearly 20% within a month. To prevent heart disease, ideally we would need to get a total cholesterol under 150, which you can see these vegetarians were, but then even just once a day with the meat and their cholesterol shot up 19%. But the good news is that within just 2 weeks of returning to their meat-free diet, their cholesterol dropped back down into the safe range. Note that their HDL good cholesterol hardly moved at all, so their ratio went from low risk of heart attack to high risk in a matter of weeks with just one meat-containing meal a day. And indeed randomized clinical trials show that dietary saturated fat reduction doesn’t just appear to reduce cholesterol levels, but subsequent cardiovascular events like heart attacks as well.

So we have randomized clinical trials, controlled interventional experiments, our most robust forms of evidence—no wonder there’s a scientific consensus to decrease saturated fat intake. This is going to be a toughie for Big Cheese and Chicken. You’ll note, though, that the Y-axis here is not cholesterol, but change in cholesterol. That’s because everyone’s setpoint is different. Two people eating the same diet, the same amount of saturated fat, the same number of chicken nuggets a day can have very different cholesterol levels. One person can eat 10 chicken nuggets a day and have an LDL cholesterol of 90; another person eating 10 a day could start out with an LDL of 120. It depends on your genes. But while our genetics may be different, our biology is the same, meaning the rise and drop in cholesterol is the same for everyone. So if both folks cut out the nuggets, the 90 might drop to 85, whereas the 120 would be expected to drop to 115. Wherever we start, we can lower our cholesterol by eating less saturated fat, but if I just know what your saturated fat intake is—how many nuggets you eat–I can’t tell you what your starting cholesterol is. All I can say with certainty is that if you eat less, your cholesterol will likely improve.

But because of this extreme “interindividual variation,” this wide variability in baseline cholesterol levels for any given saturated fat intake, if you take a cross-section of the population, you can find no statistical correlation between saturated fat intake and cholesterol levels, because it’s not like everyone who eats a certain set amount of saturated fat is going to have over a certain cholesterol. So there’s like three ways you could study diet and cholesterol levels: controlled feeding experiments, free-living dietary change experiments, or cross-sectional observational studies of large populations. As we saw, there is a clear and strong relationship between change in diet and change in serum cholesterol in the interventional designs, but because of that interindividual variability, in cross-sectional designs, you can get zero correlation. In fact, if you do the math, that’s what you’d expect you’d get. In statistical parlance, one would say that a cross-sectional study doesn’t have the power for detecting such a relationship. Thus because of that variability, these kinds of observational studies would seem an inappropriate method to study this particular relationship. So since diet and serum cholesterol have a zero correlation cross-sectionally, an observational study of the relationship between diet and coronary artery disease incidence will suffer from the same difficulties. So again, if you do the math, observational studies would unavoidably show nearly no correlation between saturated fat and heart disease. These prospective studies can be valuable for other diseases, but the appropriate design demonstrating or refuting the role of diet and coronary heart disease is a dietary change experiment. And those dietary change experiments have been done; they implicate saturated fat, hence the lower saturated guidelines from basically every major medical authority. In fact, if we lower saturated fat enough, we may even be able to reverse heart disease, opening up arteries without drugs, without surgery. But wait a second. Let’s put our Big Cheese and Chicken hat back on. Observational studies would show no correlation, mathematically could show no correlation. We’ve known since 1979 that observational studies simply don’t have the power to show the relationship. Bingo!

All we need now is a friendly researcher. How about Ronald M. Krauss? Funded by the National Dairy Council since 1989, also the National Cattlemen’s Beef Association, as well as the Atkins Foundation—perfect. Then you just combine together all the observational studies that don’t have the power to provide significant evidence and what do you know, no significant evidence was found.

This 2010 meta-analysis was basically just repackaged for 2014, using the same and similar studies. As the chair of Harvard’s nutrition department put it, their conclusions regarding the type of fat being unimportant are seriously misleading and should be disregarded, going as far as suggesting the paper be retracted, even after the authors corrected a half dozen different errors.

But it’s not like they falsified or fabricated data—they didn’t have to. They knew beforehand the limitations of observational studies; they knew they’d get the “right” result, and so they published it, helping to “neutralize the negative impact of milkfat by regulators and medical professionals.” And it’s working, brags the dairy industry: "Perceptions about saturated fat in the scientific community are changing. This is a welcome message to consumers, who may be tired of hearing what they shouldn’t eat." They don’t need to convince consumers, just confuse them. Confusion may easily be misused by the food industry to promote their interests.

It’s like that infamous tobacco industry memo that read “doubt is our product.” “Doubt is our product since it’s the best means of competing with the body of fact that exists in the mind of the general public.” They don’t have to convince the public that smoking is healthy to get people to keep consuming their products. They just need to establish a controversy. Some science says its bad, some says it’s not bad. Conflicting messages in nutrition cause people to become so frustrated and confused they may just throw their hands up in the air and eat whatever they want, which is exactly what saturated fat suppliers want–but at what cost to the public’s health?

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Sara Marchetto who is graciously volunteering her talents. If you’d like to help as well, please go to our Volunteer Opportunities page.

Doctor's Note

Dairy industry campaign to “neutralize the negative image of milkfat”? If you missed my last video, check it out here: The Saturated Fat Studies: Buttering Up the Public.

If that “Doubt is our product” memo sounded familiar, I also featured it in my recent Food Industry-Funded Research Bias video. More on how industries can design deceptive studies in BOLD Indeed: Beef Lowers Cholesterol? Food Industry-Funded Research Biasand How the Egg Board Designs Misleading Studies.

And last but not least, this is the first NutritionFacts.org video featuring the work of professional illustrator Sara Marchetto, who has so kindly offered to donate her talents to forward our mission. I hope you’ll see more of her soon!

If you haven't yet, you can subscribe to my videos for free by clicking here.

366 responses to “The Saturated Fat Studies: Set Up to Fail

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  1. This video is complicated so I’ll have to rewatch it to understand the details. But the implications are clear. This video is super. Thanks Dr. Greger!




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      1. I still don’t quite get it. I see why cholesterol and saturated fat don’t correlate, because people naturally have different starting points of cholesterol. If only 4% of the population have hypercholestemia, why doesn’t saturated fat correlate with heart disease?




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        1. I think what it means is that not everyone who eats saturated fat gets heart disease because enough people have naturally low cholesterol so that eating meat and dairy may not affect them in that way. Even though it’s the number one killer?




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            1. I think the point is that when you are testing for significant correlation you are comparing the pattern with the noise to determine significance of the pattern. When the pattern is large compared with the noise, we say the correlation is significant. When the noise happens to be large, then it is much easier for the pattern to hide.

              Add to this the fact that “normal” people are generally studied and that our population tends to have fairly homogenous behavior, the pattern gets hidden even better.




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              1. This good explanation and the excellent video itself get to the truth of the matter — but how to get the average person to understand? The message that many people have solidified in their own minds recently is that there is no correlation between dietary saturated fat and heart disease. Therefore saturated fat intake doesn’t really matter — so why limit it if it improves the taste of food? The mainstream media has done their part to make a real mess of nutritional science, but why do editors of scientific journals allow for the publication of such deceptive studies?




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                1. That’s because no real scientific study has proven it. Saturated fat from good sources are not unhealthy. Now if you’re pouring 2 table spoons of coconut oil then eating red meat every meal then that is likely cause for concern. The studies used to argue against saturated fat are just like this one http://www.ncbi.nlm.nih.gov/pubmed/28040519 so if you believe those than you believe this one that says vegetarian doesn’t help all cause mortality. Just like not all carbs are equal, not all fat is equal. The world isn’t black and white




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                  1. Andrew: if you’re serious about learning about the connection between SF and heart disease, I recommend reading some of Travis’ posts and meta-analyses at the link below. He lays bare the few ‘studies’ which, due to massive methodological flaws, erroneously aren’t able to find a link between SF and heart disease.

                    http://healthylongevity.blogspot.ca/2014/12/saturated-fat-heart-disease-meta-analysis.html

                    Here’s what has been proven:

                    – Increasing SF consumption increases LDL cholesterol. (see meta-analysis of 365 metabolic ward studies).

                    https://www.ncbi.nlm.nih.gov/pubmed/9006469

                    – Increases in LDL cholesterol are linearly related to increases in the development of atherosclerosis (heart disease), see link below.

                    http://circ.ahajournals.org/content/circulationaha/108/22/2757.full.pdf

                    So increasing SF from below 10% of calories -> increases LDL to above 75 mg/dL -> causes atherosclerosis in the average person. The link has been proven. Studies funded by the American Egg Board and the dairy industry have tried to cast doubt on the mountain of evidence in support of the diet-heart connection. Don’t let dollars beat science.




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                    1. The link you provided for the study “Increasing SF consumption increases LDL cholesterol” no longer pulls up the study. I’ve been trying to find a number of studies about how health is adversely affected by dairy on NCBI and not a whole lot is pulling up for me. Are the studies being systematically removed?




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              2. “When the noise happens to be large, then it is much easier for the pattern to hide.”

                This is technically correct, and would be an issue if the cross-sectional studies were underpowered (ie their sample sizes were too small). But that does not appear to be the case, which means if a signal existed, it would have been through the noise.

                That these studies were not underpowered and no signal was detected actually indicates the effect doesn’t exist (in this case, between subjects).

                Of course, the longitudinal studies show an effect does exist within-subjects.




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          1. Animal fats are ALWAYS going to be bad for the heart even in otherwise healthy people. Just because someone doesn’t develop heart disease does not mean their hearts aren’t suffering for their diet. Animal products are also detrimental for virtually every other single function of the human body. In no way does this suggest that animal saturated fat is ok for some people. It’s not ok for anyone, or at lest any human or other herbivorous animal.




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            1. This sounds like a very biased comment. You apply to the religion that humans are only meant to eat plants? When there’s nothing from reputable sources to back that up. It’s easy to look at the world black and white. That’s what extremists like extreme vegans and extreme panels do. Try to look at it more from an understanding of all angles. Learn to take value from everywhere. That doesn’t mean you have to believe it or align to it. But rather than closing one ear to one side you open both. Or else you may just miss out from hearing something valuable.




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              1. Andrew: don’t worry, not all vegans believe humans are herbivores. Greger himself has said that there’s no evidence of harm from very occasional meat consumption. You may be interested to read this blog from a biologist and vegan stating that we’re technically omnivorous. Personally, I don’t see any reason to care what our ancestors ate: it’s about finding what diet today makes us healthiest. The balance of evidence indicates that a whole-foods plant based diet, supplemented with B12, is the reigning champ right now.

                https://veganbiologist.com/2016/01/04/humans-are-not-herbivores/




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        2. Remember that statistics are about averages and deviations from averages. Things that are too rare, for example a whole-plant based diet, wash out in the noise as ‘outliers’. Within the normal bounds of US society: i.e. between 1 and 3 hamburgers of saturated fat a day, cholesterol is > 150 and as such heart-decease progression is random and a function of genetics and affluence (i.e. can afford a doctor to give you statins?).




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      2. Here it is: re-quoting Walter Willett, chair of the Department of Nutrition at Harvard School of Public Health, here is the problem:

        This paper is bound to cause confusion. A central issue is what replaces saturated fat if someone reduces the amount of saturated fat in their diet. If it is replaced with refined starch or sugar, which are the largest sources of calories in the U.S. diet, then the risk of heart disease remains the same. However, if saturated fat is replaced with polyunsaturated fat or monounsaturated fat in the form of olive oil, nuts and probably other plant oils, we have much evidence that risk will be reduced.




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        1. And the next line in that same article is:

          “Dr. Willett emphasized that because this meta-analysis contains multiple serious errors and omissions, the study conclusions are misleading and should be disregarded.”

          The art of reading… such an undervalued skill…




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            1. So… you post a quote out of context and I catch you red handed on trying to mislead and then reply with this?

              Wow! You seriously have no self respect.




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        2. It would be great to see a respectful exchange of ideas. We don’t need to take a “side.” But together we can help each other sift through the information.




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  2. This is such a powerful piece that it should absolutely be presented on something like dateline! Everyone should share this video to his many people as possible!
    The confusion you referred to in the general public in regards to saturated fat is exactly what I experience every single day with my patients.




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    1. I think you might mean Frontline and I totally agree!! Luckily there have already been a number of refutations of this bad research but a Frontline presentation would portray the necessary touch of evil drama that is going on.




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  3. Does anyone know if “bitters” are safe to ingest? They are a popular supplement in the
    natural foods industry but I’m not sure if they can cause more harm than good. It has
    been told that I should consider these “bitters” as a drink to help with constipation and
    digestion.

    And I like today’s video.
    Avoid animal products, and saturated fat in excess.




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    1. If you study all the various cures for cancer – real cures – you will notice they all feature something with a bitter flavor. Nature’s cyanide is a bitter flavor that is effective against out-of-control cell division. In the US, we eat sweet, salty, sour, but not bitter. We have an epidemic of cancer. Swedish bitters are a common tonic in Europe. And you don’t have to take bitters. You can simply eat raw seeds, nuts, greens… and you will get plenty of what you need to be healthy. Bitters are everywhere… safe to ingest bitters. We Americans – and Brits – avoid the bitter flavor and our bodies are therefore not well-equipped to resist cancer.




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      1. Some people rely on the the hydroxocobalmin form of B12 to get their daily B12. Hydroxocobalamin mops of the cyanide in the body and turns it into B12, thus ridding the body of cyanide. This might be a bad thing, according to your logic. What do you think?




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        1. I wonder how they determine such a thing – “Hydroxocobalamin mops of the cyanide in the body and turns it into B12.” That has to be based on an in vitro study, There are always interesting effects from manmade chemicals. What do I think? I think Mother Nature knows best. First food… and if you still need supplementation, take a natural form of the vitamin, I avoid manmade chemicals/vitamins. If you listen very closely, your body will tell you what it needs and wants. Also, observe animals… they are good mentors for humans. They know how to eat for their species – and they know how to lie down and let it all go after they’ve been stressed.




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              1. What kind of B12 supplement, methylcobalamin or the cyanocobalamin? I do very much enjoy and appreciate your comments on this and on your other postings.




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              2. Nutritional yeast does not supply natural B12 – it is unnaturally fortified (synthetic). I doubt, but do not know for sure, if we can get it from tempeh and miso.




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            1. Sure it is. Pick up a carrot straight from the ground and it eat (dirt and all) there’s your b12 (we let the animals eat dirt whilst they eat grass etc then we eat the animal therefore using them as a nutrient filter) when we could easily get it straight from the source (like I do because i care about animal, the planet and my health). You can also get b12 from nutritional yeast, non dairy milks, tempeh, spirulena, soy and coconut yoghurt.




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              1. “Contrary to the many rumors, there are no reliable, unfortified plant sources of vitamin B12, including tempeh, seaweeds, and organic produce. One of the earliest studies conducted on vegans, from the U.K. in 1955,
                described significant vitamin B12 deficiency in the vegans with some suffering from nerve damage and
                dementia. This, as well as many case studies since then of vitamin B12 deficiency in vegans, and a great deal of other evidence detailed here, has led to the overwhelming consensus in the mainstream nutrition community, as well as among vegan health professionals, that vitamin B12 fortified foods or supplements are necessary for the optimal health of vegans, and even vegetarians in many cases.” http://www.veganhealth.org/articles/vitaminb12. Any kind of plant milk that has B12 has been fortified. I am not sure, but I think eating the dirt on a carrot would only provide B12 if the soil contained manure. Eating unwashed greens MIGHT give you some B12 if it has some bugs you consume with them.




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          1. I don’t consider Hydroxycobalamin a “man made” form of B12. It is made by bacteria http://en.wikipedia.org/wiki/Hydroxocobalamin, and then converted to cyanocobalamin in the production process http://en.wikipedia.org/wiki/Cyanocobalamin#Production. But like anything, even if natural, actually treats a disease state, in this case cyanide poisoning, it can be labeled a drug by the FDA. Whether it work
            same/better/worse/ than methyl- or adenosyl- probably remains to be seen.




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        1. Me? I have an occasional cup of coffee, an occasional cup of green/black/white teas, and usually i prefer some sort of herbal concoction. At this moment, I’m drinking a “chai” type turmeric tea. I’ve been enjoying the detox dandelion tea from the “Yogi” teas. What are your ideas about caffeine? The better my diet, the less my cravings. And currently I must be 90% ‘raw’. :)




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          1. Would you mine sharing a sample menu of what you eat on a daily basis? I’m sure it changes from time to time but I do get the feeling that there a people in this community who would greatly benefit (I know I would).




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        2. Caffeine is healthy for all but those sensitive to it or who have it close to bedtime and keeping them up. It’s been found to greatly reduce the risk of Parkinson’s in those with the genetic pre-disposition. Coffee of all forms reduces risk of diabetes, and those with diabetes type II should only have decaffeinated, which helps them control blood sugar as well.

          Tea has antioxidants, but it unfortunately is tied for first place for the highest naturally occurring fluoride content of any food. Black and red have the most, green tea has almost as much, and white tea has slightly less. The other food in first place is grape products, wine, leaves, grapes, raisins, etc.. Many don’t know this and drink way too much tea and wine.




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          1. I don’t know that naturally occurring fluoride is a bad thing. The stuff they put in water is fluorine, an artificial harmful substance.




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  4. I agree that this is the best educational video pieces I have watched on your website, Dr. Greger, and it will help me in discussions with “knowledgeable” friends and colleagues regarding the saturated fats controversy. Thank you!




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  5. This video addresses saturated fat from animal foods (meats, butter, etc.) What about saturated fat from plants, say, from coconut oil? i know Dr. Greger has videos on coconut oil, but he hasn’t convinced me yet that coconut oil is bad for people. To be fair, nobody has convinced me that it’s good, either.




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    1. Why not see if it is bad for YOU? Get a home lipid test (or go to one of the anylabtestnow franchises), if you currently use CO go two weeks without it, two weeks with it and then two more weeks without it (or if not using CO, 2 wks with, then without and then with again), and see what your LDL levels are at the beginning and end of each time period? (I’m not responsible for any CVD events during the test fyi)




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      1. David, Jen, Mark, Daniel: Can you kindly refer me to a definitive study or meta analysis that shows that high blood LDL levels, as measured by a standard home or clinical blood test, causes heart disease?




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        1. You realize how you sound, right?

          I mean, can you kindly refer me to a definitive study or meta analysis that shows that high levels of smoking, as done outside with clove cigarettes, cause lung cancer?

          Before you asked that question, could you even have named 3 types of evidence that are thought to link high serum LDL with heart disease in the scientifically mainstream view?




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          1. Dear Largelytrue: Had I known, I wouldn’t have asked. I thought this site was all about education, not people trying to impose their beliefs on others.




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            1. You can ask questions, but do you understand my point? You seem to have been assuming that there’s a ~10 page report that all scientists point to about the definitive reasons why high LDL is thought to be a significant contributer to heart disease, and your question was framed in a way that suggested that if such a report could not be produced, then surely the evidence for the connection between serum LDL and heart disease is not strong, in spite of the fact that a wide consensus of professionals are organized around managing the disease through an approach that centers in part on LDL lowering.

              If you are coming from a position of general ignorance about what the science says, it helps to get the lay of the land. You might want to have a look at William Roberts’ (the presently vegan cardiologist who is editor of the American Journal of Cardiology) manuscript of 20 common questions about heart disease, which aims to give the lay of the land for a more general audience:

              “What evidence connects atherosclerosis to cholesterol?

