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Coronary heart disease is a chronic inflammatory condition

160 points by jamesknelson 9y ago

adrianN 9y ago
It is strange that anti-inflammatory drugs don't reduce risk. Which fats are pro- or anti-inflammatory also seems to be an area of active research: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/ Nutrition is pretty terrible. It seems to me that laymen have zero chance of getting useful advice out of the research, other than "Eat a varied diet, move regularly".
- danieltillett 9y ago
  There is actually some suggestion that the way the statins work is as anti-inflammatories [0]. Of course there is the wonder drug aspirin as well. 0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394171/
  - Gibbon1 9y ago
    I think there is a drug on the market that was approved because it lowered cholesterol the same amount as statins. But when studied on how well it reduced heart attacks was shown to be worthless.
    - danieltillett 9y ago
      Yes there have been a few of these that have fallen over in large scale phase III trials where they reduced cholesterol, but didn’t reduce the death rate. Shows how little we understand even some of the most studied pharmaceuticals and disease areas.
  - lawlessone 9y ago
    >wonder drug aspirin as unfortunately if you're asthmatic there is a decent chance you are allergic to aspirin
- donquichotte 9y ago
  > Nutrition is pretty terrible. It seems to me that laymen have zero chance of getting useful advice out of the research, other than "Eat a varied diet, move regularly". I completely agree, and it also appears to change every other decade. Suddenly, drinking coffee became healthy, eggs stopped being unhealthy and drinking a glass of wine a day became a major risk for CVD. Engineers are spoiled when it comes disentangeling relationships between causes and effects because our systems are relatively simple compared to the huge and complicated mess that is human (or, indeed, any) biology.
  - pngai 9y ago
    I wonder if there are categories of people that respond in similar ways when they are in the same category, but the response would vary from one category to another. For example, people with low blood pressure would not benefit from a low sodium diet. Yet we are all told "reduce your salt intake".
  - chillingeffect 9y ago
    Those are nits compared to the vast amount of nutrition advice which has remained stable.
- cageface 9y ago
  There are billion dollar industries out there doing their best to confuse you about this. Established wisdom out there hasn't really changed that much in the last few decades. Avoid processed sugars and oils and eat mostly (or entirely) plants.
  - pbhjpbhj 9y ago
    >Avoid processed sugars and oils and eat mostly (or entirely) plants. // I'll bet if you look at foods in a supermarket the main changes in ingredients will be more processed sugars and oils. This seems to happen in the UK when companies are taken over by USAmerican companies.
    - cageface 9y ago
      Food has definitely gotten worse but the nutritional recommendations haven't really changed much.
      - cies 9y ago
        Is dairy still in? I think it used to be, but is on the way out in most places due to the mountain of evidence proving it makes us sick. Processed meat is since a few years on the carcinogens lists (next to asbestos and smoking). But strange enough still on the hospital menus (also consumed by cancer patients)! It takes a while I guess... Sadly.
        DanBC 9y ago
        > carcinogens lists (next to asbestos and smoking). The quality of the evidence that processed red meat causes cancer is now as good as the evidence that smoking causes cancer. The strength of the effect is very very different. Smoking causes a lot of cancer. Red meat causes very little cancer. It's completely incorrect to suggest red meat is equivalent to smoking for cancer.
        cies 9y ago
- acct1771 9y ago
  Prescription drugs? Or all drugs? e.g. CBD?
- carbocation 9y ago
  Specific anti inflammatories actually do work: a landmark trial from last year showed that canakinumab (an IL1 antagonist) reduces recurrent adverse cardiac events. https://www.ncbi.nlm.nih.gov/m/pubmed/28845751/ https://www.ncbi.nlm.nih.gov/m/pubmed/28845751/
  - LinuxBender 9y ago
    Is there a natural form of that drug or has it been modified from its original form?
    - carbocation 9y ago
      This particular drug is a human monoclonal antibody, so it's different from many of the small molecule drugs that are derived from natural compounds.
