There aren’t too many topics that really get me riled up anymore. I’m too old and too busy to care about debating the merits of stem cell research, the legalization of marijuana, or Proposition 8. Sure, I have strong opinions on all of these topics and more, but they are just that – opinions. Furthermore, there are enough other people out there, some reasonable, most irrational, already fighting those fights. So what does get me riled up? Every time I hear someone “assert” that saturated fat and dietary cholesterol lead to heart disease I have to bite my tongue. Why do I bite my tongue?
As Frederic Bastiat once said,
“We must admit that our opponents in this argument have a marked advantage over us. They need only a few words to set forth a half-truth; whereas, in order to show that it is a half-truth, we have to resort to long and arid dissertations.”
This is, unfortunately, quite true. When I’m at a dinner party and someone starts lecturing the table about the perils of saturated fat (or red meat, or eggs, or fill-in-the-blank), I’m at the point – after years of being kicked under the table by my wife – of just asking the “authority” at the table one question: Why do you believe this is true?
I figure, put the burden of proof on them, right? This week, and I apologize for how long overdue this post is, I’m going to get into the details of how this country (and many others who followed our lead) came to believe one of the most pervasive myths in the entire field of nutrition.
To write it all out would require a tome. In fact, such a tome already exists. It’s called Good Calories, Bad Calories. But for most people, especially the “authorities” who already “know” the answer, it’s a complex and lengthy book. Furthermore, it’s not exactly something you can just whip out at a dinner party.
I recently gave a talk at the UCSD medical school. I was asked to give a talk about “ethics.” While I have no professional training as an ethicist, I still think I have a good idea about what is and is not ethical. As I’ve learned more and more about this topic, it appears to me that the state of our current nutritional environment, with food policies based on just about everything but rigorous, experimental science, couldn’t make much ethical sense. I’m pretty sure if Plato, Aristotle, and Nietzsche were still around they’d be disgusted with how we got here. So, I was happy to take this opportunity to speak with a group of thought leaders on this important topic.
I gave a more recent (circa 2015) talk on the subject which captures both the video and and my slides, which I’ll share below. It’s about an hour long. But as Bastiat essentially said, if you want to overturn half-truths, you can’t do it with bumper stickers. Hopefully you’ll find this talk informative and useful for your dinner party discussions.
The link to this video can also be found here, for those reading this post on email or those wishing to view it in a larger format.
Hello Dr,
Thank you for all of your sincere efforts. Is there any way to contact you privately?
Thank you.
Yes, do so through the contact me page.
Hi Peter,
I do not feel like completely eliminating carbs would be something that would suit me, or that I could sustain in the long run. Instead, I plan to cut out all refined sugars and simple carbohydrates, and eat purely complex carbohyrdrates that are low in sugar (porridge, wholemeal etc.).
However, If i am still eating carbs, what effect does this have on how much fat I should be eating. From what I understand, the carbs are what triggers insulin to be produced which is what puts the fat into your fat cells (thus making you gain weight). So if you are eating no carbs, then the fat will not be stored in your cells.
If you are still eating carbs, should you start worrying again about how much fat you are taking in, as this will now be put into your cells? How much fat should one be aiming to eat daily if they are maintaining complex carbs in their diet?
Dave, I’m glad you’re thinking of things through the lens of long-term sustainability. If you just eliminate sugar and simple carbs, you’re going to get a huge bang for your buck. You will also require far less fat than someone in ketosis who needs to go out of their way to ingest fat. There really aren’t great data to answer the question I think you’re asking. It certainly seems that eating saturated fat + sugar is a bad combo. I have not seen any evidence, however, that eating saturated fat in the presence of “good” carbs is bad. If you think about, most of subjects the studies I presented here were not in ketosis, suggesting ketosis is a “magical” state where one is immune to the effects of saturated fat.
Doc, I was trying to find a good place to post my questions/comments so I think this is as good as any:
I went through your site and didn’t find much on the topic of inflammation. A lot of experts and doctors who “get it” speak about reducing it, which “feels” like the way to go, but I think there is a lack of practical advice about some very basic items for us Average Joes regarding the topic:
What in your opinion is a solid comprehensive definition of inflammation?
What are the most common forms of inflammation among us struggling Avg Joes?
How do you know if you’re systemically inflamed? What are the signs? Can you specifically test for it?
What can be done to specifically target and/or reduce inflammation?
Like I said, I’m on board with the concept, but we need you guys to break it down so we know better what it means, how we know we have it and how it specifically relates to diet. I’m sure it’s a complicated, not fully understood topic so far but any more insight you can share?
