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If this is true then why have many many studies shown that vegans, who generally eat a relatively high-carb & low fat diet, are the only demographic with normal

If this is true then why have many many studies shown that vegans, who generally eat a relatively high-carb & low fat diet, are the only demographic with normal body mass index and also have much, much lower chances of developing type 2 diabetes? In fact we have a lot of evidence linking high-fat diets to diabetes: https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-type-2-diabetes/ https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-ty... High fat diets also do a lot of bad things to your cardiovascular system. Proceed with caution.

kazinator 9y ago
Fat vegans are out there. "Vegan" is no magic bullet. Calories are inescapable. The body's output changes in compensation for incoming calories, but only within a certain range. Also, there is all sorts of processed crap that's bad for you that qualifies as vegan because no animal products are involved. Hydrogenated vegetable oil, anyone? You could be a potato chip and cookie vegan.
- cageface 9y ago
  Data >> anecdotes https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight-loss-advantage/amp/ https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight...
  - kazinator 9y ago
    No amount of data or ancdotes beats calories in. Fact is, not only is it possible to eat strictly vegan and get fat, it's not even difficult. If the majority of vegans avoid that, it's not simply due to being vegan. Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
    - cageface 9y ago
      It was what was handy on my phone. Here's a recent published NIH article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ Yeah pedantically you can nothing but Oreos and be "vegan". But FTA: "In a cohort of 4384 Taiwanese Buddhists, vegetarian men had approximately half of the rate of diabetes (OR: 0.49, 95% CI: 0.28–0.89), and vegetarian post-menopausal women had one-quarter the rate of diabetes (OR: 0.25, 95% CI: 0.15–0.42), compared with their omnivorous counterparts, despite statistical adjustment for body mass index and other factors. Interestingly, the omnivores in this study consumed a predominantly plant-based diet with little meat or fish, again implying that small amounts of meat contribute significantly to the development of insulin resistance" And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes.
      - woqe 9y ago
        > And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes. I want to preface this comment by saying I am not attempting to be rude or combative, I am genuinely curious. If a calorie is a measure of energy contained in food, and food is the only source of energy for a body, and one mechanism by which the body uses that energy is to store fat, then a positive change in fat matter stored can maximally be the value of calorie intake converted to mass (in some discrete time). Or, a positive change in fat stored (mass) <= calories in (again, in some discrete time). Is this still too simplistic?
        christophilus 9y ago
        I think that saying: "A calorie is a calorie" is too simplistic because it's never just calories vs calories. 1000 calories of bananas comes with a lot of other content vs 1000 calories of ice cream. You get a lot of different nutrients, you get a lot of fiber, etc. The holistic combination of things you get in unrefined foods makes an impact on how your body processes and stores calories. [Edit: I hope it's clear that I don't advocate eating 1000 calories of any one food. :)]
      - NikolaeVarius 9y ago
        I would be amazed if you could list credible nutritionists who would claim that calorie restriction will not help you lose weight.
      - kazinator 9y ago
        Taiwanese Buddhists. Now there's a random sampling method!
    - H1Supreme 9y ago
      > No amount of data or ancdotes beats calories in Again, no. The reason obese people are so obese is because they are never satiated. You can eat potato chips and drink soda all day, without ever feeling full. Secondly, it's an addiction to refined sugars and super simple carbs. I'm not arguing that calories aren't calories, but your body reacts differently to a Snickers bar than it does broccoli.
      - kazinator 9y ago
        The thing about calories is that the high side is easier and greater than the low side. But it is easy to accumulate with excess calories. There is a severe limit on how much of a deficit you can establish relative to a baseline energy intake, but a wide-open range in the area of excess intake. Furthermore, fat is easy to store but hard to mobilize. So if you eat 15000 calories one day, then create a 1000 calorie deficit over 15 days, it won't average out to the effect of a regular intake over 16 days. The body finds ways to economize energy use and hang on to the fat.
- H1Supreme 9y ago