              The connection between cholesterol and atherosclerosis is strong (9, 10):

              Atherosclerotic plaques similar to those in humans can be produced in nonhuman herbivores by feeding them large quantities of cholesterol and/or saturated fat. It is not possible to produce atherosclerotic plaques experimentally in carnivores.

              Cholesterol is found within atherosclerotic plaques.

              In societies where the serum total cholesterol is 150 mg/dL, the frequency of symptomatic and fatal atherosclerosis increases as the level above 150 increases.

              The higher the serum total cholesterol level, and specifically the higher the serum LDL cholesterol, the greater the frequency of symptomatic atherosclerosis, the greater the frequency of fatal atherosclerosis, and the greater the quantity of plaque at necropsy.

              In placebo-controlled, double-blind, lipid-lowering studies of adults without symptomatic atherosclerosis, the group with lowered serum LDL cholesterol developed fewer symptomatic and fatal atherosclerotic events compared with controls.

              In placebo-controlled, double-blind, lipid-lowering studies of adults with previous symptomatic atherosclerosis, the group with lowered LDL cholesterol levels after the event had fewer subsequent atherosclerotic events than did the group that did not lower their cholesterol levels (controls).

              LDL receptors were discovered in the liver by Brown and Goldstein, and the absence or decreased numbers of LDL receptors in patients with quite elevated serum cholesterol levels indicates a genetic defect in an occasional patient (3–5).”

              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312295/

              So that’s a broad range of claims for you to investigate, some of which come with ready references for further reading.




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    2. It’s not scientific, nonetheless, it’s rational to assume all saturated fats have the same effect , until proven otherwise. (Aside from that, isolated fats/oils of _any_ type aren’t truly healthy.)




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      1. That is what I’m going with too. I’m just going to eat the fats that occur in plants, with the plant, and nothing but the plant, thank you very much.




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    3. Look at that coconut oil video again. As I recall, only studies funded by the Coconut Industry show no LDL rise with coconut oil.




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    4. I would stay away from CO as well. Here is a study that shows in general how bad some of the popular oils are. (Source: http://www.ncbi.nlm.nih.gov/pubmed/17174226). Once I stopped eating oil, I honestly did not see any difference in taste and moreover, food started to taste better, once you remove “the glove” from your tongue, as Lindsay Nixon from Happy Herbivore calls oils. You taste buds adjust pretty fast and go back to 100K of years of no-oil genetics that is still present in our body.




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    5. Saturated fat in animal products has stearic acid which keeps it from clogging arteries. Clogged arteries are a product of oxidized LDL’s damaging artery walls. High serum LDL is only bad if much of it gets oxidized. When it’s not oxidized, LDL is better for the body than HDL, as a recent study showed, where they raised HDL and stroke risk went up with it so much they had to stop the testing. Coconut Oil, with its MCT’s, is even safer than saturated animal fat. It doesn’t oxidize. Oxidized unsaturated fats turn rancid, and like hydrogenated fats, can damage arteries. The calcifications are made worse with high intake of calcium supplements.

      Well meaning people take extra calcium or large amounts of dairy, trying to get more, and it clogs arteries and actually makes bones more brittle. High Vitamin D intake is also meant to do well, but it causes the blood levels of calcium to rise, also causing heart disease. It MUST be taken with Vitamin K2, which guides calcium from the blood to the bones where needed. There, magnesium helps it bond with bone tissue. So Magnesium, K2 and D3 are what strengthen bones, not calcium supplements or even dairy. The typical diet has enough calcium in it.




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      1. Mark. Please provide sources of those studies, those quoted and any more you might have that shows the LDL, HDL and the CO, as I am interested in seeing the evidence. Thanks.




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      2. Mark wrote: “Saturated fat in animal products has stearic acid which keeps it from clogging arteries.”

        If anyone believes that please view video http://nutritionfacts.org/video/does-coconut-oil-clog-arteries/ that shows beef has twice the amount of myristic and palmitic acid (cholesterol increasing fatty acids) compared to stearic acid (cholesterol neutral fatty acid). The point is that when you eat a food that isn’t all good, you get the good and the neutral with the bad. And when the bad outweighs the good, why eat it?




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  6. Another awesome video. Great support as always. Super video to use in my Statistics class !!!
    Question: I miss having the option to “save” this video to “my favorites” list. Any plans to make that option available again?




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  7. The truth is that lots of people are simply waiting for an excuse to continue eating whatever they want… there was that ridiculous Austrian study that came out at the beginning of last year and the whole world was on to it in no time. These industries are continually producing lies. Great video, thanks.




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  8. Couple questions if anyone can help out. I notice in the video that the HDL levels were down in the low 30’s. I’ve read that a vegan diet will lower HDL because of the high carb component and will also turn the type A LDL’s to type B. Is a high HDL more important than a low LDL? And is this true, or even important about the type A versus type B particles? Lastly, any idea what LDL-P look like for Vegans? I assume it must in the range of optimal(i.e <1,000) ? Thanks in advance.




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    1. When total cholesterol is over 150, it doesn’t matter how low the LDL is, it’s simply too high a total. The real advantage of a low LDL is actually when it’s part of a low total. Perhaps it’s possible to have a total below 150 and still have too-high LDL, but certainly not common.




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        1. Hi Clem. If you have high LDL and low HDL, you are at greater CVD risk than someone with high LDL and low HDL.
          If you have low LDL, your HDL numbers are basically irrelevant. This is because the purpose of HDL to to remove excess cholesterol in your bloodstream and return it to the liver. I had a professor in college who is an extreme whole foods vegan athlete, His total cholesterol is 65, HDL is Zero. This gave his physician great consternation (because the blood tests say HDL should be 60+), however my friend also has a PhD in biochemistry with an emphasis on human physiology. He explained that his HDL was zero because his body didn’t have any excess cholesterol floating around that it needed to scoop up and transport back.

          So the truth is, if your Total is under 150, it doesn’t matter what your HDL is. All the big emphasis you hear about high HDL is based on the idea that “normal people” have a cholesterol of ~200, give or take, and for them (way over that 150 point) high HDL is more important. For example if your HDL is 80 and your total is 230, that’s better than having HDL 30, total cholesterol 200.

          I hope that helps




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    2. But LDL type A is benign and LDL type B is atherosclerotic. You can get an LDL particle test to measure each of these. If you measure combined LDL, and get a high number, it’s important to know which of these it is. If you have high type A LDL, it’s not harmful. But if it’s type B, you should lower the food that causes type B, and that’s omega-6 fatty acids.




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      1. chelmite: This type A and type B you are talking about, is that the same as when people talk about large, fluffy verses small dense particles?




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          1. You did a video recently on sweet potatoes, how the undigested protein from the sweet potato is beneficial for some people. I have autoimmune issues and have been told to stay away from any food that has protein that does not digest completely, as this protein might get into blood and others areas in a form that causes harm or triggers more issues. Do you feel that this un-digested protein in sweet potatoes could be a cause for someone staying away from these?

            Sounds like that this undigested protein is good the reason you highlighted, but bad for others? I do not tolerate sweet potatoes well (swollen glands within day) but would like to add small amounts from time to time with hope my body will adjust. Thank you.




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  9. Fred Pollack did a remarkable evaluation of the Chowdhury meta-analysis for the McDougall Newsletter:
    Part 1, Part 2, Part 3, supplement. Remarkably few (2-3/20) of the included studies had both enough dietary diversity to adequately test SFA guidelines, and avoided overcorrecting for blood cholesterol, believed to mediate much of the atherogenic effect of high dietary saturated fat.

    Travis at Healthy Longevity went still further, correcting a systematic error in the Siri-Tarino paper and recalculating the metaanalysis.




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    1. Those were great, but way too complicated for the general public to understand. Heck, Pollack’s treatment was too detailed for me, an informed consumer, to use myself much less explain to others.

      Dr. Greger puts it in a nutshell. Take a bunch of studies that don’t have the power to determine causality and then truthfully yet misleadingly publish that no causality is determined. Voilà! TIME Mag cover article.




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  10. Saturated fat has a high correlation with animal protein consumption (about 90%). Dr Colin Campbell believes the problem isn’t sat fat, but the animal protein causing damage to the arterial endothelium, or associated TMAO. I still don’t feel like we’ve gotten to the bottom of this issue? Are vegetable sources of sat fat, like olive oil ok? Of course, processed oils and fats contain a lot of calories and few nutrients, so are not healthy regardless of their direct effects on arteries.

    And why don’t population studies have the resolution to discern changes in sat fat consumption affecting serum cholesterol? Does practically the entire population eat enough sat fat to saturate their serum cholesterol levels?




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    1. i think that is better to stick to whole sources of food, so e.g. use little oil and enjoy whole olives instead, avoid “refined” juices for whole juices (with all the part of fruits/vegetables).

      While for your questions about resolution, i have not enough experience to give an answer, but i think that if you look into the article cited by Dr Greger http://www.ncbi.nlm.nih.gov/pubmed/313701 you could understand better the issue, or search a biostatistic, it’s part of their job.




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    2. Skeptic
      That is an interesting question whether all the increase in the risk of atherosclerosis is mediated through cholesterol.
      In my experience intake of animal proteins may play a bigger role.For last seven years i have followed CIMT results in
      patients with pre-existing CHD. I have had some of these patients with LDL-C levels as low as 50 with statins but see
      no regression in plaque as long as patients do not make life style changes to reduce red meat and dairy intake.
      Also in my own case being Statin intolerant my LDL-C is still 140 on 99% vegan diet but CIMT continue to show regression.
      My artery age is 45 at my age of 64.




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      1. An interesting post G-man. Hardly surprising that CHD patients who don’t reduce red meat and dairy don’t regress. Curious what your full cholesterol profile is; Total, HDL and LDL… and do you know your omega 6:omega 3 fatty acid ratio. What level of thickening and narrowing are you talking about and what constitutes regression?




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        1. D.R.
          Before I became Vegan my total cholesterol was 345 with LDL-C of 236. On vegan diet total cholesterol
          is 245 with LDL-C 135.My initial CIMT showed Thickness at .682 and three years later it was .608mm.
          My HDL was 48-52 before I started regular exercise of walking on treadmill 4-5 days a week now it is 70.
          I never checked omega6:omega 3 ratio.Since I never had any plaque regression is decrease in CIM thickness.




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          1. In conversation with Drs Esselstyn, Campbell they almost dismiss the significance of high LDL genetic variants. You obviously have a specific profile and I have wondered what the reduction potential is for this type through diet and exercise. Thanks for sharing. I myself am on the other end of the spectrum and have never recorded above 148 Total, and a vegan diet has dropped it to 113. Available genetic research suggests my profile leads to a typically lower LDL than average. While TC Campbell maintains >150 is an indicator of greater disease risk, thankfully there are exceptions as I am sure you’ll agree.




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            1. D.R.
              I agree.I became vegan after reading CHINA STUDY by Campbell.Based upon my clinical experience it is
              difficult to dismiss high LDL and I still use Statins to lower LDL but it is difficult to establish cause and effect relation
              to cholesterol.It may be just a marker of bad diet and life style.




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                1. D.R.
                  Most of my patients like me have Familial Hyperlipidemia. So epigenetics does not play any role.
                  Mixed Hyperlipidemia on the other hand is associated with obesity perhaps epigenetics plays some
                  role in that.




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                  1. The problem of course is that primary hyperlipidemias are no more than 4% of the population and what is regarded as the acceptable level of cholesterol for the rest is way too high. Many in the 96% are being told they have a familial trait (unqualified) and are ready to take statins while continuing to thickly butter both sides of their bread! Over and out.




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                    1. D.R.
                      You are absolutely right but the problem is patients refuse to change their lifestyle and diet therefore
                      prescribing statins becomes necessary to help them.




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              1. I appreciated your post and story. It is a dilemma for clinicians counseling patients who are eating a whole food plant based diet with no added oils and limited fruit intake who still find their LDL’s above recommended. We need studies on this population to decide if statins or other measures are beneficial. At this point without the studies it is a bit of a guesstimate. It is also nice to see the sharing of your improved arterial wall thickness and the time frames involved. Congratulations on your improved diet and lowered risk status and best of luck with your health.




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                1. Don Forrestor MD
                  Thank you for your post.You are right that we have no studies on people who are vegans and still have high LDL.
                  In my limited experience I find diet is most important component for lowering atherosclerosis.Unfortunately I find
                  that some of physicians i work with comment like “who wants to live to be vegan” they therefore do not even
                  counsel patients about diet.




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    3. Skeptic,

      Dr. Campbell states there is high correlation with both fats (particularly saturated fats) as well as animal proteins in promoting a host of problems, including atherosclerosis and tumor inititation/promotion. He has stated this numerous times during all his lectures I attended. These lectures were at conferences and may not be readily available online. Specifically, he stated there is no safe level of saturated fat intake below which there is no risk for the plethora of disease conditions to occur. The body of research cited is expansive.




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        1. Campbell seems to flaunt his own ignorance in that article:

          “Very simply, I am not aware of any serious evidence on function, which suggests that dietary saturated fat or cholesterol are causes of heart disease or cancer.”

          Serious evidence on function which suggest that dietary cholesterol is a cause of elevated serum LDL? Yes, for instance the work on the LDL receptor by Brown and Goldstein. Not easy to miss.

          Serious evidence on function which suggests that elevated serum LDL is a cause of heart disease? Yes. The pathogenesis of atherosclerosis is an ongoing topic of research, and LDL concentrations are a factor: http://www.ncbi.nlm.nih.gov/pubmed/2044253

          Methinks Campbell is a bit too enamored with his animal protein idea.




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          1. That citation discusses the role of LDL in atherogenesis, but really doesn’t establish causality. LDL is always present to some extent, but what advances the lesion cascade for some people and not others?




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            1. What could make the lesion cascade advance faster for some people and not others? LDL concentration. The concentration of the atherogenic particles modulates the rate at which they infliltrate the artery wall. It’s basic chemistry that all else being equal, higher concentrations lead to higher rates of infiltration, and that higher rates of infiltration would increase the equilibrium level of cholesterol particles in the arterial wall, no? When these concentrations are greater they will tend to drive the lesion cascade at a greater rate, all else being equal. Is there some special property of high LDL concentrations which discourages oxidation within the intima and/or macrophage recruitment?

              It feels almost as if you have entirely missed references to functional evidence of a causal role for serum/intimal LDL concentration to play, at each step of their attempt to describe the atherosclerotic process. Look at:

              1. the second paragraph in “Initial Events…”

              2. the part beginning in the left column of page I-5 with the words “The scavenger receptor pathway was initially identified functionally by Goldstein et al”, as well as the last paragraph of that section

              3. the second paragraph of “The Fatty Streak” up to the bottom of the page, together with the third paragraph of that section

              4. the second paragraph of “Lesion Progression”




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  11. The 2 meta-analysis studies that Dr. Greger refers to are the Siri-Tarino et al one in 2010, and the Chowdhury et al one in 2014 – Right Click on “Sources Cited” to the right of Greger’s video to get links to these. The 2014 study used 20 observational studies, the 2010 one used 16 of these 20.

    Both studies effectively said that the current guidelines on saturated fatty acid (SFA) intake (<10% of calories from SFA) were not justified by the evidence and should be reconsidered.

    These results surprised me since it went counter to all the research that I had previously read. Thus, back in March 2014, I decided to read and analyze all 20 of the studies cited by the 2014 paper. AND, write it up.

    My overview article was part of Dr. John McDougall’s May Newsletter that went online June 1:

    http://www.drmcdougall.com/misc/2014nl/may/140500.htm

    The details are in my supplement (100+ pages). My overview article provides the big-picture view and summary of my findings, and there is a link there to the supplement for download (in case you need something to fall asleep to), or https://www.drmcdougall.com/misc/2014nl/may/chowdhurysupp.pdf. There is one section for each of the 20 studies. Plus, there is one additional section on Finland (begins on page 20). The Finnish story was fascinating. Here are the main points of it:

    In 1973, Finland had the highest country death rate for men from CHD.
    By 2007, the CHD death rate for men dropped by 80% – 3/4 due to a reduction in risk factors.
    The decrease in serum cholesterol was 2/3 of that reduction.
    Saturated fat (SFA) intake went from 22% of dietary energy intake to 13%.
    From 1965 to 2005, butter consumption fell from 40lbs to 7lbs per person per year.

    I was shocked how bad all 20 of the studies were. In a few of the papers that I analyzed very deeply, I found evidence that the authors omitted important relevant information from their papers that would have changed the key findings (JACC [Japan] and KIHD [Finland], specifically). It is unlikely that these were mere oversights. I was also surprised that the peer reviewers of these papers did not pick up on this.




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    1. Wow, thanks Fred for the link to your thorough dissection of all these studies. I appreciate the time and effort this must have taken. A very interesting and eye-opening read!




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  12. It doesn’t take much confusion for most people to “throw up their hands and eat whatever they want”. People _seek out_ whatever “facts” they can find that allow their dietary habits to remain unchanged.




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    1. Maybe so, but for me personally it was the confusion caused by conflicting “science”. I put it in the “too hard” basket. Nothing made sense. That’s because I had degrees in “Food Science” and biochemistry. Along with hard science, I got a full load of received wisdom from the special interests that control the $ flow. So everything was simultaneously true and false. Good and bad.

      We can look to lay blame. I blame our inner apes. That monkey who cant pull his hand out of the cookie jar because he just cant bring himself to drop a few cookies. If we can constrain the human drive toward irrational self-interest we win.




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  13. Greger did you see this article by Katan et al (2010)? The authors pinpointed Krauss for not disclosing his dairy connections.
    http://ajcn.nutrition.org/content/92/2/459.2.full

    However, its worth pointing out that despite the limitations inherent in diet-heart epidemiology, as Stamler (2010) calculated, the RR for SFA and fatal CHD was 1.32 based on 11 prospective cohorts studies. For example, in Honolulu heart study SFA was statistically significantly correlated with MI and CHD death, yet the association with SFA to CHD got diluted when softer end points such angioplasty and chest pain were taken into account. The Krauss team used an RR of 0,86 for the study indicating that SFA protects from CHD :) The very authors of Honolulu themselves stated: “When interpreting these results about whether the nutrients relate differently to the different manifestations of coronary heart disease, one should keep several problems in mind. The diagnostic certainty of the soft end points (angina pectoris or coronary insufficiency) is much less than that of the hard end points (myocardial infarction or coronary heart disease death).This could result in attenuation of a true relationship”.




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  14. I’ve seen a regression analysis published in a major medical journal (can’t find it right now) that shows a hyperbolic vice linear relationship between dietary cholesterol and serum cholesterol. People like vegans who eat almost no cholesterol and then eat even a small amount, experience large increases in serum cholesterol. People who regularly eat substantial amounts of cholesterol and then reduce it a little, experience essentially no serum reduction. The characteristic curve is essentially flat (top of the hyperbola) once a normal level of dietary cholesterol consumption is maintained, so incremental increases or decreases have almost no effect on serum levels, giving the impression dietary consumption levels don’t matter. Perhaps this also occurs with sat fat?




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      1. I don’t really trust the FDA as I have heard many things about them, and believe they are more bothered about protecting companies like Monsanto than peoples health.




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        1. I sympathize with your distrust of the FDA. How about a collection of Harvard nutrition researchers? Mercola cites both the Siri-Tarino (2010) and Chowdhury (2014) meta-analysis. The Harvard researchers (Drs. Walter Willett, Frank Hu, Frank Sacks, Dariush Mozaffarian) were so upset with the Chowdhury paper that held a teach-in last May (http://www.hsph.harvard.edu/nutritionsource/2014/05/15/saturated-or-not-does-type-of-fat-matter/). From that weblink, you can download the powerpoint foils from each of these 4 doctors. For a quick summary of their views in chart form, see 3rd slide of Frank Hu. Also, from the 1997 Nurses Health Study paper (by Frank Hu et al, http://www.nejm.org/doi/full/10.1056/NEJM199711203372102), “Replacing 5 percent of energy from saturated fat with energy from unsaturated fats was associated with a 42 percent lower risk (95 percent confidence interval, 23 to 56 percent; P=0.001).”