- mtgx 9y ago
  I read somewhere that anti-inflammatory drugs neutralize the effect of Vitamin K2 in the blood. So they treat the symptoms, like making your blood less thick or expanding your arteries, but during all that time your arteries still aren't healing and you keep accumulating LDL cholesterol and calcium. So in the long term, you're probably actually making things worse, because you're not allowing Vitamin K2 to act against the calcium in your blood. You should be able to experiment with this by taking a CAC test every year or two.
- bitwize 9y ago
  Except we also know that you should be eating strict vegan, paleo, or keto, and for God's sake man, don't touch sugar or cow's milk.
- truculation 9y ago
  My guess is that we're simply overstimulating ourselves -- with food, caffeine, alcohol, drugs, sex, etc. In part to support our increased mental activity (work, video games, social media, etc). This would explain weight gain, increased inflammation and tendency to form clots (sympathetic nervous system arousal increases blood clotting, presumably for 'fight or flight' purposes). Hence the benefits of periodic fasting, observing the Sabbath, etc, -- to truly relax and allow the parasympathetic nervous system to kick back in. Hitherto our ideas of what is relaxing have been faulty e.g. watching TV
- bluGill 9y ago
  The problem with nutrition is there are two types of valid studies. The first concludes "despite our best efforts we were unable to get the subjects to eat their assigned diet". The second doesn't apply to you because you are not confined (either to a hospital bed or in prison). The above is overly cynical and not completely true, but it is a good guide to the types of science that can be done in nutrition.
- rsync 9y ago
  "It is strange that anti-inflammatory drugs don't reduce risk." Luckily, fasting does. Whatever your metabolic and inflammation markers are, they will all trend worse after energy input. If your waking day is 16 hours long, reducing your "feeding window" by even four hours increases your time spent in "low inflammation mode" by 50%. Looking for a drug or a novel intervention is silly when you haven't picked even the lowest hanging fruit. It's like installing a fancy air filter in your car but neglecting to even change the oil.
  - billmalarky 9y ago
    Additional low-hanging fruit is Omega-3 supplementation. For those interested cntl-f my username and see my other comment on this page.
- alphaoverlord 9y ago
  Anti-inflammatory drugs do reduce risk. https://en.wikipedia.org/wiki/Canakinumab https://en.wikipedia.org/wiki/Canakinumab http://www.nejm.org/doi/full/10.1056/NEJMoa1707914 http://www.nejm.org/doi/full/10.1056/NEJMoa1707914
cageface 9y ago
Literally hundreds of metabolic ward studies (the gold standard in nutrition) have demonstrated a direct, causal relationship between saturated fat intake and blood cholesterol levels. And the correlation between high cholesterol levels and CVD has been known for decades. Don't be fooled by observational studies which fail to disentangle the highly variable baseline individual cholesterol levels from the effects of fat in the diet. Here is a review of 395 direct feeding experiments, which are much more appropriate for measuring the effects of diet: https://www.ncbi.nlm.nih.gov/pubmed/9006469 https://www.ncbi.nlm.nih.gov/pubmed/9006469 http://circ.ahajournals.org/content/circulationaha/108/22/2757.full.pdf http://circ.ahajournals.org/content/circulationaha/108/22/27... https://www.theguardian.com/science/sifting-the-evidence/2016/jun/13/dont-throw-away-your-statins-yet-ldl-cholesterol-is-still-probably-bad-for-you https://www.theguardian.com/science/sifting-the-evidence/201... This video sums up the issues well: https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/ https://nutritionfacts.org/video/the-saturated-fat-studies-s...
- ggm 9y ago
  What was the exercise level of the participants in a metabolic ward study? What's the pre screening for inflammation and associated risk issues? Your rebuttal is good in as much as it points to study but surely the reappraisal of these more modern meta analyses carry some weight or are you refuting by appeal to authority? The guardian article says the peer review had misgivings so obviously the epidemiological aspects of this are up in the air. I'm not on statins but I wouldn't stop if I was. I might however take heart that moderate exercise and med diet appears to have upsides?