  Dude, what? This is nonsense. If you're sucking down potato chips, cookies, and processed shit, you're not a Vegan; you're a moron. Eating a diet based on vegetables, fruits, beans, and nuts will absolutely change an overweight persons life.
  - kazinator 9y ago
    Many people are vegan because of ideological principles not having anything to do with weight management. (Such as not killing animals or keeping them in miserable conditions.) You can in fact stuff yourself on vegetables, nuts, fruits and beans and maintain a high body fat percentage. (Potatoes and such are vegetables, by the way). Fruits are high in sugar. You're also forgetting grains.
    - issa 9y ago
      I've been vegan for 25 years and my weight has been up and down both before and after being vegan. The one thing that everyone should agree on is that there are a TON of factors that influence weight gain/loss. Obviously anyone will lose weight on a calorie restricted diet, but it isn't that simple in the real world--specifically, the level of effort involved in maintaining a low calorie diet varies greatly for different people. There are people who can skip meals and not notice, there are others who are constantly hungry. I'm excited that we're slowly figuring out why that is.
taurath 9y ago
Vegans almost always consume a ton of fiber as well - this recent study seems to indicate fiber intake creates a process that actively resists obesity and is a super interesting read - http://www.cell.com/cell-host-microbe/fulltext/S1931-3128(17)30497-3 http://www.cell.com/cell-host-microbe/fulltext/S1931-3128(17...
- cageface 9y ago
  Yes. Fiber is very very important and most Americans don't get nearly enough of it: https://www.nytimes.com/2018/01/01/science/food-fiber-microbiome-inflammation.html https://www.nytimes.com/2018/01/01/science/food-fiber-microb... Consuming fiber along with carbs dramatically changes their glycemic profile. Asians get away with eating so much white rice, for example, because they almost eat it along with a bunch of vegetables.
  - kazinator 9y ago
    Boiled rice is not calorie dense; it has a large volume due to water, which reduces it almost down to 1 kcal/g. Asians do not all eat lots of white rice. Not all eat purely white rice. On the other hand, not all eat a lot of vegetables. Asians are not immune to obesity and diabetes. They certainly do not get away with overeating white rice or anything else.
    - cageface 9y ago
      The point is that white rice alone has a high glycemic index but eating it with vegetables makes a huge difference: https://nutritionfacts.org/video/if-white-rice-is-linked-to-diabetes-what-about-china/ https://nutritionfacts.org/video/if-white-rice-is-linked-to-...
      - kazinator 9y ago
        If you go for a second and third helping of rice without additional vegetables, I doubt it. Vegetables aren't a magic bullet. Calories are calories. Maybe vegetables can slow down the absorption so smoothing and flattening out the "transient sugar peak" that the liver has to deal with after meal, but that can be overwhelmed with a big enough intake. The slender Asians you see aren't the ones stuffing on huge amounts of rice, with or without veggies.
sc4les 9y ago
It's not. People just love books about how good bacon, eggs, milk and cheese are for your health
Mikeb85 9y ago
Vegans (the healthy ones at least) tend to consume complex carbs and lots of fibre. Furthermore, due to self-selection (vegans tend to be more health-conscious than the general population) I'd wager that vegans are also more physically active.
- cageface 9y ago
  Yeah that's true and it's the reason talking about "carbs" makes as much sense as talking about "drugs". There are different kinds with very different properties. There's a huge difference between eating whole grain, complex carbs along with other fiber-rich foods and eating a slice of Wonder Bread.
jlebrech 9y ago
those who eat a lot burn a lot too. it's the sugar go to sleep with that affect you, not energy that you actually use.
- kazinator 9y ago
  Only within reasonable limits. There may be some points in favor of not eating the sugar close to going to sleep: earlier in the day rather than later. However, sufficiently fierce face-stuffing will overcome this advantage.
jlebrech 9y ago
hgf-1 consumption is lower in vegans too
ubiquitoust 9y ago
The American Standard Diet is high fat & high carb. High fat diet should be done with low carb e.g. ketogenic diet. Keto can be efffective in reversing type 2 diabetes. Same thing with high carb diets, it only works if it's low fat.
spion 9y ago