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        1. The referenced blog post is a bit long, but let me make it easier for you. Skip the intro. Start with the “The Facts” and read just 10 para’s, which describes how Gary Taubes misrepresented Ancel Keys’ research. Following that is how a long list of “low-carb”/paleo diet folk “copied” Gary Taubes’ mistake. You can skip all that, until you get to the Mercola part.




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          1. Ill have a look when i get some spare time. So just so im understanding correctly, you guys are agreeing that Saturated fats are bad and this article from the science foundation is explaining how people like mercola are wrong for claiming its good?




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            1. Yes, saturated fats are bad. The referenced blog post is by a guy named Seth, who has an MS in Nutritional Sciences. It only makes one point: Gary Taubes misrepresented the pioneering work by Ancel Keys on diet, and that several low-carb/paleo folk (including Mercola) effectively copied Taubes. If Mercola had actually read the Ancel Keys research and the Y&H research, he would have known not to repeat the mistakes that Taubes has made.

              And, well before Seth, Plantpositive made the same points as Seth. The best the source (with detailed references) to debunking the low-carb/paleo diet folk is http://www.plantpositive.com.




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              1. hmm, will defo hav a look when i get a chance. I’ve been trying to look and diet and health in terms of evolution, as it only makes sense our bodies will have adapted to what we have been eating for thousands of years. So thinking of it like that, straight away I would say anything not natural or organic is bad for you (harmful chemicals, additives, preservatives), also things like aspartame, pesticides, fluoridated water etc.

                So that aside I would have thought animal fat would be good for us as humans have been eating animals for a while, and as hunters I can imagine they would eat nearly everything of the animal, organs, meat etc and possibly make bone broth out of the bones. So if sat fat is actually bad for us then that means our bodies haven’t adapted to use it well.

                I know we need high veg and decent amount of fruit and nuts in our diet as well as omega 3 via fish oil. But getting conflicting theories about how your calories should be split up, Currently im under the impression that fat high (not trans fats, vegeatable oils, margarine ,soy oils etc instead replace with cocounut/fish/nut oils and butter), protein moderate, carbs moderate (low sugar and wheat).

                I know im going a bit off topic but interested what you guys think about what ive mentioned?




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                1. Just another vote of confidence for Seth Yoder and his well-qualified blog. His most recent post truly underscore the dishonest LCHF propagandism by “investigative” journalist Nina Teicholz and LCHF proponent Adele Hite. Once you read about the games with words they’re playing, you’ll start to recognize others doing likewise elsewhere.




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                  1. Speaking of Nina Teicholz, I was shocked to find that one of my senior level college classes had her book listed as “required” reading. The instructor had been brain washed by gary taubes and the whole low carb bandwagon came with class lectures. It was a difficult semester to say the least.




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                2. nrostaie: Your understanding of a healthy diet is not supported by the evidence. If you have some more time to check out the videos on this site, I would recommend it. You might want to start with the summary videos:

                  http://nutritionfacts.org/video/from-table-to-able/
                  http://nutritionfacts.org/video/more-than-an-apple-a-day-preventing-our-most-common-diseases/
                  http://nutritionfacts.org/video/uprooting-the-leading-causes-of-death/

                  Here is what a healthy diet looks like based on the available evidence:
                  http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/
                  Butter and fish (or fish oil) are not part of the recommendations.




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                  1. When I menioned fish oil I meant in the form of krill oil. And also if we don’t consume butter then where do we get our vitamin k2?
                    I had a quick look for Vitamin B12 I was under the impression organ meats would be the choice, like liver?




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                    1. nrostaie: I’m sorry it took me so long to respond to this. I’ve been wanting to respond for days.

                      Your question about K2 was interesting since I haven’t seen anyone ask about that before. I went to my trusty reference for specific nutrient questions, “Becoming Vegan Express Edition” by Brenda Davis and Vesanto Melina. These are two extremely knowledgeable (about the science) ladies who care very deeply about people getting the nutrients they need to be healthy, including meeting RDAs (recommended daily allowance).

                      I don’t have time to type out the entire section on vitamin K, but this bit was too interesting not to share: “If you follow popular lay health gurus on the Internet, you may wonder if you need supplemental vitamin K2, since little of this form is present in a vegan diet. At this time, there is no scientific evidence to suggest that vegans need to worry about supplementing with vitamin K2.”

                      What the push for vitamin K2 reminds me of is other stories where out of the blue, with no scientific backing, certain “experts” start proclaim some national crises due to some “deficiency” in the people that is simply untrue. I think Dr. Greger (and/or was it Plant Positive?) has a video on this topic regarding some other substance. It simply defies common sense to tell people that humans need butter (part of the breast milk of another species) to be healthy.

                      I’m not saying that other forms of vitamin K aren’t important. K is very important, including for healthy bones. But here are some healthy/safe foods to get your vitamin K from: 1.5 cups raw spinach or 1/2 cup raw or cooked kale. According to the book I mentioned above, “Leafy greens are vitamin K superstars”. The book includes some nice tables, including a big list of foods and how much nutrients are in them – including a whole column for vitamin K. The book is worth checking out.




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                    2. Thanks for the response. Leafy greens do have Vitamin K but thats K1 which isn’t for bones, its more for helping with blood clotting etc Although the body does convert Vitamin K1 to K2, but I think its a tiny amount.

                      I’m sure Vitamin K2 is beneficial for majority of the public to supplement with. I have checked reviews of Vitamin K2 products with people mention it took there bone pains away, solved teeth problems and many more. If you require scientific backing here is one of the best sites i’ve come across as it is all based on scientific articles,all cited.

                      http://examine.com/supplements/Vitamin+K/#howtotake




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                    3. nrostaie: You referred me to that website before in a different post. After I found that other post again, it was the next one I was going to reply to. I’ll just reply here instead:

                      In the video on this page, I think Dr. Greger did an excellent job of explaining how just because a study is published, that doesn’t mean that the study means anything/has any valid information to share with us. When I looked at the site you referred me to, it seems that they have fallen for just the type of study that Dr. Greger has been warning us about for years. The types of studies that are fatally flawed.

                      My bottom line is: Being able to back up one’s claims with studies is the first level to legitimacy. But that is only the first level. The second level that is equally important, is being able to understand and evaluate studies based on the body of evidence. That’s where a lot of sites fail.

                      If K2 were really important for bone health, there would be a whole lot of whole plant food based eaters, those who have been eating healthy for years or decades now, who have bone problems. They just aren’t. Brenda Davis, one of the authors of that book I mentioned, gets all her vitamin K from dark leafy greens, has been doing so for decades, and has some of the densest bones the tech had seen at her last test. That’s just an anecdote, but my understanding is that bigger studies have shown that vegans who get enough calcium (at least 500 mg a day) have no problems with bone fractures. I just don’t think its true that *dietary* K2 is some big need. At least not for those people skipping the organ meats. ;-)




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                    4. Ok thanks I’ll keep that in mind, as yes I am aware that some studies will be distorted, since there funding source may want them to find something specific. e.g Cereal companies funding experiments and only shining light on any positive they see.

                      Another thing i was curious about, I may have asked already. What do you think should be the distribution between the macro nutrients?

                      Mainstream nutritionists and the NHS here in the UK will advise High carbs, med protein, low fat approx 70/20/10 I believe. On the other hand some nutritionists like Dr Mercola advise high fat, low protein, moderate carbs (mainly from veg) probably something like 65/15/20.

                      I do realise that a lot of nutrients like Vit A, D, E, K are all fat soluble and so they need to come with a fat source to be properly absorbed but not sure how much fat is needed.

                      Your input will be greatly appreciated thanks




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                    5. nrostaie: I follow a set of experts who generally don’t care too much about percentages of macro nutrients, with the possible exception of fat. The experts I follow generally feel that if you just focus on eating all of the right kinds of foods, then you will naturally end up getting the percentages that are good for you – especially of carbs and protein.

                      For examples, here are Dr. Greger’s recommendations:
                      http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/
                      And here are PCRM’s recommendations:
                      http://www.pcrm.org/health/diets/pplate/power-plate
                      Bottom line: Stick to *whole* plant foods in about the proportions PCRM recommends (with B12 supplement) and you get not only what you need, but a diet that is optimum for long term health/disease prevention. It’s very simple!

                      Now having said that, I do have some additional information concerning the various macro nutrients and percentages. Several experts have been able to reverse (in clinical, published trials) some serious diseases like T2 diabetes and heart disease with a low fat diet. Low fat is typically defined as being around 10 to 15%. Those fat soluble nutrients that you mentioned need only a very small amount of fat to get into the body. A few nuts or seeds on a raw salad does the trick. So, that 10% does nothing to hurt your body’s ability to get the nutrients it needs. On top of a whole plant food diet, add a couple tablespoons of ground flax seed to your diet and 1-2 ounces of say walnuts, and I hear from others that that gets them right in the range for a healthy fat % as long as they leave out cooking oils (and of course, animal products and other junk foods).

                      To put the fat question into perspective: My country, America, is dealing with a whole lot of overweight people. So, focusing on diets that are less calorie dense (generally whole plant foods without oils or high fat content) makes a lot of sense. While I don’t know if science has determined for sure that say a diet that is 20% fat is harmful in general (if it comes from whole plant foods), we do know that the more fat people take in over a certain percentage, the harder it is to have a healthy weight (for many people).

                      For an even better perspective on fat, consider this: One of the longest lived and healthiest populations on the planet are the traditional Okinawans. Their diet was about 6% fat. That’s it.

                      I’ll talk about protein and carbs in a separate post.




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                    6. nrostaie: To address your question about the best percentages for protein and carbs, I would start by addressing protein. Here are the resources that I consider to be hugely helpful in understanding protein needs. These are basic primers that I think everyone should have “under their belts”:
                      http://michaelbluejay.com/veg/protein.html
                      …> AND >
                      Dr. McDougall article from December 2003.
                      http://www.drmcdougall.com/health/education/newsletter/archives/
                      You might also check out the January 2004 newsletter article, Protein Overload.

                      Those traditional Okinawans I told you about had about 9% protein. But to drive home the point I was trying to get at earlier, they weren’t interested in eating a protein percentage. They simply ate the right foods in general. It just turns out that their percentages boiled down to about 9%. (I’ve seen other quotes of 12-15% for protein for the traditional Okinawans. So, the 9 number may not be exact. But you get the idea of the range involved.)

                      ———————–

                      If the traditional Okinawans were eating 6% fat and 9% protein, then the rest would be carbs at 85%.

                      My big “beef” (or should I say “banana”?) with people talking about carb percents is that they are lumping table sugar and flour products with whole foods like steamed broccoli (which also has protein, etc.) and beans. It’s a big problem because the nutrition labels on products say, “carbs” without any distinction between what might be healthy and what is not.

                      So, if I were going to suggest to someone that they eat say 75% “carbs” (I’m basically pulling that number out of thin air), I would be severely misleading them. Because cookies and cake have a lot of carbs in them.

                      Which leads us back to my original point. If every day you eat whole (and largely intact) plant foods so that volume-wise over the course of a day, you get about: 1/4 beans/legumes, 1/4 grains, 1/4 veggies, 1/4 fruits (including lots of berries), 1-2 ounces of nuts and seeds (including 1-2 tablespoons ground flaxseed) and vitamin B12, then you naturally get the percentage of carbs (and fats and protein) that you need to thrive with the lowest risk of diseases (as far as diet is concerned) — all in the percentages that you need and with the micro nutrients that you need. You just don’t have to stress about percentages (or calories). (I got the suggestions in this paragraph by combining the advice from Dr. Greger and PCRM based on my own ‘this makes sense’ internal guide.)

                      To do this, it means no or extremely little: meat, dairy, eggs, oils, simple sugars/sweeteners, and highly processed foods.

                      I hope that provides some food for thought for you. I would recommend that you take a look at the movie Forks Over Knives. And these free videos from Dr. Greger:
                      http://nutritionfacts.org/video/from-table-to-able/
                      http://nutritionfacts.org/video/more-than-an-apple-a-day-preventing-our-most-common-diseases/
                      http://nutritionfacts.org/video/uprooting-the-leading-causes-of-death/




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                    7. nrostaie: re: “…for Vitamin B12 I was under the impression organ meats would be the choice, like liver?” I like your “choice” of words. :-) All I can say is, that organ meats would not be the choice for me! I want to be healthy and eating organ meats would not be the safest way to get B12. I don’t know how much you know about B12, but there are some excellent videos and articles on the NutritionFacts website to learn more.




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                    8. lol whats up with my choice of words like? hmm ‘main organs of animals’ (better :P) have a lot of vitamin b12, much more than most other foods.




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                3. Hi nrostaie,

                  A couple points I would make about what you’ve mentioned:

                  Evolutionary health of a species and longevity for an individual of that species are very different things. What we evolved eating that got enough of us to childbearing age to propogate vs what we now know through modern science that we should eat to enjoy a long lifespan and more importantly a long healthspan, may be different.

                  What various peoples evolved eating is highly variable and dependent on where they lived. Though one study Dr. Greger has shared shows that a likely paleolithic diet included over 100 g of fiber and 1000% of the modern rda for vitamin C, both nutrients found exclusively in plants. So, the idea that the hunter half of the hunters and gatherers tribe were supplying the majority of the food at that time, may be flawed. Further, it is somewhat arbitrary to pick a point x years in the past and say that that is the ideal diet. What about the millions of years of evolution that occurred prior? What about changes that have occurred since?

                  Keep in mind that trans fats which you wisely choose to avoid, are naturally occurring in meat, and the recommended intake is zero.

                  Short chain omega-3s can be obtained via flax and chia seeds, and long chain if desired can be obtained through algal supplements, without the biomagnified pollutants (e.g. PCBs) found in fish oil supplements.

                  Many of the readers here follow diet recommendations based on Dr. Greger, Dr. Caldwell Esselstyn, Jeff Novick RD, Dr. John McDougall, Dr. Neal Barnard, and others. They advocate a plant based and overall low fat diet. You mentioned macronutrient (carb/protein/fat) ratios. If you would like some information from a very different perspective than you have likely encountered previously, check out Dr. McDougall, who specifically recommends a very high (complex, starch-based) carbohydrate diet. He has a few books, but also countless newsletters, lectures, and other resources available free online. Best of luck in your health journey!

                  https://www.drmcdougall.com/health/education/




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  15. I want a bumper sticker: “Although our genetics may be different, our biology is the same,…” This statement is profound. This video should win a prize. Understanding these basic facts are key to blowing away the smoke generated by commercial interests.

    This is the one. If you don’t learn another thing about nutrition this year, this is the one to know. Plus other stuff.




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    1. Coacervate: great idea! I forwarded your idea on to staff to make sure they see it. Some people have asked for a t-shirt with Dr. Greger’s famous “We didn’t know…until now. NutrutionFacts.org” I thought we could add your contribution to the list of purchasable options. :-) Some day…




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      1. May have to make an alternate t-shirt for those videos when the situation is more along the lines of

        “we didn’t know… until… oops

        we’ve known since 1979”

        Maybe a Got Lentils? on the back.
        :)




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        1. b00mer: You made me laugh!

          I would totally buy one of those t-shirts too. I’m going to end up with an entire wardrobe. And the beginnings of a whole lotta questions with random people on the street. :-)




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        2. b00mer, Coacervate and Everyone: I have heard that Dr. Greger and the staff at NutrtionFacts.org have been really excited about the t-shirt/sticker ideas that people have come up with. They are researching the idea, starting with an informal pole on Facebook. The following page is a post asking people what designs they would like to see on a t-shirt and to “like” designs that others post that you like also. Everyone (who has Facebook–you can see the page without a Facebook account, but not vote) is welcome to participate!

          https://www.facebook.com/NutritionFacts.org/posts/1019332464749929




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    1. Just looking at it superficially, this line from the authors of the study can sum up the results:

      “isocaloric high-carbohydrate diets and high-carbohydrate meals also promote DNL and hypertriglyceridemia in individuals with insulin resistance. The major product of DNL is palmitate (16:0), a saturated fatty acid (SFA)”

      So they can get away with saying “plasma and dietary saturated fat are not related” by doing a study on 16 obese diabetics being fed carbs of dubious quality, which causes them to synthesize saturated fats even when they’re eating less of them through diet. This also leads to the production of the mono-unsaturated palmitoleic acid. It’s pretty common for these people to use diabetics, who have an impaired tolerance for glucose, to make a misleading study about the supposed benefits that we should believe a healthy person would experience if they were to restrict carbohydrates, even from healthy sources. To make it even more confusing, they confounded much of the data by having the subjects lose weight at the same time.

      Of course this study was performed by industry researchers, with names like Jeff Volek, Maria Luz Fernandez, and Stephen Phinney standing out. The funding disclosure also puts this study into context: “This work was funded by a grant from Dairy Research Institute, The Beef Checkoff, the Egg Nutrition Center, and the Robert C. And Veronica Atkins Foundation.”




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  16. So, I am correct in thinking that even non-animal sources of saturated fat are likely to raise our cholesterol levels? Increased saturated fat intake of any type will result in our bodies generating the production of more cholesterol?




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  17. Hi Dr. Greger,

    I’m a big fan of you and admire your effort in sharing literally vital information with us.

    Could you make a video or write an article on the website, explaining the difference between the effects of saturated fats derived from a plant-based diet (excluding hydrogenated vegetable oils) and an omnivorous diet?

    Thanks and keep up the good work!




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  18. Several years ago, in trying to diagnose what trimmed to be a medical, not a diet problem, I left veganism for a year and tried Palo, including no grains. My cholesterol went from 117 with HDL higher than LDL, to 218 w/HDL higher. Other metabolic problems too. All corrected when I returned to veganism.

    One note about this great video, we should also remember the related impacts on dementia, strokes and cancers.




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  19. Excellent explanation for all the conflicting theories about saturated fats. On concern that I still have is re hormones. Some are stating that, men especially, need cholesterol to be able to produce adequate amts of testosterone. ie eat more meat and be more manly!




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    1. Ken: NutritionFacts addresses testosterone and vegan men in this article:
      http://nutritionfacts.org/2013/02/12/less-cancer-in-vegan-men-despite-more-testosterone/

      I think that article makes it clear that one does not need to eat cholesterol to produce “adequate” amounts of testosterone. The vegan men (who by definition ate no cholesterol) had slightly more testosterone.

      To top it all off, the article explains why men would not want *too much* testosterone anyway – higher levels are correlated with more cancer.

      Does that address your concern?




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    2. It’s quite easy to check it out yourself as i did not long ago experimenting with a vegan diet. I ate pumpkin seeds, walnuts and even consumed a zinc supplement besides various whole grains and legumes. Yet my libido went down as well my strentgh and weight. I asked for advice and was told to eat more…. those same starches, legumes, whole grains etc :-)
      Then I googled for other people’s experience and found many mentions about lower libido, losing muscles and strengh on a plant based diet.
      So it’s easy to check it out yourself and find out the truth. A few months on a vegan diet will do just to make right conclusions ;)




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      1. Ken,
        I did not experience reductions in strength or libido on whole food plant based diet although I did lose 20 pounds (175 to 154 pounds).
        Started Jan 1, 2010 after reading China Study (age 48).