  - cageface 9y ago
    The main point here is that observational studies are much less reliable than mechanistic studies involving direct feeding & measurement. The genetic variability of baseline cholesterol levels is so high that it can drown out the effect of diet in cross-sectional observational studies. Meta-analyses of observational studies are the easiest kind of nutrition study to skew in the direction of the conclusions you want. What's worse, "studies" like these are used as excuse for people to adopt diets very high in saturated fat and animal protein which are not only disastrous for the environment and animal welfare, but have also been shown to be the absolutely worst diets in terms of overall mortality risk: https://www.elsevier.com/connect/controlling-protein-intake-may-be-key-to-longevity https://www.elsevier.com/connect/controlling-protein-intake-... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/
vfc1 9y ago
A plant-based diet can be very anti-inflamatory, and its reported to revert heart disease in some cases - https://www.youtube.com/watch?v=tk0iC4TOE0E https://www.youtube.com/watch?v=tk0iC4TOE0E
- Valmar 9y ago
  What about a diet with completely unprocessed meats and plants? Basically, a diet entirely devoid of processed foods? I bet that would be equally anti-inflammatory, and be good for heart health.
  - cies 9y ago
    Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. Same for the saturated fats in meat (not even to speak of dairy), which are rarely found in plants. Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. Looking for a "good for health" diet: see WFPB.
    - Valmar 9y ago
      > Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. > Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. These claims don't even seem remotely scientific, lol.
      - cies 9y ago
        > Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. https://nutritionstudies.org/animal-vs-plant-protein https://nutritionstudies.org/animal-vs-plant-protein There are so many studies on this. > Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. Your right here. You may call rotting on all things passing our colon. But rotting meat is just a little more "dangerous" I guess. Again, your right: no science to back up this claim I could find.
gassius 9y ago
BOOM the smoking gun goes off. As a nicotine addicted person, currently on recovery (but very aware of the lifelong fight that it is for me), and as a LCHF dieter, to me the relation is very clear. In my case, sugar has the same addictive effects than nicotine, and apparently, it has as most or even worst malign effects. This is not to say that everyone should follow a LCHF diet, or that it will work for everyone. I do think that if you keep your carbs under 100g daily, and they are low profile insulin type, you should be good and safe. But for me, as an addicted person, if I deviate from 15g is very easy to get into a slippery slope and the next thing I know I am eating donuts and flurries. If I smoke a cigarette on a night out, the next thing I know I am smoking a pack daily or more. The thing is, as with tobacco before, the sugar industry (which is probably the 90% of volume of the whole food industry world wide) has gone ways and beyond to hook us to their products and to cover the negative effects. Too many people is addicted to High Carbs without even knowing it. I hope this studies get more and more attention in the mainstream media and many more people could at least review their lifestyle with more information and asses what is best for each of them.
- brynx97 9y ago
  How does one review their lifestyle? I was told I've got Rheumatoid Arthritis after extensive testing and doctor visits with specialists over a few months. I'm shopping around ideas on how to review and track my day to day life.
  - cies 9y ago
    I'd look at WFPB for food (I'm NOT a HFLC or keto promoter at all) and some strength training (most bang of your hour of commitment -- see reddit.com/r/bodyweightfitness) for starters. That will get most to a place of general wellbeing (both in not toxifying your body and posture) in a few months. The basic idea I believe many of the "cronic", "infammetory", "auto-immune" and/or "unfixable by MDs" diseases lies in a diet that is not for humans. Hummans are frugavores (fruit eaters, that can only tolerate minescule, bug-size, amounts of meat), like primates. Technically frugavores are a sub-category of omnivores, but in practise there are a lot of differences (dog/bear/swine = omnivore). Herbivores are different too: they graze and have multiple stomachs. Understand that you are a frugavore, and live up to it, or --as I understand it-- the "unfixable by MDs diseases" will get you. They cannot fix it, because you need to stop something, not add a drug or cut-out/radiate a piece of body. You can look for natural remedies of RA. Flax seed powder (high in ALA-O3) and high DHA-O3 algae extract oil capsules are great. So is turmeric. More info see Dr Greger and Dr Bergman. They have videos on the topic of RA. These guys base their advice on science. Then there is the, not so well scientifically supported, next level (first eat "clean" for a while) and that is detoxing. This basically starts by a colon cleanse and "getting your kidneys to filter". Dr Robert Morse is your guy here. This will involve some types of fasting for most people. Once your colon and kidneys can properly eliminate waste, you lymph system will be able to drain the acidic waste from you inflamed joints and your body will heal you RA, naturally. G'luck! You can fix this 100%. With the emphasis on you, as your condition is due to a lack of some pharmaceutical (patented medicine). It is MOST probably due to your body's been obstructed in fixing itself somehow.