Too many questions for a simple answer. Worth of own post. Will get there, but not for a while. Check out Robb Wolf in the interim.
I came across your RadioLab randomly and was very interested, because for about two years I had already been on a high-fat, low-carb, no-sugar diet. After becoming enthralled in the topic and reading your blog often, I ironically was diagnosed with hypobetalipoproteinemia (my LDL is 17). I looked back at previous cholesterol tests and the one I took when I was a vegetarian/mostly vegan had my LDL at 47. How does that make sense? p.s. I am kind of freaking out because the doctors in KC espouse “the lower the better,” without taking into consideration how low LDL is linked to pre-term birth, suicide rates, and neurological disease. It is seriously annoying.
Kristen, it’s hard to really draw great conclusions from a lot of these data because they are very observational, as you know. Also, don’t forget that lower LDL-C and LDL-P are not the same thing.
I just got around to viewing your presentation, Peter. Great summary of where we are and how we got here. I’m visiting family in Greece and just yesterday I fell into the trap of getting into the argument “saturated fat=bad”.
Anyway…I think you know you have a long way to go. These myths and half-truths are now part of the mainstream.
Objective researchers, such as you and Gary, are doing everyone a great service. Some of us appreciate that service right now and some will in the future.
Great presentation!
Keep it up.
Hopefully this presentation can help you in your discussions with friends and family around this topic.
Dr Attia,
Thanks for putting together an amazing blog and a stellar presentation. I came across your blog 2 months ago and I’ve spent every evenning reading it late into the night (mostly reading things three and four times over, as I can be a bit thick about science). Incredible. I don’t want to open a politcal can of worms, but the issue does make me think of the Keynesian Avalanche. https://www.youtube.com/watch?v=6ubTQfr_tyY
I too have been fit and ahtletic all my life and still managed to see my weight climb to a whopping 240 lbs by last New Years (2012). At 47 yrs old and 5’11, the final straw was not being able to fit into my $1,000 GoreTex Drysuit. A ketosis based diet has been responsible for me losing 55 pounds this spring and finding your blog gives me great hope for the future. It’s great to have my Mojo back.
Question regarding the infamous old clogged artery arguement: Would it be accurate if I were to simply say (at one of our post mountain bike ride BBQ’s) that there is more than enough L-Argenine in my bacon cheeseburger and grilled broccoli to produce Nitric Oxide to improve my blood vessel dilation and maintain healthy arteries?
Keep up the great work. Thank you so much for your time and efforts.
T.Low Tom
I’d ask the question this way: can someone point to the evidence that the saturated fat you eat (or cholesterol, for that matter) is ending up in your arteries?
Oops on the video link. Wanted to link to the Hayek/Keynes Avalanche video . Yeow.
https://www.youtube.com/watch?v=d0nERTFo-Sk
It may be giving the mainstream dogma too much dignity, but I think there’s a useful analogy to the classic breakdown of the Ptolemaic earth centered model vs. the Copernican. [yea it’s only been around since the 60’s but it’s accepted so thoroughly it might as well have been around for centuries]
The stream of newly discovered problem or protective food categories…like Fiber, Red Meat, Alcohol, Salt…are really all “epicycles”. Ptolemaic earth centered models were pretty sophisticated at predicting the movements of planets..but they had to be tweaked with new “epicycles” and exceptions quite often when they failed to predict something…so epicycles and exceptions kept accumulating for every new anomaly. Eventually the complexity became an issue in itself and set the stage for a paradigm shift to the sun centered model that could account for the facts more simply.
When some “paradox” arrises like the fact that the french consume lots of saturated fat but have lower heart disease rates…there is a search to solve the “mystery” of how this can possibly be. It must be that drinking wine protects them! It can’t be that refined flour and sugar cause traditional societies to start getting a whole range of diseases because we know that fat is the culprit…so it must be the fiber that was taken out that really matters. Patients still get high blood pressure on a “heart healthy” low fat high carb diet…so we have to campaign to reduce the consumption of salt…cuz that’s gotta be it!
The shocking importance of this little niche issue is illustrated by the fact that each time the mainstream invents some new little epicycle to cover some newly discovered contradiction…it sets off billions of dollars of consumption shifts and massive “education” campaigns.
It may help to break through the clutter with some people to point out how the alternative hypothesis…kinda like the Copernican model, makes all these “paradoxes” and exceptions go away.