Most nutritionists like to cherry pick studies that support their cause (even when they're low quality observational studies) and attack studies that oppose it. Michael Greger (the author of nutritionfacts) is quite the typical example (don't get me wrong, Gary Taubes has done that too in the "opposing" camp) The most likely theory I've seen is: 1. We have a certain amount of genetic propensity for higher-than-necessary insulin secretion 2. How we develop that propensity is still unknown (!). Gary Taubes likes the sugar hypothesis (i.e. something about fructose metabolism in the liver causes the system's self-regulation to fail) but thats mostly supported by observational studies - the mechanics aren't clear at all. Michael Greger likes the lipid hypothesis (fat inhibits muscle ability to absorb carbohydrates i.e. causes insulin resistance) but that doesn't explain why the liver continues to produce tons of fat despite its insulin receptors being clogged. Jason Fung likes the overflow hypotheis (as the muscles get fuller of glycogen, they're less able to store blood glucose, which means more insulin is needed to do it - however the liver isn't resistant and insulin upregulates its fat production) - but that doesn't fully explain how there are people who do lots of heavy physical activity yet remain obese and insulin resistant. Its possible that any subset of the above could be a cause if excessive enough - high GI carbs to raise the blood sugar, fat to slow sugar absorption and lack of exercise to keep your muscle cells overfilled with glycogen all contribute to high insulin secretion, together. 3. Insulin definitely regulates fat accumulation in fat cells. No doubt about it - more insulin means less fat released by fat cells and more carbs converted to fats by the liver and stored in fat cells. Insulin also blocks leptin which signals our brain that we're full, so we feel hungrier. 4. Keto and fasting definitely work in that they remove the primary reason for insulin to secrete. You can't have raised insulin secretion if you don't have a lot of sugars in your blood to start with. 5. Its possible that vegans (on average) also remove the secondary reason for insulin to over-secrete, whatever that is. Keep in mind that vegans on average are more mindful about having a healthy lifestyle, so it could be any number of things (correlation is not causation). But if veganism itself was the definite fix, we would expect to see no long-term vegans that are obese. Good averages to compare would be long-term vegans with long-term "ketoers" Keep in mind, the mechanisms to prevent weight gain are very different from those needed to actually lose weight. The first one is about maintaining a stable homeostatic state while the second one is about deliberately causing a different non-homeostatic state.
vixen99 9y ago
Lots of videos and the odd link to a peer-reviewed paper on a site run by one physician doesn't add up to a 'lot of evidence'. That doesn't mean he's wrong but I'll agree with you on 'caution needed'.
toasterlovin 9y ago
Health outcomes for vegans are probably skewed heavily by the fact that the vegan sub-population consists of people who A) spend a lot of time obsessing over what they eat, and B) have the wherewithal to successfully pull-off a major dietary intervention (which is what veganism is, essentially).
squids 9y ago
I think the theory was that vegan food is less palatable and often less calorie dense and harder to find so vegans eat less. IIRC a study showed low carb diets worked in a similar way, people just ate less as they found it harder to find enough calories.
christophilus 9y ago
I think it's because of the high fiber, low processed sugar nature of the good vegan diets. There are very unhealthy vegans that eat lots of weird processed things. But yeah. Anecdotally, I know people who were "cured"* of type II diabetes, high blood pressure, high cholesterol, etc by switching to a high-carb (no refined carbs) vegan diet. I also know people who have had the same results by dropping carbs and moving to a high fat, high protein, high veggie diet. It sounds to me as if it's the refined carbs/sugars that are the primary enemy. * By cured, I mean they were able to get off of all medication. But if / when they revert their diets, the symptoms come back, and the meds are again required.
- cageface 9y ago
  The problem is that a high fat, high protein diet has other downsides that a healthy plant based diet doesn’t, specifically cardiovascular issues.
  - christophilus 9y ago
    I was vegan for a while (McDougall), so I'm aware of the evidence for this. But I don't know if I buy it. I don't remember seeing any studies that focused on people who had high-fat + low sugar diets. Most of them compared typical western diets with (undeniably) healthy vegan diets. The typical western diet is indeed high fat, but is also crazy high in refined sugars.
  - tracker1 9y ago
    cardiovascular issues seem to be centered around inflammation not specifically fat. Not dietary cholesterol or saturated fat. There's lots of evidence to also support intermittent and extended fasting. In general minimizing starchy carbs alone, along with refined sugars and grains goes a long way. If you eat vegan or keto/lchf. I've done both... with vegan, I still had to take a large amount of insulin and gained weight, even at 1500-1800 calories a day... on keto, I eat a little more but managed to lose 63# last year and come off insulin (mostly).