jbb67 9y ago
This talks about a Mediterranean Diet quite a bit, but what, exactly is such a diet?
- Someone 9y ago
  https://en.wikipedia.org/wiki/Mediterranean_diet https://en.wikipedia.org/wiki/Mediterranean_diet: The Mediterranean diet is a diet inspired by the eating habits of Greece, Southern Italy, and Spain in the 1940s and 1950s. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of non-fish meat products.
  - tonyedgecombe 9y ago
    Important to note that list doesn't include Pasta and Pizza :)
    - jbb67 9y ago
      I guess this is my problem, I understand the principle of Mediterranean diet, I just don't know _specifically_ what food to make.,
      - jaclaz 9y ago
        >I guess this is my problem, I understand the principle of Mediterranean diet, I just don't know _specifically_ what food to make., What do you mean? Do you need a (say) weekly example? Mind you this would greatly depend on where you live, and which products you can find (and the actual quality/originality of those products). Personally I am an advocate of the Mediterranean Diet (not really as "coded" by the various scientists, but more like traditional eating), but you need to have "real", "good" ingredients not the kind of stuff that you can normally buy at a supermarket - say - in the UK (with no offence intended to the British or to their supermarkets, of course, only an example) if you want to have the "right" experience, at least regarding taste, but I suspect that also the (supposed) health benefits come from fresh, genuine ingredients. And I would add - OT but connected to other recent discussions on HN about Vitamin D and sun - that most probably part of the generic Mediterranean good health might come from eating "right" while living in the "right" climate.
cryptokush 9y ago
Dr Aseem Malhotra is a well known low carb high fat shill and has many books to sell on this, he has a strong bias and agenda against the saturated fat and cholesterol consensus. This is garbage.
carbocation 9y ago
The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. Much of what is written here is accepted widely: that many types of fats are not really the issue driving heart disease; that fructose and other sugars are problematic; that lifestyle interventions can have a real impact; that stenting stable atherosclerosis has no benefit; and that atherothrombosis is the killer. The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. That LDL is a primary contributor to cardiovascular disease, myocardial infarction, and death is supported by human genetic data and by hundreds of thousands of individuals followed in clinical trials, as well as millions of people in post marketing monitoring. The casual dismissal in this article by referring to low quality, confounded evidence (observational studies) is not responsible and it taints an otherwise useful summary.
- riahi 9y ago
  Agree. To give context, this is an editorial in a sports medicine journal. It's not a trial, meta-analysis, or even a systematic review.
  - abainbridge 9y ago
    No, but the first reference is to, "A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults." Which you can find here: http://www.bmj.com/content/351/bmj.h3978 http://www.bmj.com/content/351/bmj.h3978
    - YeGoblynQueenne 9y ago
      The reference concludes that trans fats are bad for you and that the evidence for saturated fats not being bad for you is not complete: Conclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. Note "but the evidence is heterogeneous with methodological limitations" and "Trans fats are associated with all cause mortality, total CHD, and CHD mortality"
vanderZwan 9y ago
> Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions Doesn't saturated fat trigger inflammation? Because if I remember that correctly, then this is a "guns don't kill people, bullets do" argument. Similarly, doesn't it also cause arterial stiffening? It is not the same process as arterial clogging but definitely makes it worse and is part of heart disease. Again, I may be misremembering this - I could be confusing fat and meat, for example. Either way it boils down to "eat mostly plants"
- weego 9y ago
  Wouldn't that suppose that you're not doing progressive damage by slowly clogging arteries over long periods of time and that eating saturated fat is something you can cycle/regulate? Still being bad for you is one thing, but the manner in which it is bad for you seems like it would have some wider implications.