        Three years later weight 172:
        still eating earth balance margin, 1+ quarts soy milk daily, generous peanut butter, you get the point.

        Starting Feb 2014 started true low fat whole food plant based after McDougall conference and reading old Pritikin book.
        The really low fat part required an “adjustment”.
        However, without really dieting or counting calories weight just slowly melted away over about 8 months.
        I really did wear the fat I was eating.
        Currently eat fruits and complex starches ate each meal, fruits for snacks and several servings of greens/nutrient dense low calorie veggies a day.
        Occasional (not daily) nuts in moderation.
        B12 but no other nutritional supplements.
        I live in So Cal and get plenty of sun.

        Interesting part to most men:
        I’m 5’6″ tall; chest went from 48″ expanded to 46.5″, arms same size (I don’t measure but fit t-shirt same), waist 34-35″ to less than 31″ (three belt notches). I did not look “fat” then but was. Buttocks a lot trimmer. BMI went from > 28 to 25 on the nose.

        Power/Endurance:
        dead lift 480 pounds (2010) to 460 pounds (2015)- had not dead lifted since 2010;
        squats don’t know max (max reps @ 225 lbs about same ~ 30)- don’t do often (>20 years knee issues).
        Chin-up/ pull up: 17 then/26 now (full clean legit chin-ups).
        Max endurance time using elliptical or treadmill (65% VO2 & 80 % VO2 estimated by HR/Max HR): more than double. Before diet change I completed treadmill stress test through Bruce stage 6 at 172 pounds- have not retested this but expect would perform better.

        I’m former college wrestler, restarted submission grappling from 2006-20011.
        Using retrospectroscope (youth wasted on the young)- wish I had this diet starting back in high school or college.

        Libido ~ same
        Do feel less aggressive and don’t feel urge to work out as much (don’t have too).
        But do make myself work out- both aerobic moderate intensity, brief high intensity several times a week, isometric and actual weights at least once a week.

        This was my experience




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  20. Fats in general do not promote heart disease, cooked fats (particularly animal fats) and excessive omega-6’s promote heart disease because they are highly inflammatory, and inflammation is what causes heart disease. Raw, plant-based high-fat diets that have a well-balanced omega fatty acid ratio do not promote heart disease.




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    1. The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk. No associations were observed plant or butter SF and CVD risk”. – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396447/

      “Similar intakes of saturated and unsaturated fatty acids between the cases and controls indicated that the consumption of total fat or saturated fat, including that from coconut, was not a predictor for CHD in this food culture. However, the intakes of animal foods, total protein, dietary cholesterol and less plant derived carbohydrates were predictors of CHD”. – http://www.ncbi.nlm.nih.gov/pubmed/15563444

      Tokelauans obtain a much higher percentage of energy from coconut than the Pukapukans, 63% compared with 34%, so their intake of saturated fat is higher. The serum cholesterol levels are 35 to 40 mg higher in Tokelauans than in Pukapukans. These major differences in serum cholesterol levels are considered to be due to the higher saturated fat intake of the Tokelauans. Analysis of a variety of food samples, and human fat biopsies show a high lauric (12:0) and myristic (14:0) content. Vascular disease is uncommon in both populations and there is no evidence of the high saturated fat intake having a harmful effect in these populations”. – http://www.ncbi.nlm.nih.gov/pubmed/7270479




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      1. http://www.ncbi.nlm.nih.gov/pubmed/15329324 – “”RESULTS: VCO obtained by wet process has a beneficial effect in lowering lipid components compared to CO. It reduced total cholesterol, triglycerides, phospholipids, LDL, and VLDL cholesterol levels and increased HDL cholesterol in serum and tissues. The PF of virgin coconut oil was also found to be capable of preventing in vitro LDL oxidation with reduced carbonyl formation.”

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687594/ – “This study showed that VCO supplementation is capable of preventing elevation in blood pressure and also decreasing deactivation of nitric oxide in male rats fed with repeatedly heated palm oil. In addition, VCO does not influence relaxation but DECREASES vasoconstriction of the endothelium”.




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        1. So the first study doesn’t tell you the baseline cholesterol of the rats, and in particular, no low-fat diet is explored. Look at Table 1 of this study, for example, where control Wistar rats on rat chow have an LDL of ~8mg/dL.

          http://www.biochemj.org/bj/234/0493/2340493.pdf

          The second rat study seems interesting, but the array of positive results reported is fairly limited. VCO may be protecting the rats against repeatedly heated oil, but that’s something that no one should be consuming to the tune of 15% energy anyway. Benefits on vasodilation under ad libitum feeding conditions seem real enough, but the baseline diet is probably deficient in the polyphenol fraction, which could be among the things driving the apparent benefits to blood pressure and vasoconstriction. There is no strong indication that VCO would be a good addition to a low fat diet already rich in other sources of polyphenol.

          Assuming that the good would outweigh the bad in some diets is not that hard to imagine, but it doesn’t mean that VCO is a superfood that does something which non-oily foods cannot. The authors report feeding the rats by gavage an amount corresponding to a 10ml dose in humans. 1 T of coconut oil is 117 calories (http://ndb.nal.usda.gov/ndb/foods/show/636?fg=&man=&lfacet=&format=&count=&max=25&offset=&sort=&qlookup=coconut+oil ) so 10ml coconut oil is about 117*10/14.787 = 79.1 calories, or 3.9% energy. This is not the hugest increment in the world, so in a polyphenol-poor, low-cholesterol diet of ‘human pellets’ the added polyphenol fraction might well offset the negative effects of the added SF.




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      2. First study:

        The full quote from the abstract is, ” No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow.”

        That part at the end refers to the authors’ belief that the statistical power may not have been sufficient for finding a substantial association between plant or butter SF and CVD risk even if it were there.

        SF from non-butter dairy sources seems to be better than SF from meat sources in this study, but that doesn’t mean that it’s good. They do some very wonky adjustments in their choice of models. For instance they don’t ever correct for dietary cholesterol, and an advantage of dairy SF over meat and egg SF is that it comes with comparatively less cholesterol. The authors say the association for benefits of increased SF in a regression model strengthens when they go from model 2 to model 3, but note that they are also adjusting for PUFA consumption as they do this. One of the most mainstream recommendations of all is that exchanging SF with PUFA tends to be good for the lipid profile. Model 3 also adjusts for fiber, so the range of things for which the SF calories can be exchanged in a way that would attribute reductions in risk to the reduction in SF is greatly reduced. If decreasing SF consumption is most frequently accompanied by increases in refined carbohydrate, SF won’t look so good in either model. Correcting for trans fat would further amplify the association if the authors’ hypothesis that trans fat in milk is comparatively good is correct.

        The basic fact that they never explore nutrient exchanges between dairy SF (or dairy itself) and unrefined carbohydrate makes this study pretty poor for your contention that high fat diets are better than low-fat diets with respect to CVD risk. Also, looking at table S2, the results for dairy are statistically non significant for CHD risk by, so it’s not clear that the dairy SF is even benefiting all aspects of CVD. It is, at any rate, not shown to be simply a matter of one array of saturated fatty acids versus another. In the words of the authors,

        “In conclusion, we showed that associations between SF and incident CVD
        depend on the food source; the consumption of dairy
        SF is inversely associated with risk, and the
        consumption of meat SF is positively associated with risk. Our findings
        raise
        the possibility that associations of foods that
        contain SF with health may depend on specific fatty acids present in
        these
        foods or the complex admixture of other food
        constituents, in addition to SF.”

        The fact that they didn’t control very well for other food constituents strongly raises the possibility that it is substantially a matter of patterns of nutrient consumption that correlate with dairy SF versus meat SF.




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      3. Second study:

        The population under examination does not eat much of a high fat diet: only 24% energy. They consume pitiful amounts of fiber so the primary exchange for coconut oil and palm oil is probably refined carbohydrate, meat, and eggs. Coconut milk is primarily consumed in fish and vegetable dishes according to the authors, and additional long-chain omega-3 may reduce the CVD risk in this population. In the words of the authors:

        “In this population, coconut (a saturated fat source) is used in the cooking of fish and vegetables. Hence, any potentially adverse effects of coconut-derived saturated fat may be offset by the cardio-protective role of the coconut-associated fish and vegetable intakes in the Minangkabau food culture. ”

        Above all, this is a case-control study, making it only marginally better than a raw cross-sectional analysis. Any associations linking plant sources of SF to CVD are likely to be biased toward the null.




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      4. Third study:

        The Tokelauans eat a high-fat diet more coconuts and have higher cholesterol. How does this support your contention? “No evidence of high saturated fat intake having a harmful effect” may sound definitive in the abstract, but with remote islanders like this, how hard do you think they actually looked? If there were a moderately harmful effect, did they have the power to detect it? The authors themselves have this to say, if you actually read the study:

        “The influence these traditional diets may have on development of atherosclerosis is an important question. Twelve lead ECGs have been taken in both groups and the rate of subnormal Q waves, Minnesota Code 1 and 12 was very low in both groups. The samples of adults on the two atolls are, however, too small for definitive studies of coronary heart disease and vascular disease.”

        In other words, they don’t have a definitive study on coronary disease in this population. Their sample is too small. Combine this with factors particular to the island natives but not general to the postindustrial world, such as genetic drift or cholesterol-lowering parasites, and it is hard to see how you can reliably generalize this to a statement about the healthfulness of plant-based SF for the general population of the developed world.

        Plant Positive made a number of these same criticisms about the study and a few more. You can watch here: http://plantpositive.com/blog/2012/3/27/the-tokelauans-the-samburu-and-the-masai-again.html

        To talk about your style of argumentation currently, one problematic pattern is that you don’t seem to be giving much indication that you have actually read the studies in question. For each study you mine out a single quote, often one from the abstract, and at times selectively, dropping out an important part of the sentence. Even if your quotations were all complete, you show no synthesis. You don’t actually talk about how your studies relate to each other, how they work together in a chain of reasoning to support your claim, and you certainly don’t discuss where your argument could be weak.

        The sort of things that I would like to see to really give credibility to the claim that high-SF whole plant foods like coconuts don’t affect coronary risk would be:

        1. systematic observations (preferably controlled trials) that more coconuts don’t worsen the lipid profile of people with good lipid profiles
        2. cohort studies of reasonably large populations in which substitution of coconuts for unrefined starches is shown to not substantially increase rates of symptomatic CVD or CVD mortality
        3. strong mechanistic arguments that most types of saturated fatty acids have little effect on LDL in humans, provided some aspect of a healthy diet (such as low dietary cholesterol) is in place
        4. intervention trials in which high-SF WFPB diets markedly reduce CVD in high risk groups.

        Otherwise I will tend to assume that coconut oil is, like other refined oils, a relatively suboptimal food from a health standpoint; and that while one could probably do much worse than eating coconuts, the health of high-fat WFPB foods as a major component of the diet is a bit less evidenced than, say, legumes.

        Also, I don’t think you’ve presented any coherent evidence at all for your idea that raw foodism is important for optimal health.




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      1. Specific omega-6’s and excessive omega-6’s are highly inflammatory. Some omega-6’s, such as GLA, are anti-inflammatory but most are not. High amounts of raw, omega-3 fats (walnuts, chia, flax, hemp) do not promote heart-disease.




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  21. Modern medicine has made a consensus health recommendation that supports the recommendations of Dr. Greger in this site that meat, and particularly the saturated fat in meat, is unhealthy.

    people should only get 5%-6% calories from saturated fat
    people should reduce their percent of calories from saturated fat
    people should reduce the percent of calories from trans fat

    Saturated fat and cholesterol has a linear relationship. With LDL = 1.5 times saturated fat intake. Each extra gram of saturated
    fat you take increases your LDL by 2/3 gram.

    In the study presented here, feeding vegetarians meat just once a day raised their cholesterol 20 points in a month to a risk level (LDL about 150 units) for heart disease. After they stopped eating the meat, within two weeks their cholesterol fell the same 20 points. This was just on one piece of meat a day. There doesn’t seem to be any safe level of meat consumption.

    To lower bad cholesterol, this site would recommend

    nuts (particularly almonds), whole grains (like Cheerioes), flax seed meal, kiwi, grapefruit, red yeast rice, dried apples, amla, and beans like chickpeas. The vegan diet is very recommended for heart disease, however, according to Dr. Greger, it is “maybe too effective,” with some people having to add diary or meat back.




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    1. In my book Cheerios may start with whole grain oats but then adds modified corn starch, sugar, Tripotassium phosphate, wheat starch and then a variety of synthetic vitamins, hardly making it a natural healthy food. Read the ingredients on the box. http://www.cheerios.com/Products/Cheerios.aspx Why not just cook up some steel cut oats overnight in the crock pot? Even rolled oats would be a better choice than Cheerios.




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      1. Yes of course. Rolled oats are a very good choice. Eating 48 grams of whole grain is very beneficial, and as you say, unprocessed whole grain should be better! Almost 40 percent of America will never eat whole grains. A single bowl of rolled oats would be statistically more whole grain than most Americans eat in a month. Eating a bowl of oatmeal a day could add as much to your life as jogging four hours a week or eating four handfuls of walnuts a week, according to this site. The FDA claim that Cheerios lower cholesterol is asserted by this site and uses this source: Maki KC, Beiseigel JM, Jonnalagadda SS, Gugger CK, Reeves MS, Farmer MV, Kaden VN, Rains TM. Whole-grain ready-to-eat oat cereal, as part of a dietary program for weight loss, reduces low-density lipoprotein cholesterol in adults with overweight and obesity more than a dietary program including low-fiber control foods. J Am Diet Assoc. 2010 Feb;110(2):205-14.




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        1. Well that last part is the key to understanding the entire study. “Whole-grain ready-to-eat oat cereal, as part of a dietary program for weight loss, reduces low-density lipoprotein cholesterol in adults with overweight and obesity more than a dietary program including low-fiber control foods. ”
          If you compare those who ate whole grain ready-to-eat cereals as part of their dietary program for weight loss to those whose dietary program for weight lose included low-fiber foods, of course the ready to eat cereals would reduce LDL more. But cheerios is still a processed food with sugar and corn and wheat starch. Still like plain steel-cut or rolled oats as a healthier choice.
          Cheers!
          Linda




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      2. And I myself am not too fond of red yeast rice either. Basically a natural statin, which (although to a much less degree) interfere with CoQ 10 production and “possibly” activate the atrogen 1 gene like the statin drugs. This gene promotes muscle breakdown.




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  22. The “study” used by those advocating the use of saturated fat was not really a study at all. Instead, it was advertising dressed up as a study.




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  23. This is one of the best videos you have ever posted! Thank-you. I agree with those that say this needs to be on Dateline or something. It is shameful that influential magazines and even journals are publishing such fraudulent and misleading reports without challenge.




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  24. This is gratifying that the Today show would say here, http://www.today.com/health/avocado-day-lowers-cholesterol-1D80410564
    “The findings are similar to a batch of studies that showed people who were given olive oil and nuts and told to add them to their diets ended up healthier. They were less likely to have strokes or heart attacks, and they were less likely to die over a period of years than people who didn’t get the extra oils.

    Saturated fat – the kind found in meat and butter – has a different chemical structure from the unsaturated fats found in plant products. Repeated studies have shown it raises the risk of heart disease.”

    This must have the same metabolic ward studies that Greger mentioned in mind.
    It also makes me think of how the calorie theory has been proven by similar kinds of studies in which diet is totally controlled. Usually these studies show similar weight loss to similar calorie deficits. The calorie theory is true for everyone, but similarly to cholesterol levels, the required calorie intake level varies by individuals quite a bit.
    I am interested in refuting the low carb crowd on the saturated fat issue, the calorie theory which they deny, as well as their view that exercise is totally inefficacious for weight loss. I lost a lot of weight by controlling calorie intake and exercise. Once I added in an almost completely plant based diet, I lost even more weight and my LDL and triglycerides continue to drop. By the way, being almost entirely plant has not lowered my HDL score as Clem K below noted, which is around 80 now. Exercise is infinitely better for raising HDL than eating saturated fat. I used to have HDL below 20 and it has shot up much further by daily bicycling than eating saturated fat ever could. Probably eating plants is better for lowering LDL than exercise, but exercise is better for raising HDL. Losing 100 pounds has also helped in improving my numbers, but further improvements in diet improved it even more.




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  25. Astounding analysis! This is what you do best. You should really be proud of this sort of work because it not just promotes science, it defends it against its worst enemies: pseudo-science and praying on common misunderstandings.

    I have been wondering about these very things for some months now and every time that people like Gary Taubes speaks, I feel less confident about the subject. Perhaps I should take this quote from him more sceptically than in the past: In the Epilogue to Good Calories, Bad Calories on page 454, Taubes notes ten “inescapable” conclusions, the first of which is:[13]

    Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization.




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  26. How is this video NOT telling me that it is better to eat lean skinless chicken breast than walnuts? I really need an answer to this since I regularly encourage folks to eat walnuts.




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    1. Yesterday (1/7/2015), Dr. Greger posted a short article on walnuts at the care2 website: http://www.care2.com/greenliving/walnuts-improve-artery-function.html
      Excerpt: “Eating at least one serving of walnuts per week may drop our chances of a cardiovascular-related death by 50%.”

      And, he has a good summary about the problems with chicken on this website:
      http://nutritionfacts.org/topics/chicken/
      Excerpt: “Chicken is deficient in antioxidants, phytonutrients, and fiber, while potentially containing excessive salt, flame-retardant chemicals, AGEs, arachidonic acid, paralysis-causing bacteria (that can cross-contaminate other foods and surfaces), and cancer-causing agents.”

      From the USDA website 3oz of skinless roasted chicken breast (about 1/2 of a chicken breast) has the exactly the same amount of saturated fat (0.87g) as 1/2 ounce of walnuts (which is what I eat daily). The chicken breast serving has 73mg of cholesterol vs. 0 for the walnuts. The chicken has 0mg of fiber vs. 1mg for the walnuts. The chicken has ~0.04mg of omega-3s, whereas the walnut serving has 1.3g (as alpha-linolenic acid, ALA).




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  27. Posted this y’day and got no answers. So I’ll try again.

    Couple questions if anyone can help out. I notice in the video that the HDL levels were down in the low 30’s. I’ve read that a vegan diet will lower HDL because of the high carb component and will also turn the type A LDL’s to type B. Is a high HDL more important than a low LDL? And is this true, or even important about the type A versus type B particles? Lastly, any idea what LDL-P look like for Vegans? I assume it must in the range of optimal(i.e <1,000) ? Thanks in advance.




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    1. W.r.t. HDL, Dr. McDougall set it best 10+ years ago in his newsletter, “When one eats more garbage (saturated fat and cholesterol) one may need more metabolic garbage trucks (like HDL) to get rid of it. Eating a stick of butter may raise one’s HDL, but that doesn’t mean chewing one down is good for one’s heart.” Thus, when one switches from SAD (Std American Diet) to a low-fat whole-food plant-based diet (WFPB), one may notice a drop in HDL. On a personal note, when I did this, my HDL dropped ~10%, but my LDL dropped ~30% (6 years ago). My latest numbers: Total Cholesterol is 141; LDL, 75; HDL 47; Triglycerides, 75. No Medications. Only supplement is B12.




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        1. Between 10 and 15%. <10% is optimal (per Ornish and Esselstyn published research) for someone who has heart disease. The most important aspect is to keep Saturated Fat < 5%, which is easy for me to do.