kazinator 9y ago

Fat vegans are out there. "Vegan" is no magic bullet. Calories are inescapable. The body's output changes in compensation for incoming calories, but only within a certain range. Also, there is all sorts of processed crap that's bad for you that qualifies as vegan because no animal products are involved. Hydrogenated vegetable oil, anyone? You could be a potato chip and cookie vegan.

cageface 9y ago
Data >> anecdotes https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight-loss-advantage/amp/ https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight...
- kazinator 9y ago
  No amount of data or ancdotes beats calories in. Fact is, not only is it possible to eat strictly vegan and get fat, it's not even difficult. If the majority of vegans avoid that, it's not simply due to being vegan. Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
  - cageface 9y ago
    It was what was handy on my phone. Here's a recent published NIH article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ Yeah pedantically you can nothing but Oreos and be "vegan". But FTA: "In a cohort of 4384 Taiwanese Buddhists, vegetarian men had approximately half of the rate of diabetes (OR: 0.49, 95% CI: 0.28–0.89), and vegetarian post-menopausal women had one-quarter the rate of diabetes (OR: 0.25, 95% CI: 0.15–0.42), compared with their omnivorous counterparts, despite statistical adjustment for body mass index and other factors. Interestingly, the omnivores in this study consumed a predominantly plant-based diet with little meat or fish, again implying that small amounts of meat contribute significantly to the development of insulin resistance" And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes.
    - woqe 9y ago
      > And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes. I want to preface this comment by saying I am not attempting to be rude or combative, I am genuinely curious. If a calorie is a measure of energy contained in food, and food is the only source of energy for a body, and one mechanism by which the body uses that energy is to store fat, then a positive change in fat matter stored can maximally be the value of calorie intake converted to mass (in some discrete time). Or, a positive change in fat stored (mass) <= calories in (again, in some discrete time). Is this still too simplistic?
      - christophilus 9y ago
        I think that saying: "A calorie is a calorie" is too simplistic because it's never just calories vs calories. 1000 calories of bananas comes with a lot of other content vs 1000 calories of ice cream. You get a lot of different nutrients, you get a lot of fiber, etc. The holistic combination of things you get in unrefined foods makes an impact on how your body processes and stores calories. [Edit: I hope it's clear that I don't advocate eating 1000 calories of any one food. :)]
    - NikolaeVarius 9y ago
      I would be amazed if you could list credible nutritionists who would claim that calorie restriction will not help you lose weight.
    - kazinator 9y ago
      Taiwanese Buddhists. Now there's a random sampling method!
  - H1Supreme 9y ago
    > No amount of data or ancdotes beats calories in Again, no. The reason obese people are so obese is because they are never satiated. You can eat potato chips and drink soda all day, without ever feeling full. Secondly, it's an addiction to refined sugars and super simple carbs. I'm not arguing that calories aren't calories, but your body reacts differently to a Snickers bar than it does broccoli.
    - kazinator 9y ago
      The thing about calories is that the high side is easier and greater than the low side. But it is easy to accumulate with excess calories. There is a severe limit on how much of a deficit you can establish relative to a baseline energy intake, but a wide-open range in the area of excess intake. Furthermore, fat is easy to store but hard to mobilize. So if you eat 15000 calories one day, then create a 1000 calorie deficit over 15 days, it won't average out to the effect of a regular intake over 16 days. The body finds ways to economize energy use and hang on to the fat.
H1Supreme 9y ago
Dude, what? This is nonsense. If you're sucking down potato chips, cookies, and processed shit, you're not a Vegan; you're a moron. Eating a diet based on vegetables, fruits, beans, and nuts will absolutely change an overweight persons life.
- kazinator 9y ago
  Many people are vegan because of ideological principles not having anything to do with weight management. (Such as not killing animals or keeping them in miserable conditions.) You can in fact stuff yourself on vegetables, nuts, fruits and beans and maintain a high body fat percentage. (Potatoes and such are vegetables, by the way). Fruits are high in sugar. You're also forgetting grains.
  - issa 9y ago
    I've been vegan for 25 years and my weight has been up and down both before and after being vegan. The one thing that everyone should agree on is that there are a TON of factors that influence weight gain/loss. Obviously anyone will lose weight on a calorie restricted diet, but it isn't that simple in the real world--specifically, the level of effort involved in maintaining a low calorie diet varies greatly for different people. There are people who can skip meals and not notice, there are others who are constantly hungry. I'm excited that we're slowly figuring out why that is.