  - vanderZwan 9y ago
    Perhaps, but that is not the language used in the headline nor in the article: > It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat.
- cageface 9y ago
  You're correct. Both saturated fat and animal protein are inflammatory, which certainly contributes to their effect on CVD. http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-to-avoid-limit/food-ingredients-and-inflammation-3.php http://www.arthritis.org/living-with-arthritis/arthritis-die...
  - vanderZwan 9y ago
    Every time food is discussed on this site, someone downvotes everyone who says excessive meat is unhealthy. I don't know who it is but it's pretty sad.
billmalarky 9y ago
For those interested in supplementing Omega-3 oil in their diet (which should probably be everyone), don't get Omega-3 off the rack at the store. Most Omega-3 supplements (even at GNC/Vitamin Shoppe/etc) consist of a small amount of Omega-3, and a lot of filler "fish oil" which does nothing for you. Furthermore, in order to get the levels of Omega-3 you need to really see benefits (roughly 500mg DHA and 500mg EPA per day, 1000mg DHA/1000mg EPA if you have heart disease - but ask your doctor) you would need to consume so much of this filler you will really start to see side effects (fishy breath, gastrointestinal distress, etc). Here's an example of what you will see at the store: https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels/dp/B00MGNMMHI/ref=sr_1_7_s_it?s=hpc&ie=UTF8&qid=1520870949&sr=1-7&keywords=omega%2B3%2Bfish%2Boil&dpID=51eg6Tzy3DL&preST=_SY300_QL70_&dpSrc=srch&th=1 https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels... Notice there's 1000mg of fish oil there, but only 300 mg Omega-3 (only 250mg of which is actually DHA/EPA) and they don't even give you the ratio of DHA to EPA in that 250mg - you need an even split to see best benefits as they work together. What you need to look for is pharmaceutical grade Omega-3, which is basically just concentrated so you don't get the filler oils. I'm a huge evangelist for OmegaVia (https://omegavia.com/ https://omegavia.com/), since they also use a enteric coating on the pills so they do not dissolve until they hit your small intestine. As a result there are zero fish breath/burp side effects. Give it a try, it's a game changer.
- toss1 9y ago
  Also working on substitution in the diet of Omega-6s to Omega-3s. It's actually very difficult, as almost everything is swamped with O-6s. I've literally given up on Mayo for sandwiches, just using high O-6 olive oil for now. I've provisionally concluded that this is because of shelf life -- the O-6s have good shelf life, but the O-3s do not, so essentially need to be made fresh or kept in special containers, cooled, etc. I feel like supplements can be good as a supplement, but I'm looking to improve my eating system. Any suggestions welcome!
  - Scaevolus 9y ago
    I think it's cost more than shelf stability. Canola oil actually has the best n-6:n-3 ratio (2:1) of the common vegetable oils [1], and you can buy (or make!) canola oil mayonnaise easily. Beef fat has much better ratios when grass fed than grain fed as well [2]! [1]: http://www.susanallport.com/images/Dietfatchart_8_.jpg http://www.susanallport.com/images/Dietfatchart_8_.jpg [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/table/T2/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/table/T...
watertom 9y ago
I’m with Linus Pauling, and his belief that an L-Ascorbic Acid deficiency is the cause of heart disease.
toddh 9y ago
Dr. Malcolm Kendrick has a good over 40 part series on What causes heart disease? https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-disease/ https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-d.... It may be of interest.