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    2. Clem: Fred did a truly great job of answering part of your question. I believe that the following NutritionFacts video will answer your question about type A vs type B. The video talks about the size of cholesterol particle. I could be wrong, but I think that “LDL size” is the same argument/issue as A vs B:
      http://nutritionfacts.org/video/does-cholesterol-size-matter/

      Bottom line is: worrying about size/A/B of LDL cholesterol is like worrying about whether you should eat beat sugar or cane sugar … or … canola oil vs olive oil, etc. It’s not an argument worth having. None of it is terribly healthy. Keep the focus on the big picture, which is: having an overall healthy eating pattern leads to lower risk factors. In the case of heart attacks, the way to be heart-attack proof is to have a total cholesterol under ~150 and an LDL under ~70. The evidence shows that the best way for most of us to get those low risk factors is with a low fat whole plant food based diet.

      If you want a more detailed look at the issue, here are some great videos from Plant Positive:
      http://plantpositive.com/25-cholesterol-confusion-8-a-l
      http://plantpositive.com/apob-at-the-eating-academy-nus




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    3. If you will scroll all the way back to your previous posting, you will find a few answers and discussion input. You will not be emailed an answer, nor alerted when you enter the site. If you have posted a question and want to check for replies, from the top of the appropriate video page try Ctrl F to Find Clem K. Works on PC, don’t know about Apple.




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  28. IN.CRED.IBLE.
    But also very sad to see the intentional misleading information spread by certain food industries to keep profits up. And the worst thing is that people WANT to believe this stuff, so few look deep enough to find the truth.

    Thank you Dr. G for finding the truth.




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  29. I could only comment on the “video” after reading the transcript first. Please, why the change in video format? I am hearing impaired and before I always had the option of CAPTIONING. (Capitalized for the captioning impaired! LOL!) It hasn’t been available for a while but I was hoping maybe it was just a temporary thing, but not so. Help, this is not good!!! Anyone?




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    1. Hi Charzie, Thank you so much for getting in touch about this. We are working on this as fast as we can. Right now, we’re waiting for Vimeo’s authorization to load all of the captions which are still hosted on YouTube. I’m so sorry for the inconvenience! Switching to Vimeo was an unforeseen event, so we’ve been working hard to get everything back up as quickly as possible. You can still view the closed captioning on YouTube. Our channel is here: https://www.youtube.com/user/NutritionFactsOrg I hope that helps!




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      1. Oh yes Tommasina, that does help immensely, thank you soooo much! In the meantime, may I suggest posting this info in the space adjacent to the video until this is resolved, if possible, so others won’t miss it? I saw the change to Vimeo and didn’t even think of checking YouTube. (I guess ’cause I like it here best! LOL) I really appreciate the quick reply, this is such an awesome site! Thanks again!




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  30. What this video fails to tell you is that there are three different types of LDL. Small dense, Medium and Large fluffy. It has been verified by a multitude of studies, that the large fluffy LDL is actually good for you. What turns your LDL into large fluffy particles? Saturated Fat. What raises your HDL (good cholesterol)? Saturated Fat. What lowers your LDL and turns it in to small dense particles? Sugar, Wheat or any high glycemic carbohydrates. More and more studies are showing that the higher your cholesterol actually means you have a chance at living longer. Thousands of people that have heart disease have shown to have optimal low cholesterol. So why does it still happen? Because its the type of cholesterol you have. Next time you get a blood test, ask for a particle test as well. Vegetables are fantastic for you, don’t get me wrong, but don’t get the wrong idea about saturated fat. There are no controlled studies that actually prove the connection between saturated fat and heart disease.




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    1. Here’s a video (mentioned above by Thea) on the LDL size matter:
      http://nutritionfacts.org/video/does-cholesterol-size-matter/

      …in which you will find, for example, this:
      “Cholesterol, largely transported through the body as LDL-C, has clearly been established as a causal agent in atherosclerosis over many decades of extensive research (10). Regardless of size, LDL particles are atherogenic.”
      http://www.sciencedirect.com/science/article/pii/S073510971204942X

      I look forward to the citations that “large fluffy LDL is actually good for you” …




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    2. Hi Josh,
      Not to be a stickler but when you make a comment like “It has been verified by a multitude of studies, that the large fluffy LDL is actually good for you” you should cite your source. That source should be a well done study.




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  31. Interesting. Someone may have mentioned this already, but the Hooper et al. review paper you discuss only shows a modest decrease in cardiovascular events in men, but no decrease in either cardiovascular deaths or total deaths from all causes. Also very important for 1/2 the population, no changes were seen in women. I also believe that there is a body of research that shows that cholesterol lower than 150 is associated with more cancer deaths. So you are correct, nutrition data is VERY complicated, and I don’t think the answer is actually clear yet. It is complicated to study though, that it seems like it may be a long time before the answer is really clear. One thing I do believe though is that one should eat LOTS of fruits and vegetables no matter what you believe about fat/animal protein.




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    1. If you read the review, a lot of studies with low risk populations were included and with such short trial duration, I anticipate that this would tend to attenuate the benefits. Women in particular were not in the interventions for high risk groups. When SF intakes are only modestly reduced cholesterol levels will only be modestly reduced, and especially over the short term, cardiovascular events may be driven more by the inflammation of plaque than its gradual buildup per se. The authors have this comment about the cholesterol reductions actually achieved:

      “Rather surprisingly much of the total cholesterol reduction in the dietary trials comes from a low risk trial, the Minnesota Coronary trial, as modified institutional food was provided to a vast number of low risk people over only one year on average, resulting in a large reduction in total cholesterol, but with little change in cardiovascular events and a slight increase in mortality. If the Minnesota Coronary trial is excluded the initial total serum cholesterol level within the dietary trials is 6.46 mmol/litre and the mean change in total cholesterol between the control and intervention groups is a fall of 0.47 mmol/litre (7.3%) in the intervention groups, only a third of the total serum cholesterol fall expected with statin therapy.

      This relatively small degree of lipid lowering may be a reason that no significant effect of dietary fat intervention was seen on total or cardiovascular mortality in the short term. The larger number of total cardiovascular events than of deaths provides greater statistical power. There was a suggestion from the meta-regression that a greater degree of reduction of total serum cholesterol resulted in a greater reduction in events.”

      Plant Positive has also covered the Minnesota Coronary Study, and centers much of his attention on this comment about the diets:

      “Procurement of suitable foods for the treatment diet, (with the desired polyunsaturated fat, which were yet palatable, stable, and indistinguishable from the corresponding components of the control diet) presented a great challenge. It was achieved through cooperation of the study nutritionists, the hospital dietitians, manufacturers of food products, and the Food Inspection Division of
      the Minnesota Department of Agriculture. Products that proved particularly useful were filled milk and ice cream, a whole egg substitute, soft margarine, whipped topping, filled cheese, low fat ground beef with added vegetable oil, and filled sausage products.”

      http://atvb.ahajournals.org/content/9/1/129.full.pdf+html

      That is, given the time at which the study was conducted and the lengths to which they were processing oils to make them seem similar to S, one can expect a lot of trans fats, which probably have negative effects on cardiovascular risk above and beyond their effects on the lipid profile. At 45% E from fat and only about 8% E from S with P:S = 2.5, that’s a lot of unsaturated oil to act as an entry point for trans fat. There are probably some good reasons to exclude this study, therefore.

      This issue with trans fats is just one example of the variables which may have confounded the effect of saturated fat reduction.




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  32. Thanks for the reference Kyle. I need to think about reverse causation more, but as for survivorship bias, the Hooper et al review paper did not demonstrate a difference in either cardiovascular mortality or overall mortality in the “less sat fat” group, so I’m not sure that the “survivorship bias” argument would hold here. I think the data is actually very conflicting, and I’m still trying to figure it all out. Some papers support, some do not. So confusing, and I don’t think it’s just the dairy/egg industry that is trying to make it confusing, I think it just IS confusing. And again, it seems that for women, there is no clear evidence that higher sat fat diets cause increased cardiovascular events, cardiovascular mortality or overall mortality. At least not in the review paper that Dr. Greger cites in the video.




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  33. Thanks for the reference Kyle. I need to think about reverse causation more, but as for survivorship bias, the Hooper et al review paper did not demonstrate a difference in either cardiovascular mortality or overall mortality in the “less sat fat” group, so I’m not sure that the “survivorship bias” argument would hold here. I think the data is actually very conflicting, and I’m still trying to figure it all out. Some papers support, some do not. So confusing, and I don’t think it’s just the dairy/egg industry that is trying to make it confusing, I think it just IS confusing. And again, it seems that for women, there is no clear evidence that higher sat fat diets cause increased cardiovascular events, cardiovascular mortality or overall mortality. At least not in the review paper that Dr. Greger cites in the video.




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  34. This is the same principal as using exam league tables in UK schools to judge how well schools are doing. There is no recognition of the fact that children from poorer socioeconomic backgrounds have a different starting point than those of their wealthier peers. This misinterpretation of data allows government to blame teachers rather than spend additional money to give these children the support they need to fill the gap. Use and abuse of data. Must teach my pupils about this tomorrow.




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  35. Dr Greger, what about this group of “doctors” who are saying that cholesterol is NOT the problem, inflammation is. They claim they’ve seen people with cholesterol levels above 500 who are “healthy”. The “Cholesterol Myth” they claim, is false. They are saying that sugar is the reason our bodies put down plaque to protect our arteries from the inflammation. There seems to be a pretty big camp promoting this. I left a doctor because of it. (he himself was obese, not a good example!). My chiropractor is promoting this lie even now. The Atkins diet is a no sugar diet isn’t it? Those people have to have cholesterol levels through the roof, is there any study showing the heart disease rates and other disease rates for people eating a high fat, no sugar diet? There is a big enough group of them out there, they seem to be popping up everywhere because people love to be told that they can indulge in all the meat/dairy they want and still be healthy and trim! http://www.naturalnews.com/035514_cholesterol_myths_heart_doctor.html#




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    1. The current “healthy fats” thing is just a really lazy but surprisingly effective way to sell a bad diet to people. “Healthy fats” used to mean things like nuts and avocados, for which most of the benefits probably actually come from the polyphenols than the actual fats, but you could still say they were a healthy source of fat compared to obviously unhealthy sources like lard and butter. Now fad diet promoters have hijacked the phrase and label high saturated fat foods “good fats” or “healthy fats” to make them sound nice.

      Like I said, it’s just a really lazy way to convince people that obviously unhealthy foods should be considered healthy. Add a “grass-fed” or a “pasture-raised” too and people will think it sounds natural enough that it must be good for you.




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      1. thank you for this. i have tried many diets and fitness but stay stubbornly at the same weight. I have to admit that i have recently been trying the bullet proof diet and find the butter laden coffee in the morning satiates me and i am losing weight as a result. You are saying I shouldn’t be doing this?




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        1. I’m saying for health reasons, drinking coffee mixed with a stick of butter isn’t a great thing to do. For weight loss, if it’s working, I can’t argue with the results, although I don’t think it’s the only option and probably still not the best option. Vegetables, fruits, legumes, and fiberous whole grains would be more sustainable diet choices for long-term weight loss/management.




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          1. Thank you so much. I am very lost in the diet debates and i know quite a lot of science. are you an expert in this stuff? paleo vs vegetarian vs vegan vs dr hymn’s vs perlmutter etc?




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            1. Hi Khawar, below is an excellent presentation by Dr. Doug Lisle, which describes a way of eating that will not only facilitate weight loss, but will also improve those aspects of our health which may not be visible, e.g. protecting us from diseases such as heart disease, cancer, and diabetes. If you haven’t watched them yet, I would also highly recommend Dr. Greger’s year-in-review lectures (~1 h long): “Uprooting the Leading Causes of Death”, “More Than an Apple a Day: Combating Our Most Common Diseases”, and “From Table to Able: Combating Disabling Diseases with Food”. They are all linked to at the bottom of the nutritionfacts home/front page.

              Dr. Doug Lisle: “How to Lose Weight Without Losing Your Mind”
              https://www.youtube.com/watch?v=xAdqLB6bTuQ




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  36. What I don’t understand is the following. If it is al one big conspiracy of the industry. Why does red-meat comes out so bad in all the meta-analysises on cardio vascular disease? Is the red-meat industry not able to hide the results? Dairy comes out not so bad, chicken not bad too (in these papers) however red-meat does comes out bad. I kind of trust the results about dairy, because the researchers ARE able to find a very bad relationship with red meat and CVD… dispite the industry.




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    1. It is not One Big Conspiracy. There is good science and there are good scientists. Industry doesn’t have a limitless power to distort the science, and distorted science tends to be more effective on naive consumers than on experienced academics. There are conflicts within industry and many industries (like the chicken industry) have much to gain by saying they are better than beef or by allowing other people to say that beef is bad. Even pork, a red meat, has promoted itself in the US as “the other white meat”.

      There are in fact meta-analyses out there stating no association between red meat and CHD. Here’s one:

      http://circ.ahajournals.org/content/121/21/2271.full

      It’s making that conclusion based on a grand total of 4 included studies. One of the two studies which found a relative risk less than 1 also found a strongly protective association for sweets, cakes, and puddings. The other is based on a limited questionnaire of eating habits for a population of Australian Aborigines, during a time when they were known to be on a very poor diet linked with poverty, poor education, and low social status in an industrial society — probably part of the reason why none of the items on the questionnaire actually asked about vegetable consumption. I wouldn’t call it a high-quality or particularly informative meta-analysis, but it’s a meta-analysis.




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  37. Attention: Doctors Michael Gregor, Caldwell Esselstyn, Dean Ornish, John MacDougall and others. I COULD USE YOUR HELP!! Not for Myself, but for many thousands of others who will likely follow the same path as my husband and I have. Here’s why.

    Timely video. Yesterday, The Vancouver Sun newspaper (Vancouver, BC) published a story in their “Health” section titled “St. Paul’s to launch Mediterranean Diet Course”. Sounds like a lofty goal that should be beneficial to someone eating a standard North American diet. The problem is that St. Paul’s Hospital cardiology department is setting up this course. St Paul’s also happens to be arguably the premier cardiac center of British Columbia, Canada. Quoting a study published last year in the New England Journal of Medicine which apparently shows that the two groups of patients eating a higher fat Mediterranean diet did 30% better than the low-fat diet group(and who also apparently happen to be more prone to diabetes because they are eating the low-fat diet). For any one interested in reading the article, here is the link http://www.vancouversun.com/health/Paul+Hospital+launch+Mediterranean+diet+course+public/10716642/story.html

    I wanted to write a letter to their cardiology department and am having difficulty pulling together enough information quickly and compiling it into a compelling case for them to give their heads a shake – to take the time to get the truth. Over five years ago, my husband had a heart attack and had two stents put in. He was never told there was any other option. He was only told to eat less and exercise more but with no actual guidelines or parameters. He chose to go on an Atkins type diet. A friend chose the same path. Although they both lost weight, the friend dropped dead of a massive heart attack within a year. So, he went back to the old way of eating, trying to consume less. And of course, he had to take several drugs for blood pressure, cholesterol, blood thinning (all the usual and then all the subsequent additions and modifications until everything was regulated to their satisfaction). He also had to see the doctor every six months for follow-up including bloodwork. He was given copies of the blood work and told everything was in order. But, we now know it never really was. Five years later he was having heart attack symptoms and although he didn’t actually have a second heart attack, he did require a second round of stents. It is to be noted here that the stents were for blockages in arteries that had not been occluded initially. There still remained occluded blood vessels that were insufficiently blocked to require stenting but that after five year also hadn’t gotten any worse. This time the operating cardiologist told him this outcome was to be expected because, afterall, heart disease is a chronc condition that continues to progress throughout one’s life.

    Then I had a stroke. I decided to look for information I needed to improve my health on the internet. And guess what I found? I got real answers. Yes there was the usual rhetoric and confusion on the issue but I found information backed by real studies with real results. I now eat a low fat vegan diet (whole food plant-based and organic as much as possible). Because I discovered that my blood pressure was sodium driven, I eliminted it from my diet. Of course that ruled out virtually every processed food – even vegan. Of course I pay no attention to the sodium found naturally in foods as it doesn’t seem to drive my blood pressure. You won’t actually find much advice to completely stop adding sodium. I have even seen articles stating that to do so could be dangerous. But my intuition told me that if human beings were supposed to eat as much sodium as recommended, well we wouldn’t even exist on this planet. Because, except for people consuming a lot of sea vegetables and sea water, most humans could not consume a level much higher than 500mg per day from real food sources. The drugs I was initially prescribed have all been abandoned in favour of nothing other than food. And my blood pressure and blood work numbers are all in the very best range. The 50 extra pounds I was carrying around literally melted off my body in just over 3 months and has never come back. I can eat as much as I want, whenever I want. No calories to count. No diet to follow. And I feel great. We walk 30 minutes everday.




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    1. Thanks for your other posted reply! Further to your reply somewhat similar to here, well organized community elbow grease with appropriate levers of power can accomplish much with less effort. Metaphorically totally in line with your own new found lifestyle Some offline contact in face of all the delusional stuff going on might make for a better prep regarding this fall. I can be contacted at my full name dot com




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  38. You talk as though cholesterol was a disease. We all want to avoid heart disease but, since that doesn’t correlate with cholesterol, who cares?
    Big pharma has conned us into buying their drugs, not for good health, but for low cholesterol. Billions wasted!




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  39. How do these experts address the curious fact that half of the people that have heart attacks have high cholesterol and half have low???
    How about the study in Denmark that showed the higher the cholesterol, the longer people lived?




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    1. How about citing the actual study or the actual fact with links? Also, it helps to define what you mean by ‘low’. It’s hard to respond to your language at present because it is lacking in important details.




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    2. karl arman: For low to have any meaning in regards to health, “low” has to mean the level which does not cause disease. To truly have low cholesterol, someone needs to have a total cholesterol under about 150 and LDL under 70. At that level, people do not have heart attacks.

      The problem is that the medical establishment has taken the stance that low should be defined in relationship to populations which are dying of heart attacks. In other words, it is not true that half the people who have heart attacks have low cholesterol. Instead, what we know is that the definition of low in the medical community/testing labs is meaningless and that almost all of the people who have heart attacks have high cholesterol. Make sense?

      I don’t know anything about that study in Denmark. As largelytrue requested, it would be necessary to get a link to that study in order to be able to comment on it. And I’ll leave it up to largelytrue if you do. She/he has a great handle on the studies out there.




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  40. You can make all the same arguments about studies funded by the Vegetable Oil industry, the Statin industry, or any others (vegetarians) who have a vested interest in a specific outcome. What you are saying is that your diet-heart theory cant be proven by Observational study so we should accept on faith that SFA’s cause heart disease, even in light of a multitude of other studies that show no correlation. According to your analysis cross-sectional studies present inaccurate conclusions because they are not tightly controlled. However, given the massive amount of data and studies conducted you would have to assume some valid information could be extracted, its silly to suggest otherwise. And yet no correlation can be shown between SFAs and CAD/CHD. We now know that cholesterol is much more complex than originally thought with HDL, LDL particle size ( and fat vs sugar’s affect on it), etc. LDL may be an indicator for coronary risk but its not a very good one relative to others. For this reason its possible that SFA’s affect on LDL may not be as detrimental as once thought.




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    1. What Greger is saying is that one type of statistical study design is generally inappropriate for testing one aspect of diet-heart: namely, the connection between diet and serum biomarkers such as the LDL fraction. There are other study designs which are better for studying the relationship, such as prospective cohort studies or metabolic ward studies.

      Got any references about a biomarker that is a better marker of coronary risk in those who don’t already face a relatively high risk?