This is a great insight, Mark. Thanks for laying it out there. Important to keep this problem in perspective. I think sometimes we discount the “human” element of this dissonance because we have more technology, or better science, or more X or Y today than in the days of Copernicus.
Hi from up here in Canada. This mornings Canadian news featured a report from the university of western Ontario wherein they compared egg yolks to cigarettes. Yes, cigerettes. I like eggs, and I eat them every morning; and I’m going to keep on eating them every morning.
As a low carber, these kinds of “reports” drive me nuts. I know in my heart that if I could read the actual report, I’m sure I could find the flaws in it. However, as I can’t actually find a copy of the study, I can only go by the university’s press release.. They seem to be saying that the older you get, the more plaque one is going to get irrespective, but the cholestoral in egg yolks will make the natural accumulation faster.
After all of my reading here and elsewhere, how in gods name did these scientists come up with this report? What are they looking at that leads them to these conclusions!! How does a working stiff with not much of a science background deal with these kinds of media reports?
Anyway, my eggs are waiting and I’m off to breakfast. I like’m scrabbled in coconut oil.
Here’s the link to what made headline news in Canada.
https://communications.uwo.ca/western_news/stories/2012/August/research_finds_egg_yolks_almost_as_bad_as_smoking.html
Dennis, the cholesterol you eat does not end up in your arteries. Observational studies do not establish causality. 2 fatal flaws in one study = should have never been published.
You and Dr. Dayspring and others have said that a low carb diet improves lipids for many, but not all people. I think you estimated it at 60-70% who respond positively. We have had on this blog quite a few though, that report negative effects on their lipids. I have been wondering whether the response might be predicted by whether or not a person is insulin resistant? With the insulin resistant persons getting the positive response. So that perhaps the insulin resistance test could be used as a screen to see if the low carb diet is appropriate?
These exact questions are being asked in studies going on right now. While it make a few more years to find out the answers, the hypothesis that those whose atherogenic particles are part of an IR picture may be most responsive to dietary intervention is a logical one.
Of course you don’t make these allegations, but there seems to be a political and financial benefit to coming to the “convenient” conclusion when reporting these government (or government grant-funded) research results.
Secondly, the media is clearly in bed when they’re pushing the topic as hard as they can, with no more evidence than “that branch of government implied it is so”, especially when the evidence contradicts those findings.
Spot on in all respects but one. I’m a living example of the fallacy that at the most 10% of dietary cholesterol is absorbed, and therefore the contribution to chol lebels is marginal. As an egg-afficianado, I went into an egg-whites only mode for several years when my chol (read LDL) zoomed, and such dietary controls plus statins and a rigorous exercise programme brought LDL down to acceptable levels. Voila! I thought I had the leeway now to try out eggs including yolks again, and lo and behold within a year my LDL was way up there again. Some googling led to views that about 1/3rd of the human population IS susceptible to hi chol absorption from food. Now, whether 1/3rd or less, I am certainly an example of the fact that SOME people at least DO absorb dietary chol. Any views?
Now I have a question. Having accepted that chol per se is not the cause of atherosclerosis, and that it’s inflammation levels in the body which cause plaque formation, would it not still be sensible to try and limit chol levels since, without hi-chol even inflammation will not result in plaque. Seems to be much like a gun control situation with children in the house, when any accident is not directly attributable to the gun, only to the child, but then we know where that leads us. Likewise, the normal human body will, from time to time, suffer hi inflammation due to various causes, either external or personal. Does it not make sense to keep chol below levels wich will result in atherosclerosis in the event of hi-inflammation from time to time? Anything wrong with my logic?
No doubt. Remember, about 15% of the population actually have a “defective” ATP binding cassette G5, G8 and absorb too much FREE cholesterol. That majority of dietary cholesterol is esterified and literally unabsorbed. The important question, though, is not what happened to your LDL (I assume you’re reporting LDL-C), but what happened to your LDL-P (or apoB). Ultimately, of course, this speaks to a recurring theme on the blog…custom eating solutions are necessary for optimal health.
So glad to find your blog! Even though it’s been slow going trying to convince people that low-carb is an effective and healthy lifestyle, I’ve seen the idea starting to normalize a bit more among my friends/family. All of a sudden, a bunch of people I know are on the paleo diet (which is not inherently low carb, but when you cut out processed foods and all wheat/grains, of course you will naturally reduce your carb intake), and even though many people are resistant of the idea of giving up carbs, not as many people seem to question its efficacy or call it a “fad.” Amazing how the general public seems to be getting the picture while much of the medical community is still convinced that you just need to “reduce your calorie intake and exercise” to loose weight. Truly, it’s staggering. Keep fighting the good fight! 🙂
Thank you so much, Jacquie.