160 points by jamesknelson 9y ago

It is strange that anti-inflammatory drugs don't reduce risk. Which fats are pro- or anti-inflammatory also seems to be an area of active research: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/ Nutrition is pretty terrible. It seems to me that laymen have zero chance of getting useful advice out of the research, other than "Eat a varied diet, move regularly".

danieltillett 9y ago
There is actually some suggestion that the way the statins work is as anti-inflammatories [0]. Of course there is the wonder drug aspirin as well. 0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394171/
- Gibbon1 9y ago
  I think there is a drug on the market that was approved because it lowered cholesterol the same amount as statins. But when studied on how well it reduced heart attacks was shown to be worthless.
  - danieltillett 9y ago
    Yes there have been a few of these that have fallen over in large scale phase III trials where they reduced cholesterol, but didn’t reduce the death rate. Shows how little we understand even some of the most studied pharmaceuticals and disease areas.
- lawlessone 9y ago
  >wonder drug aspirin as unfortunately if you're asthmatic there is a decent chance you are allergic to aspirin
donquichotte 9y ago
> Nutrition is pretty terrible. It seems to me that laymen have zero chance of getting useful advice out of the research, other than "Eat a varied diet, move regularly". I completely agree, and it also appears to change every other decade. Suddenly, drinking coffee became healthy, eggs stopped being unhealthy and drinking a glass of wine a day became a major risk for CVD. Engineers are spoiled when it comes disentangeling relationships between causes and effects because our systems are relatively simple compared to the huge and complicated mess that is human (or, indeed, any) biology.
- pngai 9y ago
  I wonder if there are categories of people that respond in similar ways when they are in the same category, but the response would vary from one category to another. For example, people with low blood pressure would not benefit from a low sodium diet. Yet we are all told "reduce your salt intake".
- chillingeffect 9y ago
  Those are nits compared to the vast amount of nutrition advice which has remained stable.
cageface 9y ago
There are billion dollar industries out there doing their best to confuse you about this. Established wisdom out there hasn't really changed that much in the last few decades. Avoid processed sugars and oils and eat mostly (or entirely) plants.
- pbhjpbhj 9y ago
  >Avoid processed sugars and oils and eat mostly (or entirely) plants. // I'll bet if you look at foods in a supermarket the main changes in ingredients will be more processed sugars and oils. This seems to happen in the UK when companies are taken over by USAmerican companies.
  - cageface 9y ago
    Food has definitely gotten worse but the nutritional recommendations haven't really changed much.
    - cies 9y ago
      Is dairy still in? I think it used to be, but is on the way out in most places due to the mountain of evidence proving it makes us sick. Processed meat is since a few years on the carcinogens lists (next to asbestos and smoking). But strange enough still on the hospital menus (also consumed by cancer patients)! It takes a while I guess... Sadly.
      - DanBC 9y ago
        > carcinogens lists (next to asbestos and smoking). The quality of the evidence that processed red meat causes cancer is now as good as the evidence that smoking causes cancer. The strength of the effect is very very different. Smoking causes a lot of cancer. Red meat causes very little cancer. It's completely incorrect to suggest red meat is equivalent to smoking for cancer.
        cies 9y ago
acct1771 9y ago
Prescription drugs? Or all drugs? e.g. CBD?
carbocation 9y ago
Specific anti inflammatories actually do work: a landmark trial from last year showed that canakinumab (an IL1 antagonist) reduces recurrent adverse cardiac events. https://www.ncbi.nlm.nih.gov/m/pubmed/28845751/ https://www.ncbi.nlm.nih.gov/m/pubmed/28845751/
- LinuxBender 9y ago
  Is there a natural form of that drug or has it been modified from its original form?