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      1. Both HDL and Triglycerides are beginning to get more attention as the superior measures of coronary risk. See the link below (hopefully this site accepts them).

        http://www.functionalmedicineuniversity.com/public/796.cfm

        Also, Metabolic Syndrome has proven to be a very good indicator of risk (HDL, Hypertension, large waist, etc). It does not measure LDL. Lastly, resting heart rate may also be a good predictor. Although not widely used there is compelling evidence that it can predict coronary risk. With every 10 bpm rise in RHR there is a dramatic increase in risk. I like this one because its intuitive. if you have narrowing of the arteries your heart has to work harder to supply blood to the body, hence it beats faster. Both of these are well documented by reputable sources if you google them. Sorry but I am short on time to provide additional links.




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        1. I was specific in asking for a predictor of the variation in risk for comparatively low-risk groups because when LDL is lowered by means of lifestyle, most measures put people in a low-risk category. My last basic lipid panel indicates TC:HDL as ideal according to your source, for example — and on sight alone, it would be laughable to claim that I have metabolic syndrome. The metabolic syndrome is meant to pick out people with relatively high risk (for diabetes especially) within a group of people with fairly high CVD risk on average, as far as I know. A measure that is principally validated in high risk groups over the short term is not the measure that I want for determining my risk over the long term.

          Just look at the table for the controls’ lipids in your references reference about TG/HDL (http://circ.ahajournals.org/content/96/8/2520/T4.expansion.html ). Normotensive, nonsmoking males with the median scores of the lowest-TG quartile would have 10-year MI risk of 1% at age 40(!) according to the Framingham model. Females would have 3% risk at age 70. In reality we know that these basic, well-validated risk factors would probably get worse for these people as middle age progresses. The situation looks even uglier for the other quartiles, to say nothing of the matched cases who actually had MI (whose risk factors and plasma characteristics were for some reason not reported in this study).

          The concern about robust causation is important, too. Something that best signals a problem in the free-living population is not necessarily the best target for treatment or lifestyle management. Resting heart rate may be ‘intuitive’ to you (isn’t LDL concentration also ‘intutive’, especially over the entire lifespan?) and is probably a sign of good health when it’s on the low side, but there are highly relevant ways in which RHR may improve without seriously affecting the risk of MI. After all, you say that it is a marker for stenosis, but functional impairments due to stenosis are not necessary in order to yield a major thrombotic event. And while cardiovascular exercise is generally good for you and a stronger heart can help a lot in giving a lower RHR, the tissue in a strong heart is just as prone to dying as that in a weak one when a feeding coronary artery is plugged by thrombus.

          I could go on in trying to unpack the circumstances in which HDL changes are likely to be good for you versus those in which the changes may have null (or even harmful) effect on LDL risk (something that I’m not fully settled on), but as you say, you don’t have much time even to point to strong reviews of the literature, so I probably can’t expect to get much for myself out of the conversation on this topic. I’ll leave it with my above comments for now and perhaps we can come to this topic eventually if you turn out to have enough of both time and expertise for a useful conversation.




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          1. Intuition is not science, just a personal comment.

            http://www.webmd.com/heart-disease/news/20111220/study-increase-in-resting-heart-rate-over-time-linked-heart-disease-death

            “Increase in Resting Heart Rate Linked to Death

            The study included nearly 30,000 men and women without known heart disease. Researchers measured their resting heart rate twice about 10 years apart. Compared to healthy people whose resting heart rate stayed less than 70 beats per minute during a 10-year period, those whose pulse was less than 70 beats per minute at the first measurement and then greater than 85 at the second were more likely to die from heart disease and other causes after 12 years of follow-up.

            Participants whose heart rate was between 70 and 85 at the first measure and then greater than 85 the next time it was measured were also more likely to die from heart disease or other causes.

            Further study is needed, but the findings may help identify a group of seemingly healthy people who are at risk for heart disease before they develop any other signs or symptoms, the study authors conclude.”

            Note the last paragraph. If your question is how to identify risk in otherwise healthy, low-risk people this shows promise. Like I said, not as widely used.

            Another link, more academic:

            http://www.sciencedirect.com/science/article/pii/S0735109707018232

            With that, I am not sure I completely understand your question/concern. If you are in a low risk group and TG/HDL looks good there should not be a concern. Obviously, nothing in life is guaranteed. Low LDL levels don’t seem to guarantee survival either. BTW, the Framingham risk score has been critisized, I wouldn’t put too much stock in it.

            http://healthland.time.com/2011/09/14/rethinking-the-framingham-score-is-there-a-better-way-to-predict-heart-disease/

            Lastly, I don’t believe these things get worse as you get older. I am 48 and my cholesterol and blood pressure are exactly what they were over 10 years ago. The primary reason they get worse with age in some people is because of inactivity. I am an endurance cyclist and I have no doubt this is why my numbers are stable.




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            1. The exact optimality of the Framingham model was not my primary reason for using it. Use your chiropractic reference’s standard of HDL/TC if you like; the study population is still less than ideal, on the whole. I don’t really see what it is in that news article that has you questioning the predictive power of the Framingham model so strongly, and one of the most notable ways in which the model was suggested to underperform in that article — namely. the increased tendency to respond to a poor score with improved behavior — is essentially irrelevant to a discussion of what should be considered a poor score in the first place.

              The paper on HR is interesting, and as a risk factor which can be readily measured without any special equipment or physician’s help, it has some promising potential. I’m not sure that the extent of the causal underpinnings is yet well understood, but this could be a factor which impacts risk somewhat independently of other factors such as LDL, thus improving predictive power in epidemiological models and the overall causal theory.

              I’m not really sure I understand your concern about misunderstanding my concern. If I’m in a ‘low’ risk group that nonetheless experiences some risk, that means that I would want to understand what causes risk to vary within the group so that I could move toward the shallow end of the pool. Even if I thought myself to be in a zero-risk group, I still have some basis risk because my theory might be wrong; I’ll want to be alert to any sufficiently plausible thing that may knock me out of the group. Even if I have low risk of ischemic stroke and MI so long as I continue as I am, I’m also concerned about more subtle risks (like transient ischemic attack) that could impact my quality of life but haven’t been studied in depth because the symptoms don’t always stand out acutely.

              The reality is that I’d agree with you that much of the climb in TC and LDL with age is probably connected with increasing adiposity and concomitant inflammation. Those without the fat gain will tend to do better. Still, age appears as an independent risk factor in many epidemiological models, largely because atherosclerosis continues to progress on an atherogenic diet and because plaques become less stable as other aspects of aging progress. I’m a bit of a halfling, having eaten an atherogenic diet for much of my life. To the extent that I can help it, I do not want the plaque that I have to become a liability later in life. Because of this and other risk factors which I cannot modify so easily, I’m interested in having a highly protective diet that may also regress some aspects of the physical disease. As long as I’m relatively indifferent to what I eat (healthy food is plenty tasty, cheap, and not that hard to prepare) and as long as I’m not compromising my ability to protect myself from other diseases through diet (the evidence seems to be that the dietary prescriptions for limiting the risk of the most common diseases are largely compatible), I can let my risk-aversion toward CVD run relatively freely so long as I am working with credible evidence.




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    2. “LDL particle size”

      And this is a perfect example of why cholesterol deniers such as yourself are hard to take seriously. We have know for a long time that LDL particle size does not matter and that Large fluffy LDL damages endothelial lining only slightly less but it still damages it none the less. You ignore this fact and spin it as “large fluffy LDL doesn’t cause any damage and is just fine”. That is a lie.




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    1. These types of misleading blog posts appear all the time and are not based on real science. There is a widespread push right now to bring back the dangerous low-carb fad that killed millions including Atkins himself because there is so much money to be made from people who want to hear good things about their bad food choices. We see this happening a lot in blog articles like the one you linked to usually authored by amateur hobby writers with no nutritional background. I would stick to what this site and Dr G teaches.




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  41. What total drivel! Call yourself a professor? There is not connection between cholesterol level and heart disease, that is the point! Read the research and stop being biased. Bias in science renders it non-science, otherwise known as nonsense.




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    1. No it’s not drivel, you have been suckered into believing that Cholesterol is not associated with heart disease. The amount of evidence that it IS linked to heart disease is overwhelming. You just don’t want to hear it and instead get your info from bloggers. You should probably stick to the info on this site and dump the Atkins 2.0 pro-fat bloggers. They are not basing thier posts on any real science.




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  42. Dr Gregor, What is your opinion of the book by Dr Malcolm Kendrick – he is claiming that cholesterol levels are not an indicator for heart disease




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  43. Saturated fat and cholesterol don’t cause heart disease. The people who told you this for years aren’t happy with the truth coming out. The only thing that is “bad” in cholesterol is oxidized LDL, not HDL or even LDL. Weston Price studied people eating massive amounts of saturated fat and cholesterol in places where their intake of high antioxidant foods kept the LDL from oxidizing. High LDL cholesterol is found in people with low rates of cancer.

    It is more important to our health than HDL. In fact, studies where they raised HDL increased stroke risk so much they had to stop the testing. The oils they try to push on you, unsaturated (polyunsaturated) are in fact the quickest to oxidize and become rancid. Rancid oil can make LDL bad. There is so much to it, and this desperate attempt by the nature folks to tell you they were wrong for decades condemning non-oxidized LDL and saturated fat is sad to watch.

    Eat a low meat diet, include coconut oil in place of polyunsaturated oils. It’s a source of energy, doesn’t clog arteries, and the high medium chain triglyceride oil does not go rancid, even at room temperature storage for long periods. In fact, it keeps nearby unsaturated fats from rancidity. Get a lot of anti oxidants from healthy fruits and vegetables or supplements. Eat low glycemic load foods. High glycemic high calorie diets are the top cause of weight gain and that resulting fat storage caused by too many simple carbs is the top cause of heart disease and strokes.




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    1. “Saturated fat and cholesterol don’t cause heart disease”

      Yes, they do. You’ve been reading to many bro-science blogs and profit motivated high fat diet sites. Saturated fat is indeed a contributor to heat disease as well as many other diseases like T2 diabetes, you just don’t want to hear it. LDL particle size doesn’t matter, that is just another smoke and mirrors tactic used by industry to attempt to give saturated fat a free pass when in reality, large fluffy fun happy LDL damages endothelial lining only slightly less, but it still damages it none the less. High fat diets are a dangerous fad. don’t buy into them.




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  44. The video tries to say higher saturated fat intake raises LDL (it calls “bad”) as if it’s bad. But higher LDL levels are found in healthier people, LDL cholesterol is essential for our immune system, and those with higher LDL have lower cancer risk. Oxidized LDL is what is bad, not getting enough anti oxidants in fruits / vegetables, or supplements to prevent oxidation, and high intake of rancid oils (unsaturated oils go rancid, saturated oils like coconut do not) oxidizes LDL. High simple carb / high glycemic diets are also a problem. Eat low glycemic, high organic fruits and vegetables and fiber. Eat low dairy and avoid meat in general (but don’t abstain from it) and try to get more safe fish (low in mercury) or take Omega 3 fish oil supplements.




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  45. Okay, but one thing that those that rec. saturated fat recently have stated, which I agree with, is the negative effects of all the vegetable oils that are often extracted with hexane. So then are we supposed to have no fats? Fat is a necessary ingredient for a host of body functions, hormone regulation, etc… so what’s left?




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    1. Right. Vegetable oils are not healthful be it the hexane or the rancidity or the fact they are pure fat with no fiber and little antioxidants, if any. Nuts, seeds, avocado, olives, coconut flakes, etc are fibrous plant sources of fat containing antioxidants so those could be a choice, as you are correct fat is a necessary component of the diet. Keep in mind even beans, grains, and leafy greens have fat just in smaller amounts, which appears to be the advantageous. We really do not need much fat in the diet.




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      1. Great suggestions. I guess it really boils down to not having ANY processed foods in the diet. Including even the supposed ‘healthy’ options for chips and crackers. I have zero meat, but still some cheese and yogurt, but I will look at that as well. Thanks for the information.




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  46. I kinda understand the dogma of cholesterol. I see it as though plaque build up starts as early as childhood. If you as a child and even into your younger years have high cholesterol, the damage is done then. Then later in life you start a healthier lifestyle or by accident just choose a healthier diet, you still have the reprecussions of what you did in early life. Then when these individuals have cardiac events, whats recorded is the NOW. The cholesterol is good. The saturated fat intake is minimal as recorded. The given is they had already done what was needed as far as plaque and then given that age progresses smaller arteries, you get recorded as a healythy lifestyle but had an cardiac event. I dont know this as fact, but I do know from medical journals that state that arteriosclerosis starts in your youth. I remember the guy that started the running revolution for better health and lifestyle and wrote many books on running, died of a HA while running. Even though he had changed his lifestyle, he had been a chronic smoker and overweight most of his life into middle adult hood




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  47. Hello,

    I have seen your videos on the ‘Saturated fats study’. One question that I believe is worth addressing is the effect of grass fed non-pasteurized milk and its relation to the negative effects of saturated fat consumption.

    Many pro raw milk enthusiasts claim that the butterfat from organic grass-fed non-pasteruized milk is substantially different than normal everyday butter. The differences include a claimed significant great amount of Vitamin K2, omega 3 fatty acids, and conjugated linoleic acid (CLA); all of which apparently mitigate, and even improve heart health.

    Can you speak to this claimed difference?

    Thanks




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    1. I think in another talk Dr Greger compares it to eating a Mars bar or a Snickers bar. The latter has nuts in it, which ostensibly would make it “healthier”….but it’s still a candy bar. The harm is not being outweighed by the “benefits”.




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  48. I wonder, maybe it’s you who refuses to accept that you were wrong and not the people who designed these studies. Here is another one for you, and this one isn’t sponsored by any “big butter” industry: https://news.osu.edu/news/2014/11/21/study-doubling-saturated-fat-in-the-diet-does-not-increase-saturated-fat-in-blood/
    How about you show a study that saturated fat increases the number of heart attacks, not just LDL cholesterol (because while it increases LDL-C it also increases HDL and decreases LDL-P), but actually reduces the number of heart attacks. You cannot. There was only one old population study that did it, but it was very flawed because it selected the countries for comparison that supported that saturated fat is bad, and deliberately omitted countries like France and Skandinavian countries where consumption of saturated fat was higher but the number of heart attacks is lower. The truth is – there is ZERO evidence that saturated fat is bad.




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    1. ” this one isn’t sponsored by any “big butter” industry”

      Actually it’s supported by a lot more than Big Butter. Here’s the study: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113605

      “Funding: This work was funded by a grant from Dairy Research Institute, The Beef Checkoff, the Egg Nutrition Center, and the Robert C. And Veronica Atkins Foundation.”

      As for the study itself, the industry funded researches took diabetics and played around with amount of (presumably refined) carbs in their diet, and found that circulating levels of saturated fat were similar even when dietary saturated fat was lower. These lines from the study explain the findings:

      “A consequence of consuming dietary sugars and starches above levels that can be directly oxidized is that a greater proportion is converted to fat (i.e., de novo lipogenesis). isocaloric high-carbohydrate diets [4] and high-carbohydrate meals [5], [6] also promote DNL and hypertriglyceridemia in individuals with insulin resistance. The major product of DNL is palmitate (16:0), a saturated fatty acid (SFA),”

      So the industry funded researchers did their study by feeding junk food to people who have a disease that doesn’t allow them to process glucose properly, then noted that this caused them to produce high amounts of saturated fat from the carbohydrates they were fed. The concern raised by the study essentially admits that high circulating levels of saturated fat is a bad thing, but they still try to make a high saturated fat diet sound like the winner.

      As for that “old population study,” this article can clear things up for you

      http://plantpositive.com/blog/2014/6/28/how-time-magazine-sacrificed-its-standards-to-promote-satura.html

      The work of Ancel Keys obviously isn’t the only studies scientists have considered to say that saturated fat is bad for you, but it’s worth clearing up how that study was actually conducted. Certain countries were excluded from the final analysis because their data simply wasn’t reliable/usable. Keys also dropped data from some countries that would have supported his fat hypothesis because he knew it might be flawed and skew his results. You need to have some skepticism when you read the claims of the saturated fat deniers. They don’t give an accurate view of the science.




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      1. ha–gotta love when the answer to the very premise of the argument (that the study wasn’t funded by a competing interest) is readily apparent and obvious right away. Well played, Nfc:)




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  49. Dr Greger, I’m not sure I’m following your logic: you are saying that there is great variability between different people in their LDL levels. Well, if this is the case, then people with genetically low LDL baseline, can safely eat saturated fat?
    If the noise is so large that you cannot observe health as a function of the saturated fat intake, it means that a lot of people can enjoy croissant… They just have to check their baseline LDL before. I’m not sure that’s what you meant to present.




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  50. This is for animal fats. Any studies on coconut oil and red palm oil? Also, can Dr. Greger please address correlation versus cause and effect relative to increase risk of cardiovascular events and what they are related to? For example, I recall exotoxins from animal products being a causative factor for inflammation and the corresponding cascading of events with endothelial damage, which is then spackled over with cholesterol as a repair mechanism.




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  51. Trying to spin the old saturated fat = dietary cholesterol = cholesterol in blood = heart disease manufactured by the Ansel Keyes and his flawed study in the 70’s (i think). When we lowered sat fat and added grains and fake food, we are now obese. Anecdotally, just look at pictures of folks in the 40’s through the 70’s. Lots of butter and sat fat but not combined with high levels of grain and sugar.




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    1. LOL! Its not spin Christie… It’s what the actual data suggests when not tainted by the meat, egg and dairy industry…. and on a side note, grains are great! I eat oatmeal every day or buckwheat. Nothing wrong with grains. as seen here..

      ~~~> http://nutritionfacts.org/video/alzheimers-disease-grain-brain-or-meathead/

      There is much evidence that cholesterol that goes in your mouth = raise in cholesterol in the blood = heart disease. You should probably stop listening to opinion bloggers and industry funded fake science. Dr Greger has many videos on the subject. here are a few…

      http://nutritionfacts.org/video/trans-fat-saturated-fat-and-cholesterol-tolerable-upper-intake-of-zero/

      http://nutritionfacts.org/video/can-cholesterol-be-too-low/

      http://nutritionfacts.org/video/heart-attacks-and-cholesterol-dying-under-normal-circumstances/




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  52. Despite the push toward grains and sugar, and statins and lowering cholesterol, heart disease remains the number one cause of death since 1935 (probably when they started recording such) and alzheimer’s has steadily risen. Maybe better diagnosing but the brain needs cholesterol! Lower cholesterol? Maybe not. People who have low cholesterol have the same rate of heart attack as do high cholesterol.




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    1. I don’t think there is a push towards sugar… That we can all agree on.

      The body makes all the cholesterol we need. There is no need for added dietary cholesterol in the diet.




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  53. What is Dr. Greger’s opinion on Colin Campbell’s contention that saturated fat and cholesterol do NOT cause heart disease?

    http://nutritionstudies.org/fallacious-faulty-foolish-discussion-about-saturated-fat/

    He postulates that animal protein is a more likely cause, but that, more importantly, the combination of nutrients in animal products and the reduced consumption of plant foods are the true causes. Trying to isolate the cause to a single nutrient, such as saturated fat, is moot.




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    1. The good Dr Esslestyn wrote a response to this misleading study here. The meat, egg and dairy industry are powerful and have deep pockets to keep churning out bogus studies like the one you linked to here. We must stay vigilant as these types of wolf in sheep clothing “pro fat” studies are everywhere…

      —————— quote snip! ————-

      Caldwell B. Esselstyn, Jr., M.D.
      Director Cardiovascular Disease Prevention and Reversal Program
      Cleveland Clinic Wellness Institute
      1950 Richmond Road
      Lyndhurst, Ohio 44124
      Andrew Freeman, MD, FACC

      “Much work has already shown adverse outcomes from too much
      saturated fat in the diet, in addition to the development of diabetes,
      heart disease, and other cardiovascular events. As such, your work
      published here has gone too far in that anytime one over-adjusts for
      important variables, the real data and trends become hidden. it is
      analogous to over-smoothing an image — the granular image becomes so
      smooth it obscures some of the salient features.