taurath 9y ago

Vegans almost always consume a ton of fiber as well - this recent study seems to indicate fiber intake creates a process that actively resists obesity and is a super interesting read - http://www.cell.com/cell-host-microbe/fulltext/S1931-3128(17)30497-3 http://www.cell.com/cell-host-microbe/fulltext/S1931-3128(17...

cageface 9y ago
Yes. Fiber is very very important and most Americans don't get nearly enough of it: https://www.nytimes.com/2018/01/01/science/food-fiber-microbiome-inflammation.html https://www.nytimes.com/2018/01/01/science/food-fiber-microb... Consuming fiber along with carbs dramatically changes their glycemic profile. Asians get away with eating so much white rice, for example, because they almost eat it along with a bunch of vegetables.
- kazinator 9y ago
  Boiled rice is not calorie dense; it has a large volume due to water, which reduces it almost down to 1 kcal/g. Asians do not all eat lots of white rice. Not all eat purely white rice. On the other hand, not all eat a lot of vegetables. Asians are not immune to obesity and diabetes. They certainly do not get away with overeating white rice or anything else.
  - cageface 9y ago
    The point is that white rice alone has a high glycemic index but eating it with vegetables makes a huge difference: https://nutritionfacts.org/video/if-white-rice-is-linked-to-diabetes-what-about-china/ https://nutritionfacts.org/video/if-white-rice-is-linked-to-...
    - kazinator 9y ago
      If you go for a second and third helping of rice without additional vegetables, I doubt it. Vegetables aren't a magic bullet. Calories are calories. Maybe vegetables can slow down the absorption so smoothing and flattening out the "transient sugar peak" that the liver has to deal with after meal, but that can be overwhelmed with a big enough intake. The slender Asians you see aren't the ones stuffing on huge amounts of rice, with or without veggies.

sc4les 9y ago

It's not. People just love books about how good bacon, eggs, milk and cheese are for your health

Mikeb85 9y ago

Vegans (the healthy ones at least) tend to consume complex carbs and lots of fibre. Furthermore, due to self-selection (vegans tend to be more health-conscious than the general population) I'd wager that vegans are also more physically active.

cageface 9y ago
Yeah that's true and it's the reason talking about "carbs" makes as much sense as talking about "drugs". There are different kinds with very different properties. There's a huge difference between eating whole grain, complex carbs along with other fiber-rich foods and eating a slice of Wonder Bread.

jlebrech 9y ago

those who eat a lot burn a lot too. it's the sugar go to sleep with that affect you, not energy that you actually use.

kazinator 9y ago
Only within reasonable limits. There may be some points in favor of not eating the sugar close to going to sleep: earlier in the day rather than later. However, sufficiently fierce face-stuffing will overcome this advantage.

jlebrech 9y ago

hgf-1 consumption is lower in vegans too

ubiquitoust 9y ago

The American Standard Diet is high fat & high carb. High fat diet should be done with low carb e.g. ketogenic diet. Keto can be efffective in reversing type 2 diabetes. Same thing with high carb diets, it only works if it's low fat.