Hi Peter,
Reading the recent obituary of diabetes and insulin pioneer Dr. George Cahill in the NY Times I came across this very succinct explanation of what you are trying to tell people about diet and insulin metabolism. The question we have to ask is, if this has been known for so long, how has the knowledge been perverted and obscured? The answer, I guess, is the idea that fat is bad and causes heart disease.
Could the summary of this research done 50 years ago be any more plain in pointing the way to losing fat?
” Among his research subjects were divinity students who were paid $300 to fast for a week and hibernating bears. Some of his most important research, in the 1960s, involved tracking the blood chemistry of people who were trying out an experimental treatment for severe obesity: total starvation, for up to six weeks, in the hospital.
A crucial finding was that in the first few days without food, the liver starts breaking down protein to make glucose to feed the brain. But using protein as fuel can be perilous, because it is the stuff of vital organs and muscle.
But people do survive weeks of starvation. Dr. Cahill’s study helped explain why. After about a week, the body makes another shift, and instead of cannibalizing its own proteins it starts breaking down fat into substances called ketones, which can feed the brain in place of glucose. A natural drop in insulin is what drives the shift to ketones, Dr. Cahill determined. ”
https://www.nytimes.com/2012/08/17/health/george-f-cahill-jr-diabetes-expert-dies-at-85.html?src=recg
Now we know that obese patients can skip the starvation and instead initiate ketosis by limiting carbohydrates and lowering insulin levels.
Thanks again for all your good work.
Yes, Dr. Cahill really seemed to understand this problem. I’ve been re-reading some of his papers later. I’m really disappointed I never got to meet him. Similarly, I’m disappoint I never got meet Ancel Keys. While I didn’t agree with about 80% of what Keys put forth, for better or worse, these men were the pioneers of our nutritional paradigm. If I could have met anyone, though, it would have been John Yudkin.
Hi again.
Well it appears that up here in Northern Ontario there is no way to get an NMR profile. My doctor tells me however that I can get an Apo-b protein test included with my blood work.
The reason I’d like a particle count is that my LDL C in my last blood work dramatically increased after going high fat. Mind you, my triglicerides to HDL C ratio went from 1.45 to .65 so I’m pretty happy with that. Still, I’d feel better getting some hard numbers on the particles.
So in the absence of an NMR test, is the above test still worth doing, or should I drive to Michgan (assuming I can find an NMR test there 🙂 .
Thanks for all the work your doing here. I don’t know how many lives your changing, but you’re having a big influence for the better in our family.
Yes, it seems OHIP won’t send out for NMR, but if you get a proper apoB test, it’s almost as good. An remember, the person of figured out the role of apoB is at McGill!
Heck, I’d have been happy to pay for it, however, the labs just don’t do them ( come to think of it that’s probably because OHIP doesn’t pay for it and there’s not enough private interest.)
Allan Sniderman is the fellow from McGill. : I vaguely remembered that from Good Calories, Bad Calories. In fact it was that section of the book that lead me to first discuss the test with my Doctor back in march. He’s another very cool doctor. When I told him I’d been going low carb since January, he basically said ” it’s your life, live it the way it works best for you..I don’t judge.” I did not expect that response. I actually bought him a copy of Good C, Bad C. I guess I’ll find out if he read it next visit.
One last question: the Apo-b test doesn’t tell me anything about the LDL particle subsets, only the total LDL particle count; true or false?
Thanks again.
Correct, but that’s really all that matters, at least at the first-order.
I totally missed this post for some reason, and just left a comment on the what-your-daughter-eats post that would have been better here. It looks like my question about getting a certification in nutrition will be answered in the video.
I liked Bastiat’s quote, but I like Mark Twain’s, too – or sometimes ascribed to James Watt:
“A lie can travel around the world while the truth is getting its boots on.”
That’s a great quote.
I really enjoyed the video – or should I say “video?” I was really hoping to see YOU giving the presentation, because I imagine you being as animated and energized as you sound. I’m very surprised to read that this was your first time giving this talk. Give it a few more times and it will be killer!
I found that I didn’t need the slides, because after obsessing about this topic for 10 years I was familiar with almost every study (and graph) you cited. I still found the talk very engaging, but it definitely needs YOU in it to go viral. IMHO.