      As the authors indicate in their own work, a 5% increase in saturated
      fat increased mortality by nearly 5% — this is a highly important trend
      that was not included in the final conclusions.

      Furthermore, recent work (1) reported experience eliminating
      saturated fats in 200 participants with significant cardiovascular
      disease. They were requested to eat whole food plant based nutrition
      and avoid oils, meat, fish, poultry, dairy products, eggs, and sugary
      drinks. After 3.75 years of follow up highlights of the 177 adherent
      participants included:

      1 Program adherence 89.3%
      2 Elimination of major cardiac events (heart attack, stroke, death) 99.4%
      3 Resolution of angina 93%
      4 Evidence of disease reversal via angiogram,
      carotid ultrasound, stress test, resolution of claudication and erectile
      dysfunction.
      5 Twenty-seven participants successfully avoided
      previously recommended interventions of stents and bypass surgery.

      This study, the pioneering work of Ornish and more recently others
      employing similar techniques, makes it inconceivable to embrace
      saturated fats and disagrees with the findings of De Souza, et al.

      Co-chair, American College of Cardiology Nutrition Workgroup

      Director of Clinical Cardiology, National Jewish Health, Denver, CO

      1. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A Way
      to Reverse CAD. The Journal of Family Practice. July 2014 Vol 63, No 7
      page 257




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    1. james: Does cholesterol size really matter? This question is answered very well right here:
      http://nutritionfacts.org/video/does-cholesterol-size-matter/

      It looks like authority nutrition is not an authority on nutrition at all. I checked out the first part of the page that you linked to. It starts out with a lot of the same miss information that you see on paleo/Weston Price sites. The following set of videos from Plant Positive goes into great depth/research into those very issues and shows how the article you point to is simply incorrect. For example, there is very clear, non-controversial evidence that Keys did not cherry pick. To learn more:
      http://plantpositive.com/
      More specifically, this video addresses the Keyes question on cherry picking:
      http://plantpositive.com/4-the-journalist-gary-taubes-4




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    1. The link you supplied is exactly the type of dangerous pseudo-science cholesterol confusion-ism that is talked about in this video. People like Siri-Tarino are paid by industry to produce bogus studies in an effort to confuse the public just enough so they will keep eating meat, eggs and dairy. The ajcn study you posted about is a famous one that has already been audited and found to be misleading and false. Here is one of my favorite dissections of that study. To find the truth you need to dig deep to get past the meat, egg and dairy funded pseudo-science.

      here ~~~> https://www.youtube.com/watch?t=18&v=a-Tx9dCbv-g




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  54. I love the Atkins Association mention. I’ve watched this video a few times, but didn’t recognize that until this play through. Atkins made hundreds of MILLIONS killing American citizens slowly, and happily. I feel that mean was consumed in cognitive dissonance.




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  55. It would be very helpful if you would list the sources you cite under the video, so people can follow the links and research what you say. Thank you




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  56. I’m a devoted follower of Dr. Greger and this wonderful website. But speaking of saturated fat studies, today was day 1 of Dr. Mark Hyman’s Fat Summit. Hyman is challenging the idea that saturated fat is bad for you (it depends on where it comes from, he says; from fast food, bad, from organic grass-fed animals, good), that high LDL cholesterol is a problem (it’s not if your HDL is high, he says, and good saturated fat raises HDL), that keeping your consumption of fats in general low is in any way beneficial (one speaker today said he is careful to eat 7 or 8 tablespoons of olive oil every day), and, among much else, that a WFPB diet is any better than a high quality Paleo diet. I listened to the sound tracks of the the’s summit’s first day videos and I have to say they sounded very convincing, leading me to wonder if I have vegan blinders on. So this is a heads up, and a cry for help. In my opinion, I hope Dr. Greger and staff are monitoring the Fat Summit carefully because it is directly challenging, in a pretty convincing fashion, the conclusions Dr. Greger has been advocating, also very convincingly, for years. Today’s videos, for example, were careful to cite studies to back up the conclusions being presented very much the same way Dr. Greger does. In case it will help, here is a link to an article Dr. Hyman sent out today on how eating good quality meat is good for you (in addition to lots of veggies), and near the bottom, the article contains a link to the Fat Summit home page. Article URL: http://drhyman.com/blog/2016/01/22/is-meat-good-or-bad-for-you/.




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  57. This strategy, on the part of the meat, dairy, egg industry is classic agnotology- the study of willful acts to spread confusion and deceit, usually to sell a product or win favour. (From the two root words -Agnosis, the neoclassical Greek word for ignorance or ‘not knowing’, and ontology, the branch of metaphysics which deals with the nature of being.)




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  58. This is assuming that high cholesterol is bad. Here is a video claiming that high cholesterol is good and that it is inflammation that is the culprit, not the cholesterol. Their claim is that it is the inflammation that causes the cholesterol to stick and build up. Can some clarity be advanced toward a better understanding of this? Please and thank you. https://youtu.be/sGIGXfIDaJo




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  59. Whilst high fat diets from animal sources which include saturated fat cause disease and reduce telomere length can the same be said for high fat diets from plant sources? I am interested in the affects saturated fat from nuts, cacao and coconut etc have on health? Some reports suggest that a high fat diet from nuts, cacao etc. have anti ageing (skin) effects, is this true?

    Having watched the various videos on nuts, cacao etc. that you have online, they seem to suggest that nuts cacao etc. are good for the health due to antioxidants etc. but what about the fat contained within these food sources? Is it indeed another helpful component of these items or is the fat a negative point which is somehow negated by the positive health benefits such as high fibre etc.

    Online you hear Doctors advocating high fat diets from healthy fats including saturates, what are your thoughts? I am looking to include 50g walnuts along with my seeds to help with skin ageing after watching the most healthy nuts video. ( I currently have pumpkin seeds or hemp seeds usually 50g)




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    1. Great question! I have a post that links to many other videos that help tackle this. Can you let me know if this post on coconut oil helps? Here is a great video by Dr. Greger that explains the research between nut intake and body weight. Make sure to checkout the bottom of the video’s “Doctors Note” to see more links and info. Lastly, a follow-up to that video is solving the mystery of the missing calories, which may also help.​

      I think walnuts are just fine and there is abundant research to suggest including an ounce (28 grams) into your daily diet. Pumpkin seeds, too. Some folks may get into trouble by eating too many nuts and seeds, but for most people the quality of the food (whole walnuts and pumpkin seeds) matters more than the quantity. Of course it depends on what else is consumed. Anyway, check out those videos if you haven’t seen already and search the Health Topics button above for more info on “skin health” and “walnuts.”




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      1. Thank you very much for your message. The videos and information is very interesting but they do not seem to give a definitive answer, is high fat (incl saturates) from plant sources good, bad or indifferent for our health?

        Thankfully I’m not in the overweight category so I think the nuts should be fine in terms of calories.

        The skin and anti agng videos seem to point towards high veggie consumption with little mention of whether a high fat diet could actually improve wrinkles and slow the skin’s ageing. Perhaps worth a little deep dive video?




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  60. if I only eat vegetables & beans/ lentils all day, how do I get my sources of fat? What sources would you recommend? In terms of “real foods”, I thought of olives, tofu & avocado, as well as the fat that I use to stir fry (avocado, coconut oil, organic grassfed butter). Thoughts?




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    1. david: Some thoughts for you: Even broccoli has a good amount of fat in it. And dark leafy greens are a good source of omega 3s in the context of a low fat whole plant food diet. And soy beans are a high-fat food. And while some people need to each high calorie dense foods in moderation, avocado is also a whole plant food option, one which is high in fat.
      .
      But you will note that Dr. Greger does not recommend you eat only veggies and beans all day. He also recommends a serving of flaxseeds (1-2 tablespoons ground) plus a serving of nuts (1/4 cup whole nuts or 2 tablespoons nut butter). These are very high fat foods.
      .
      One confusion a lot of people have is equating a diet of no oil and processed food with being a diet that is no fat. A balanced diet of whole plant foods have plenty of fat. Hope that helps!




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  61. Wouldn’t it depend on what the source(s) of saturated fat were in these experiments? For example, meat vs. dairy vs. coconut oil? Vegetarians’ cholesterol went up when eating MEAT. That doesn’t prove it was the saturated fat in the meat.




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  62. It is interesting that the pro-fat advocates are still spreading their deadly message. In the UK, the self-styled National Obesity Forum – apparently it is legally a charity – is the latest vehicle for this campaign. Charity or not, it is clear where the financial support for such efforts comes from:
    “The National Obesity Forum says it is an independent organisation that receives professional and financial support from the food industry, pharmaceutical companies and medical bodies.”
    http://www.bbc.com/news/health-36345768




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    1. Tom Goff: Your post particularly resonates with me since I recently saw the following video titled, “Dr. McDougall, Your Fired!” Dr. McDougall had been invited to talk at some kind of obesity conference and he got uninvited after seeing what he was going to talk about. It’s a short video about what happened and exposing the conference for what it is: https://www.youtube.com/watch?v=M6vbr_adABM It’s not just happening in the UK!




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  63. Thank God for Dr. Michael Greger! In 2016 a Google search on saturated fat will give you pages of results from the leading blogs and popular doctors’ websites that saturated fat is now “good” for you; this is nonsense. I am very thankful Michael Greger is dispelling the deception from Big Dairy, the American Egg Board and the meat industry, whose misleading studies contradict the long-established evidence of saturated fat’s relationship with raising LDL cholesterol. As Dr. Greger puts it, they are “buttering up the public.”




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  64. Thank God for Dr. Michael Greger! In 2016 a Google search on saturated fat will give you pages of results from the leading blogs and popular doctors’ websites that saturated fat is now “good” for you; this is nonsense. I am so thankful Michael Greger dispels the deception from Big Dairy, the American Egg Board and the meat industry, whose misleading studies contradict the long-established evidence of saturated fat’s relationship with raising LDL cholesterol. As Dr. Greger puts it, they are “buttering up the public.”




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  65. I have been on a statin for years to lower my cholesterol. After 6 months on a whole food plant based diet, I stopped my statin and my cholesterol went up to 237! I was still on a whole food plant based diet, very close to the recommendations in How Not to Die. How can this be?




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    1. Thanks for your question Linda,

      I would suggest you consult your physician not regarding diet but to actually see if you do not have some underlying problem regarding normal blood cholesterol levels.

      To ensure that you are following your diet correctly, How Not to Die is a great source of information but for a complete evaluation, speak with your Registered Dietitian.

      Hope this answer helps.




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  66. Many Paleo/Ketosis types post their blood profiles and unless they are all lying do not support these observations.
    What is a layman to think. You have vegetarians throwing loads of studies at you to prove they are right,and then on the other end of the scale the Paleo types doing the exact same but in favour of their diet. Is there a good debate somewhere between best intellectually honest proponents of each side somewhere?




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    1. praxeologue: re: “Many Paleo/Ketosis types post their blood profiles and unless they are all lying do not support these observations.” I disagree. Even if they are all telling the truth, most of the brags I have seen from the paleo/ketosis types are actually unhealthy numbers. The people making the brags just do not acknowledge what risky waters they have put themselves in.
      .
      re: “You have vegetarians throwing loads of studies at you to prove they are
      right,and then on the other end of the scale the Paleo types doing the
      exact same but in favour of their diet.” While I agree that paleo types throw loads of studies at you, that does not mean that the studies do a good job of backing up their claims. While I don’t know about a debate to follow, I do know a great site that investigates the claims made by paleo advocates in detail. If you want to get into the nitty gritty, check out the very scholarly videos on http://www.plantpositive.com.
      .
      I agree that it can be very hard on a lay person to figure it all out. I found several ways to make judgement calls myself. For example, note that Dr. Greger makes *no* money off this website, his books, DVDs or speaking engagements. His time on this site is a donation to people who want to learn about the body of evidence for nutritional science. The lack of conflict of interest is a good sign. Combine that with the number of people who check Dr. Greger’s work and this site becomes a pretty reliable source of information.
      .
      The first part of the following NutritionFacts video explains another way to judge: http://nutritionfacts.org/video/taking-personal-responsibility-for-your-health/ When there is only one proven diet that fixes our number one cause of premature death, that’s pretty compelling.
      .
      Hope these ideas help.




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      1. Thea
        Thanks for the reply.
        Your response is really saying exactly what I have noticed.
        So sure you can find Paleo braggarts who exaggerate but I am sure the same applies to vegetarians. There are intellectually honest ones out there who are not sponsored by bacon or coconut suppliers.

        As you an Tell I do read the research if those I may not agree with by the fact I am on this site. As you identify yourself it seems you haven’t looked very hard for the good arguments and data presented by the respectable Paleo types. If your only view of their argument is from this site and others as you suggest maybe you should try and look at the other sides ?

        You notice even the very slow to change NYT and BMJ are turning their views in a decidedly Paleo direction? Is that likely because they are just fools and can’t read the data or else they are blinded by lobby groups?

        I notice the Oaleo guys use the same arguments as to why carbs /grains/ sugars are or were recommended basebof food pyramid.

        Many Paleo and vegetarian problems with mainstream diet heavily overlap and my guess is a less extreme Paleo diet with plenty of plant based foods and occasionsl fasting is likely a very good path.




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        1. I have actually looked at the other sites directly. I found them lacking in logic and not backed up by the science. Not all arguments/sides are legitimate just because they exist. At some point, after doing due diligence, it is OK to say that a perspective is generally invalid. That’s what I have done.
          .
          By NYT, do you meant the New York Times? If so, that’s interesting. I don’t consider a newspaper to be a legitimate source of information about science, especially nutrition science. The media is out to make headlines and tell you what you want to hear. They have no ability or interest to understand the science. It’s also very interesting that you mention NYT and BMJ, equating them in the same sentence. You might want to check out the following information about spin in both the media and medical journals: http://nutritionfacts.org/video/spin-doctors-how-the-media-reports-on-medicine
          .
          Equating grains to sugars tells me that you have already bought the paleo arguments hook, line and sinker. It also tells me that while you may be on this page, you have not yet learned or absorbed the information on this site. Of course, where you go from here is up to you. I do highly recommend that you check out the videos on http://www.plantpositive.com as they directly address the claims made by the cholesterol denialists. Good luck!




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          1. May I ask who the most reputable source you read advocating Paleo diet was ?

            I don’t buy extreme Paleo lifestyle as I said but there is a lot of truth to their basic claims andI think extreme claims on both sides are obviously invalidated by the evidence of the blue zone diet of longest lives humans who do neither.

            Shouting ‘my science beats your science’ and ‘media and medical journals are all biased unless they agree with me’ will convince no one I’m afraid.




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  67. My business partners required ID RE-21 last year and were told about a web service with a searchable forms database . If others need ID RE-21 too , here’s https://goo.gl/YfNmhr




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    1. Thank you for posting the article and your interest in this tremendously misunderstood, complex, chronic disease and efforts to counter the all too common and unfortunate biases around weight and obesity. As you are aware, Dr. G has many videos addressing various aspects of the weight issues society is facing. There is also a fantastic website for both health professionals and the public to get support around this issue, the Canadian Obesity Network. Dr. Arya Sharma blogs on obesity topics/research. Check it our at http://obesitynetwork.ca/




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  68. Scott: Some time ago, moderator Rami put together some great info about ketogenic diets. I copied the information below for you.

    I will also add that the evidence against saturated fat, especially from animal products, is overwhelming. This site covers that information in great detail. http://nutritionfacts.org/topics/saturated-fat/ As you can see, it’s even bad for the brain… But as you know, it can be hard to communicate such information even to people who are open to hearing it. I don’t know that you would have much luck communicating this wealth of information to someone who simply does not want to hear it.

    It was nice to hear from you Scott. All the best to you.
    ******************
    FROM RAMI:

    Ketogenic diets (very low carb, high fat) have been shown to be helpful with children with epilepsy for the short term. All other aspects of the diet for the short term show ill health effects. Its not something you want to put your body through. I will share the SHORT TERM evidence below. The long term evidence is also damning, but here is short term data.

    “Cognitive Effects of Ketogenic Weight-Reducing Diets,” researchers randomized people to either a ketogenic or a nonketogenic weight loss diet. Although both groups lost the same amount of weight, those on the ketogenic diet suffered a significant drop in cognitive performance.After one week in ketosis, higher order mental processing and mental flexibility significantly worsened into what the researcher called a “modest neuropsychological impairment.”
    http://www.ncbi.nlm.nih.gov/pubmed/8589783

    A review over low carb diets revealed that “Complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities can all be linked to long-term restriction of carbohydrates in the diet.”
    http://www.ncbi.nlm.nih.gov/pubmed/14672862

    Low-Fat Versus Low-Carbohydrate Weight Reduction Diets
    Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial

    This study looked at 24 people who were overweight/obese and divided them into 2 groups. One group was low carb, high fat and the other high carb, low fat.
    High carb group: 20% calories from fat/60% calories from carbs
    Low carb group: 60% calories from fat/20% calories from carbs
    In addition, the study was designed so that participants would lose 1 pound per week, so calories were reduced by 500 per day.