  - carbocation 9y ago
    This particular drug is a human monoclonal antibody, so it's different from many of the small molecule drugs that are derived from natural compounds.
mtgx 9y ago
I read somewhere that anti-inflammatory drugs neutralize the effect of Vitamin K2 in the blood. So they treat the symptoms, like making your blood less thick or expanding your arteries, but during all that time your arteries still aren't healing and you keep accumulating LDL cholesterol and calcium. So in the long term, you're probably actually making things worse, because you're not allowing Vitamin K2 to act against the calcium in your blood. You should be able to experiment with this by taking a CAC test every year or two.
bitwize 9y ago
Except we also know that you should be eating strict vegan, paleo, or keto, and for God's sake man, don't touch sugar or cow's milk.
truculation 9y ago
My guess is that we're simply overstimulating ourselves -- with food, caffeine, alcohol, drugs, sex, etc. In part to support our increased mental activity (work, video games, social media, etc). This would explain weight gain, increased inflammation and tendency to form clots (sympathetic nervous system arousal increases blood clotting, presumably for 'fight or flight' purposes). Hence the benefits of periodic fasting, observing the Sabbath, etc, -- to truly relax and allow the parasympathetic nervous system to kick back in. Hitherto our ideas of what is relaxing have been faulty e.g. watching TV
bluGill 9y ago
The problem with nutrition is there are two types of valid studies. The first concludes "despite our best efforts we were unable to get the subjects to eat their assigned diet". The second doesn't apply to you because you are not confined (either to a hospital bed or in prison). The above is overly cynical and not completely true, but it is a good guide to the types of science that can be done in nutrition.
rsync 9y ago
"It is strange that anti-inflammatory drugs don't reduce risk." Luckily, fasting does. Whatever your metabolic and inflammation markers are, they will all trend worse after energy input. If your waking day is 16 hours long, reducing your "feeding window" by even four hours increases your time spent in "low inflammation mode" by 50%. Looking for a drug or a novel intervention is silly when you haven't picked even the lowest hanging fruit. It's like installing a fancy air filter in your car but neglecting to even change the oil.
- billmalarky 9y ago
  Additional low-hanging fruit is Omega-3 supplementation. For those interested cntl-f my username and see my other comment on this page.
alphaoverlord 9y ago
Anti-inflammatory drugs do reduce risk. https://en.wikipedia.org/wiki/Canakinumab https://en.wikipedia.org/wiki/Canakinumab http://www.nejm.org/doi/full/10.1056/NEJMoa1707914 http://www.nejm.org/doi/full/10.1056/NEJMoa1707914

cageface 9y ago

Literally hundreds of metabolic ward studies (the gold standard in nutrition) have demonstrated a direct, causal relationship between saturated fat intake and blood cholesterol levels. And the correlation between high cholesterol levels and CVD has been known for decades. Don't be fooled by observational studies which fail to disentangle the highly variable baseline individual cholesterol levels from the effects of fat in the diet. Here is a review of 395 direct feeding experiments, which are much more appropriate for measuring the effects of diet: https://www.ncbi.nlm.nih.gov/pubmed/9006469 https://www.ncbi.nlm.nih.gov/pubmed/9006469 http://circ.ahajournals.org/content/circulationaha/108/22/2757.full.pdf http://circ.ahajournals.org/content/circulationaha/108/22/27... https://www.theguardian.com/science/sifting-the-evidence/2016/jun/13/dont-throw-away-your-statins-yet-ldl-cholesterol-is-still-probably-bad-for-you https://www.theguardian.com/science/sifting-the-evidence/201... This video sums up the issues well: https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/ https://nutritionfacts.org/video/the-saturated-fat-studies-s...

ggm 9y ago
What was the exercise level of the participants in a metabolic ward study? What's the pre screening for inflammation and associated risk issues? Your rebuttal is good in as much as it points to study but surely the reappraisal of these more modern meta analyses carry some weight or are you refuting by appeal to authority? The guardian article says the peer review had misgivings so obviously the epidemiological aspects of this are up in the air. I'm not on statins but I wouldn't stop if I was. I might however take heart that moderate exercise and med diet appears to have upsides?