spion 9y ago

Most nutritionists like to cherry pick studies that support their cause (even when they're low quality observational studies) and attack studies that oppose it. Michael Greger (the author of nutritionfacts) is quite the typical example (don't get me wrong, Gary Taubes has done that too in the "opposing" camp) The most likely theory I've seen is: 1. We have a certain amount of genetic propensity for higher-than-necessary insulin secretion 2. How we develop that propensity is still unknown (!). Gary Taubes likes the sugar hypothesis (i.e. something about fructose metabolism in the liver causes the system's self-regulation to fail) but thats mostly supported by observational studies - the mechanics aren't clear at all. Michael Greger likes the lipid hypothesis (fat inhibits muscle ability to absorb carbohydrates i.e. causes insulin resistance) but that doesn't explain why the liver continues to produce tons of fat despite its insulin receptors being clogged. Jason Fung likes the overflow hypotheis (as the muscles get fuller of glycogen, they're less able to store blood glucose, which means more insulin is needed to do it - however the liver isn't resistant and insulin upregulates its fat production) - but that doesn't fully explain how there are people who do lots of heavy physical activity yet remain obese and insulin resistant. Its possible that any subset of the above could be a cause if excessive enough - high GI carbs to raise the blood sugar, fat to slow sugar absorption and lack of exercise to keep your muscle cells overfilled with glycogen all contribute to high insulin secretion, together. 3. Insulin definitely regulates fat accumulation in fat cells. No doubt about it - more insulin means less fat released by fat cells and more carbs converted to fats by the liver and stored in fat cells. Insulin also blocks leptin which signals our brain that we're full, so we feel hungrier. 4. Keto and fasting definitely work in that they remove the primary reason for insulin to secrete. You can't have raised insulin secretion if you don't have a lot of sugars in your blood to start with. 5. Its possible that vegans (on average) also remove the secondary reason for insulin to over-secrete, whatever that is. Keep in mind that vegans on average are more mindful about having a healthy lifestyle, so it could be any number of things (correlation is not causation). But if veganism itself was the definite fix, we would expect to see no long-term vegans that are obese. Good averages to compare would be long-term vegans with long-term "ketoers" Keep in mind, the mechanisms to prevent weight gain are very different from those needed to actually lose weight. The first one is about maintaining a stable homeostatic state while the second one is about deliberately causing a different non-homeostatic state.

vixen99 9y ago

Lots of videos and the odd link to a peer-reviewed paper on a site run by one physician doesn't add up to a 'lot of evidence'. That doesn't mean he's wrong but I'll agree with you on 'caution needed'.

toasterlovin 9y ago

Health outcomes for vegans are probably skewed heavily by the fact that the vegan sub-population consists of people who A) spend a lot of time obsessing over what they eat, and B) have the wherewithal to successfully pull-off a major dietary intervention (which is what veganism is, essentially).

squids 9y ago

I think the theory was that vegan food is less palatable and often less calorie dense and harder to find so vegans eat less. IIRC a study showed low carb diets worked in a similar way, people just ate less as they found it harder to find enough calories.

christophilus 9y ago

I think it's because of the high fiber, low processed sugar nature of the good vegan diets. There are very unhealthy vegans that eat lots of weird processed things. But yeah. Anecdotally, I know people who were "cured"* of type II diabetes, high blood pressure, high cholesterol, etc by switching to a high-carb (no refined carbs) vegan diet. I also know people who have had the same results by dropping carbs and moving to a high fat, high protein, high veggie diet. It sounds to me as if it's the refined carbs/sugars that are the primary enemy. * By cured, I mean they were able to get off of all medication. But if / when they revert their diets, the symptoms come back, and the meds are again required.

cageface 9y ago
The problem is that a high fat, high protein diet has other downsides that a healthy plant based diet doesn’t, specifically cardiovascular issues.
- christophilus 9y ago
  I was vegan for a while (McDougall), so I'm aware of the evidence for this. But I don't know if I buy it. I don't remember seeing any studies that focused on people who had high-fat + low sugar diets. Most of them compared typical western diets with (undeniably) healthy vegan diets. The typical western diet is indeed high fat, but is also crazy high in refined sugars.
- tracker1 9y ago
  cardiovascular issues seem to be centered around inflammation not specifically fat. Not dietary cholesterol or saturated fat. There's lots of evidence to also support intermittent and extended fasting. In general minimizing starchy carbs alone, along with refined sugars and grains goes a long way. If you eat vegan or keto/lchf. I've done both... with vegan, I still had to take a large amount of insulin and gained weight, even at 1500-1800 calories a day... on keto, I eat a little more but managed to lose 63# last year and come off insulin (mostly).