    Volunteers were given pre weighed foods given as daily portions and were assessed by a dietician to make sure that they were adhering to the diet. After 8 weeks, this is what was found to be significant between the two groups. The low carb, high fat group experienced arterial stiffness which basically means impaired arterial function. What this means is that the people on this diet experienced low grade inflammation which can lead to the growth of atherosclerotic lesions and can become heart disease. “It is possible that the high fat content of a low-carbohydrate diet exerts detrimental effects on endothelial function, which raises concern s regarding the long-term safety and efficacy of low-carbohydrate diets…Currently, supported by evidence from long-term trials, we believe that a low-fat diet should remain the preferred diet for diabetes prevention.”
    http://diabetes.diabetesjournals.org/content/58/12/2741.long

    Benefit of Low-Fat Over Low-Carbohydrate Diet on Endothelial Health in Obesity
    20 subjects participated in this study. “The [low carb] diet provided 20 g of carbohydrates daily, supplemented with protein and fat content according to the Atkins’ diet recommendation.19 The [low fat] diet provided 30% of the calories as fat, modeled after an American Heart Association diet.” I wouldn’t exactly call the low fat diet “low fat”, but regardless, its far less fat then the low carb diet. Both groups were given 750 calories less with pre made meals so they would stick with the protocol.
    After 6 weeks, there were significant differences between the low carb and the low fat group. The researchers performed a brachial artery test which basically tests to see if arterial function is impaired or not. Typically, the arm is cut off from circulation for about 5 min., then they release the arm, and measure how dilated the blood vessels are. If the blood vessels are constricted, it represents arterial impairment whereas dilation indicates good arterial health.
    On week 2 of the diet, both low carb and low fat groups had poor arterial health and were not significantly different, but by week 6, those on the low carb diet had far worse arterial health then before, and those eating low fat had far better.
    (See figure 1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702133/figure/F1/ )
    This again shows that this type of diet is promoting heart disease risk.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702133/

    Low carbohydrate, high fat diet increases C-reactive protein during weight loss.
    Unfortunately, I was unable to find the full text of this study so it is difficult for me to view the details and all I can do is base my conclusions of the study based on the abstract which is not something I like to do. Regardless, the study revealed a very interesting finding. It showed that when subjects of the study went on a low carb, high protein diet for 4 weeks, they had a 25% increase in C-reactive protein. C-reactive protein is a marker of inflammation which basically means that this group of people were promoting the development of a chronic disease. In contrast, the high carbohydrate subjects decreased their levels of C-reactive protein by 48%.
    http://www.ncbi.nlm.nih.gov/pubmed/17536128

    Comparative Effects of Three Popular Diets on Lipids, Endothelial Function, and C-Reactive Protein during Weight Maintenance
    This study is quite interesting. It examined 18 adults aged 20 or over for 6 months. The aim of the study was to examine their health when on 3 diets, the Atkins diet (high fat, low carb), the South beach diet (Mediterranean) and the Ornish diet (low fat, high carb). They found no significant differences between the 3 diets in terms of calories consumed. The results are interesting as seen in table 1 of the study.
    They found higher LDL in the Atkins diet and lower LDL in the low fat Ornish diet. They also found significantly higher levels of C-reactive protein in the atkins diet as opposed to the Ornish diet. What was also found was that the atkins diet had poor results for the Brachial Artery test which again shows impaired arterial function. “High saturated fat intake may adversely impact lipids and endothelial function during weight maintenance. As such, popular diets such as Atkins may be less advantageous for CHD risk reduction when compared to the Ornish and South Beach diets”
    http://engine2diet.com/usrfiles/files/publishedstudies/obesity/comparative-effects-of-3-diets.pdf




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    1. Everything you say against the saturated fat/meat etc diet is like a carbon copy of what Rob wolf, Peter Attila, Mark Sisson say against the vegetarian diet. Kind of a rolling the eyes ‘why are these people do silly, the evidence is unequivocal look here are loads of studies! Except it obviously isntvthT ckeaevas there are highly intelligent qualified people on both sides who can’t all be dismissed as hacks. Now that is a fact




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      1. Jonathan: That’s the problem with lay people looking at the evidence. They are not able to distinguish good science from the bad. How many people are able to look at all the evidence I provided in the post above and know whether it is valid or not?
        .
        People are so confused “Hey, the experts are telling me something different. What to believe?” In cases like this, I think it is helpful to go back to one simple fact which is a good starting place: In America, the number one disease resulting in early death is heart disease. The *only* diet proven to reverse heart disease is a low fat whole plant food based diet. Such a diet has been proven in medical peer reviewed published studies multiple times. You can take people with clogged arteries, put them on a proper low fat diet, and watch the arteries clear up. You can’t say that about *any* other diet.
        .
        So, if a long list of studies is confusing for someone, this is a good place to start as it is very simple and very black and white.




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        1. Thea ,

          It isn’t only lay people who support contrary diets to yours as you surely must know.

          National medical bodies, university faculties and a long list of enthusiastic doctors ( like those on nutrition facts.org) endorse various degrees of some kind of Paleo diet not the comical straw man version anyone can attack,

          Any study posted on this site you can quickly google and pick holes in with other studies by academics not lay people and the same goes for ALL diets.




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            1. I maybe didnt express myself clearly.

              To take a specific case which will be a good example, you self identify as somewhat of an expert able to distinguish good studies from others and have concluded ‘ The *only* diet proven to reverse heart disease is a low fat whole plant food based diet. Such a diet has been proven in medical peer reviewed published studies multiple times. You can take people with clogged arteries, put them on a proper low fat diet, and watch the arteries clear up. You can’t say that about *any* other diet.’

              But, if I wanted to be boring, I could readily play around on the internet and find credible sources of qualified people who can nitpick that conclusion to death and provide many studies with examples of differnt diets with similar claimed results.

              I am not going to do so as all that will happen is you will then start countering with all the usual defence/attack manoeuvres that everyone in this field on any side does. Undermine the source, look for conflicts, find statistical weaknesses in the study, look for follow up studies that dont match these etc.etc.

              I am not Paleo or Vegetarian but am skeptical of diets that seem to be at the more extreme ranges. EG bulletproof coffees and pounds of butter no paleo man ever ate, which is ironic. And again, vegetarian diets… you note that you have to be very careful on such diets and even supplement to make sure you dont have material deficiencies. Again, this seems a bit extreme when our system clearly can handle and historically has meat/fish etc . I respect the ethical argument but I dont like the easy to predict take down by either side straight away of any diet that doesnt match their own conclusions.

              The pattern is the same on all sides.




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              1. Jonathan: You misunderstand me. I am constantly posting that I am not an expert. I am not and do not see myself as one. I am pretty good at picking out credible experts, but that’s not really the point either. The point is that you are not able to distinguish good studies from bad either. You think that those sources you are looking at are credible. You don’t have the skills to distinguish one way or the other.
                .
                But that’s why the main point I made is important. It is not about finding competing studies. There really are no other studies showing other diets that reverse heart disease. You can look all you want. You may find some studies that show this or that lowers risk. Those studies are usually flawed. But even if you don’t want to believe that, you will not find any study showing any other diet (than a low fat whole plant food based diet) reverses (opens up arteries) heart disease. That’s not my conclusion. That’s what we have. That is a starting place that someone who thinks all the people spouting health information are equally credible can begin with.
                .
                Or not. It’s your choice of course whether you want to take this information in or not.




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                  1. Jonathan: You will notice that nowhere in that article did they find a study showing before and after pictures of arteries and where the arteries opened up. The only studies showing such results are studies on low fat whole plant food based diets. What you linked to above is an opinion piece. As Dr. Greger shows here, that’s not something you can necessarily rely on: http://nutritionfacts.org/video/spin-doctors-how-the-media-reports-on-medicine/
                    .
                    There is no tide. I understand that it is very confusing. I’m sorry, but I don’t have anything to make it easier on you if you find such articles as the one you linked to above compelling. The best I can offer is to encourage you to hang out here on NutritionFacts, where there is no conflict of interest when it comes to dispensing nutrition information.




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    2. “This study looked at 24 people who were overweight/obese and divided
      them into 2 groups. One group was low carb, high fat and the other high
      carb, low fat.
      High carb group: 20% calories from fat/60% calories from carbs
      Low carb group: 60% calories from fat/20% calories from carbs”

      Yea, when you have over 10% of calories in carbs in the diet, and less than 70% in calories in fat, IT IS NO LONGER CONSIDERED A KETOGENIC DIET, hence the reason for the bad outcome. SO AGAIN, FLAWED STUDY…… BTW, Dr. Ornish would tell you that over 10% fat isn’t “low fat” either…. The study is basically feeding subjects a modified SAD diet. Total rubbish.




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  69. Given the facts:
    – Cross-sectional studies show no correlation between dietary sat. fat and serum cholesterol
    – Reducing dietary sat. fat causes a reduction in serum cholesterol

    It seems we ought only conclude that one should reduce dietary sat. fat *if* their serum cholesterol is high. It seems the conclusion ought not be, at least for the individual, “reduce dietary saturated fat,” as one with healthy cholesterol would have no (all else equal) health motivation to do so.




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  70. This is all based on flawed experiments to begin with, the infamous rabbit dietary study. This is where they fed rabbits (a herbivore) high amounts of cholesterol, and it killed them. Well, that’s because herbivores, DO NOT process dietary cholesterol the same way that a carnivore or omnivore (humans) does. So the dietary cholesterol theory should have been a non-starter to begin with. More recent studies have PROVEN that dietary cholesterol intake has little to do serum cholesterol (IN HUMANS). In rabbits, well that’s another (flawed) story. The other flawed study this lipid theory is based on (pretty much cherry picked data) was the 7 countries study done by Ansel Keys, which has now been totally debunked for the bad science it really was.

    These flawed experiments he talks about in the video,well, while they did vary the fat intake, there is NO MENTION of carbohydrate intake WHATSOEVER!!!! So yes, if you eat a shit load of fat along with a shit load of carbohydrates, you will get a really bad case of heart disease (AKA a Standard American Diet, AKA SAD). But it IS NOT necessarily the fat that is the primary problem, it’s the sugar. Yes, if you cut out all the fat the sugar does less damage, as the combination of the two is really deadly.

    A good example of this is president Clinton, who had Dr. Ornish (the king of low fat diets) as a dietary consultant in the white house. Yet only a few years later, even though he strictly followed that diet, he needed to have four way heart bypass surgery. Hmm, guess that low fat diet ain’t so healthy after all…. Oh, and upwards of 30% of people doing extreme low fat diets have to have their gall bladder removed.

    Cut your dietary calorie intake of carbohydrates to 5% (low glycemic only), and increase your fat intake to 70~75%%, with about 20% protein. All of a sudden you see massive weight loss, your triglycerides drop down into the basement, and your HDL goes way up. You’ll have to get an LDL-P test instead, as the standard LDL-C is not valid once your trigs go below 100 or above 200 (Friedewald equation) This assumes your eating good animal and plant based sources of fat, NOT including margarine, “vegetable oil”, corn oil, soybean oil, or canola oil (which are all high omega 6, use hexane to extract, and trans fats crap). Oh, and guess what else happens? Your BP drops too, even though your allowed (even encouraged) to salt your food liberally. Mine went from 160/96 down to 123/73 within 4 or 5 months.

    I know this because I lost 75 pounds in 7 months, and have kept it off ever since using the above dietary formula. It is no accident that Dr. Atkins was a cardiologist, and a good one at that. I had an LDL test before and after starting this diet, and it is like night and day. I had tried low fat, and 40 to 60 minute very strenuous workouts every day for over a year, to no avail, and NO weight loss. The severe edema in my legs was a sure sign of CHD and/or CHF, as I couldn’t stand up for more than an hour, even with TED socks on. My CAC score was over 400. My weight was 395, my pant size was 46 going on 48. I finally bitched to my doctor about my dieting & exercise situation (and lack of weight loss), and she said (pretty casually) “you’re insulin resistant, just do Atkins”.

    Now I’m 220 pounds, have NO edema in my legs whatsoever, and my CAC score has gone down to under 100 and is still dropping. While my total cholesterol hasn’t gone down very much, my HDL has gone way up, my small dense LDL (the REAL bad cholesterol) has gone down to almost nothing, and my trigs are below 50. If you want to find out how your body really processes lipids and cholesterol, go look up Ivor Cummins on YouTube, and watch his “Cholesterol Conundrum” video, as well as some of his other enlightening fact based nutrition videos.

    FYI, I am also on high dose vitamin D3 (10,000IU per day), 200mg of magnesium citrate, 500 mg of turmeric, 600 mg of fish oil, 4000 IU of vitamin A (preformed), 15mg x 2 of K2-MK4 (which rids my arteries of calcium), 300mg aspirin, and a B complex multi vitamin. The D3, A, K2, & magnesium work in concert to drive the calcium build up in my arteries (CAC score) into my bones where it belongs. BTW ladies, this is also how you REVERSE/CURE osteoporosis. The massive D3 & K2 doses also super charges my innate immune response, and increases my insulin sensitivity. I rarely get colds or flu anymore, as my immune system kicks them to the curb like a red headed step child. The last time I had the flu, I had been exposed to a virulent influenza A virus recently. Woke up after a nap with chills, coughing up flem, running a slight temp. Ate supper (and took my pills), took a hot bath, drank a few bottles of water, went back to bed. Woke up 6 hour later, and it was totally gone and out of my system. Everyone one else I know who had it was throwing up, and had diarrhea for days.




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    1. Hi Joni
      I had a look at the article link you posted. The text describes a study where researchers give abdominally-obese men a diet high in saturated fat. Unfortunately the article provided no link to that actual published study, so I wasn’t able to analyze the details. But saturated fat is definitely a hot topic in the nutrition world.

      What is saturated fat exactly? One thing to realize is that there are many types of fatty acids and when we have ‘fat’ in our food, whether that be an animal OR a plant food, it contains a variety of different fatty acids. Some are ‘saturated’, some are ‘polyunsaturated’ and some are ‘monounsaturated.’ Within each of these main groups are distinctly different fatty acids. So, for example, there are several kinds of saturated fatty acids including stearic acid and palmitic acid. An example of an unsaturated fatty acid is alpha-linolenic acid (aka as omega-3). Different foods contains different proportions of the different types of fat and specific fatty acids.
      In general the types of fatty acids found in a plant oil, like olive oil, or in a plant food, such as avocado, has high proportion of unsaturated fats and small amount of saturated fats. An animal food has higher amounts of saturated fats, but still contains some of the unsaturated fatty acids. Meat, cheese and butter, for example, are referred to as being high in saturated fat because it contains a large proportion of saturated fatty acids.

      While we have decades worth of research showing the health risks associated with consuming high amounts of saturated fat (which is achieved by eating foods that are high in it, such as lots of meat, chicken, cheese and other dairy), there are some people who claim that a few new studies have debunked all the previous research findings. This is why you will hear some people say not only that saturated fat is not ‘bad’ for you, but that it is even ‘good’ for you. Some people are even recommending that you put butter–which is high in saturated fat– in your coffee!

      Yet, we still have major research associations such as the American Heart Association, the American Diabetes Association, cancer groups and others who have conducted systematic evidence reviews and concluded that saturated fat should be kept low in the diet because its consumption is linked to risks of many of the chronic diseases we die from. The high-fat advocates often cite a couple of meta-analyses as proof that the decades of research to date is all wrong. (Meta analyses are research papers that analyze a group of studies.)

      So, what gives? It’s a complex discussion and Dr. Gregor has addressed this topic extensively in lots of interesting posts: http://nutritionfacts.org/?fwp_search=saturated+fat&fwp_content_type=video One particularly interesting video analysis he did is here: http://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/ There are a few things we know and that is that eating high amounts of saturated fat cause insulin resistance http://nutritionfacts.org/video/lipotoxicity-how-saturated-fat-raises-blood-sugar/ and are linked to a greatly increased risk of diabetes http://nutritionfacts.org/video/why-is-meat-a-risk-factor-for-diabetes/ . We also know that the effects of a high fat and high saturated fat meal can impair the functioning of the arteries for hours afterwards http://nutritionfacts.org/video/fatty-meals-may-impair-artery-function/ . We know that this sort of food intake increases cholesterol numbers and plaque on the arteries. And the list goes on. This is why the plant-based doctors find better overall health, and even reversal of some chronic diseases and health conditions by lowering overall fat intake and cutting out those foods that are high in saturated fat. – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬




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  71. Why do the books by Gary Taubes say that eating saturated fat is fine and he seems to have a lot of studies to back this up. Sometimes I go crazy reading so much conflicting data. One thing we can all agree on, I guess, is that eating highly processed food, sugar and carbs is a bad but the issue of fats seems to have lots of contradictory data. His newest book is the case against sugar. I guess we can all agree sugar is not a good thing to be eating.




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    1. Nancy: Yeah, I don’t know anyone who thinks that sugar is actually healthy. But it’s probably not as unhealthy as some people would have us believe either. If you research the Kempner diet here on NutritionFacts, you will see that this diet reversed a serious disease that had been considered a death sentence previously – and the sever diet consisted of nothing but white rice, fruit juice and sometimes sugar.
      .
      As for Taubes, he has books and he has references in those books, but when people check the references, those references do not actually back up his claims. That’s the difference. For detailed look at Taubes’ claims, you might want to check out some videos from the site Plant Positive. He includes references and study quotes so you can check it all out for yourself if you want. http://plantpositive.com/display/Search?moduleId=19496100&searchQuery=taubes Understand that Taubes is a journalist, not a scientist nor doctor, and Taubes makes a lot of money off his books…




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    2. I think you have to factor in bias. This is a vegetarian website and hosted by a guy selling books. He’s never going to read a respectable study like say this one http://bjsmbeta.bmj.com/content/51/2/133 and say, ‘ooh, fair enough .. they make some good points and maybe my caricature of the high fat low carb diet isn’t teally representative of more pragmatic stuff like that. ‘ I am reminded of debates in economics, investing, politics, religion and climate science where a good heuristic is if the person you are reading only points to evidence of one side and never raises or represents the better aspects of the opponents side. Usually both sides have good points and the job is to weigh them up. The response to say the article I just linked to isn’t just to send another one back refuting it. We make no headway except to show it isn’t as obvious as either side pretend.




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  72. While I do think over consumption of saturated fat as a main fat source is likely unhealthy having a moderate intake looks like it’s not. Also health when conscious omnivores are smart about their animal intake in conjunction with plenty of vegetables, and plant based fats. Not to mention the major link is vegetable oils and added sugar.

    “​​Western omnivore diets are not necessarily detrimental when a certain consumption level of [plant] foods is included.”
    – Danilo Ercolini, PhD

    https://www.ncbi.nlm.nih.gov/pubmed/19364995
    http://www.bmj.com/content/351/bmj.h3978
    https://www.ncbi.nlm.nih.gov/pubmed/8842068
    https://www.ncbi.nlm.nih.gov/pubmed/23497300
    https://www.ncbi.nlm.nih.gov/pubmed/20479151
    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2012.01021.x/abstract
    http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract
    http://ajcn.nutrition.org/content/67/5/828.short
    https://www.ncbi.nlm.nih.gov/pubmed/22810464
    https://www.ncbi.nlm.nih.gov/pubmed/19364995
    http://ajcn.nutrition.org/content/67/5/828.short
    http://ajcn.nutrition.org/content/67/5/828.short

    It’s obvious that trans fat and processed meats are unhealthy. However not all fats are created equal, just like not all saturated fats/animal products are created equal. Just like not all carbohydrates are not created equal. It’s the dose and the quality of the source that’s the poison, not the source itself. Just like people say not to demonize carbohydrates, there’s not enough evidence to completely demonize animal based products either.

    Not to mention the WHO new stance, and Salim Yusuf’s video.




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  73. Andrew Roquiz, MD
    Mar 21, 6:25 PM EDT

    Hi Dr. Greger,

    I get the “Family Practice News” as a family practice doc and the headline story is “Eat Some Cheese” Consider This Advice for Heart Patients.

    I enjoy following your videos and have read your book and advocate a plant-based diet to my patients regularly. However I was surprised to see the multiple studies, systematic reviews even that seemed to back up the cardiac benefits of a diet high in saturated fat. I”m curious to know if you could review some of these studies and post a video or podcast regarding them (or perhaps you have responded to it but I have yet to see it).

    18% lower risk of CHD and 13% risk of stroke (Br J Nutr. 2016;115[4]5:737-50).

    13% reduction in stroke (J Am Heart Assoc. 2016 May 20;5[5]. doi; 10.1161/JAHA.115.002787)

    14% RR reduction for CHD (Eur Nutr. 2016 Aug 12. doi; 10.1007/s00394-016-1292-z).

    Decrease risk of Diabetes (Am J Clin Nutr. 2016 Apr;103[4]:1111-24).

    I appreciate you because even though you have a bias you are keen on discussing the weaknesses of certain studies or ideas. What do you think?




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    1. Hi Andrew, thanks for pointing out those studies. As a vegan I too am interested in the findings.

      I don’t have time at the moment to dive into all of them, but one quick thing i noticed is that in the second study you posted, they found minimal risk at less than half of median intake for people in Western countries. In other words, the study findings could be described as saying that reducing milk/dairy intake in the West reduces risk of stroke etc.

      So to simply state (as you did) that dairy consumption is associated with a 13% reduction in stroke risk doesn’t seem appropriate given the current levels of consumption in Western countries. It would be more accurate to say that the average person in Western countries should REDUCE their consumption of dairy to lower stroke risk, which I think Dr. Greger would agree with!

      I hope to take the time to review the other studies at some point, but I hope this gives some indication that the ‘headline’ is often misleading, and depends considerably on the aims/biases/motivations of the authors.




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