- cageface 9y ago
  The main point here is that observational studies are much less reliable than mechanistic studies involving direct feeding & measurement. The genetic variability of baseline cholesterol levels is so high that it can drown out the effect of diet in cross-sectional observational studies. Meta-analyses of observational studies are the easiest kind of nutrition study to skew in the direction of the conclusions you want. What's worse, "studies" like these are used as excuse for people to adopt diets very high in saturated fat and animal protein which are not only disastrous for the environment and animal welfare, but have also been shown to be the absolutely worst diets in terms of overall mortality risk: https://www.elsevier.com/connect/controlling-protein-intake-may-be-key-to-longevity https://www.elsevier.com/connect/controlling-protein-intake-... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/

vfc1 9y ago

A plant-based diet can be very anti-inflamatory, and its reported to revert heart disease in some cases - https://www.youtube.com/watch?v=tk0iC4TOE0E https://www.youtube.com/watch?v=tk0iC4TOE0E

Valmar 9y ago
What about a diet with completely unprocessed meats and plants? Basically, a diet entirely devoid of processed foods? I bet that would be equally anti-inflammatory, and be good for heart health.
- cies 9y ago
  Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. Same for the saturated fats in meat (not even to speak of dairy), which are rarely found in plants. Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. Looking for a "good for health" diet: see WFPB.
  - Valmar 9y ago
    > Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. > Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. These claims don't even seem remotely scientific, lol.
    - cies 9y ago
      > Animal proteins are inflammatory, as they contain sulfur based amino acids. So meat is going to inflame. https://nutritionstudies.org/animal-vs-plant-protein https://nutritionstudies.org/animal-vs-plant-protein There are so many studies on this. > Finally out intestine is too long, and not acidic enough to meat, it may rot in our intestine causing inflammation. Your right here. You may call rotting on all things passing our colon. But rotting meat is just a little more "dangerous" I guess. Again, your right: no science to back up this claim I could find.

gassius 9y ago

BOOM the smoking gun goes off. As a nicotine addicted person, currently on recovery (but very aware of the lifelong fight that it is for me), and as a LCHF dieter, to me the relation is very clear. In my case, sugar has the same addictive effects than nicotine, and apparently, it has as most or even worst malign effects. This is not to say that everyone should follow a LCHF diet, or that it will work for everyone. I do think that if you keep your carbs under 100g daily, and they are low profile insulin type, you should be good and safe. But for me, as an addicted person, if I deviate from 15g is very easy to get into a slippery slope and the next thing I know I am eating donuts and flurries. If I smoke a cigarette on a night out, the next thing I know I am smoking a pack daily or more. The thing is, as with tobacco before, the sugar industry (which is probably the 90% of volume of the whole food industry world wide) has gone ways and beyond to hook us to their products and to cover the negative effects. Too many people is addicted to High Carbs without even knowing it. I hope this studies get more and more attention in the mainstream media and many more people could at least review their lifestyle with more information and asses what is best for each of them.

brynx97 9y ago
How does one review their lifestyle? I was told I've got Rheumatoid Arthritis after extensive testing and doctor visits with specialists over a few months. I'm shopping around ideas on how to review and track my day to day life.
- cies 9y ago
  I'd look at WFPB for food (I'm NOT a HFLC or keto promoter at all) and some strength training (most bang of your hour of commitment -- see reddit.com/r/bodyweightfitness) for starters. That will get most to a place of general wellbeing (both in not toxifying your body and posture) in a few months. The basic idea I believe many of the "cronic", "infammetory", "auto-immune" and/or "unfixable by MDs" diseases lies in a diet that is not for humans. Hummans are frugavores (fruit eaters, that can only tolerate minescule, bug-size, amounts of meat), like primates. Technically frugavores are a sub-category of omnivores, but in practise there are a lot of differences (dog/bear/swine = omnivore). Herbivores are different too: they graze and have multiple stomachs. Understand that you are a frugavore, and live up to it, or --as I understand it-- the "unfixable by MDs diseases" will get you. They cannot fix it, because you need to stop something, not add a drug or cut-out/radiate a piece of body. You can look for natural remedies of RA. Flax seed powder (high in ALA-O3) and high DHA-O3 algae extract oil capsules are great. So is turmeric. More info see Dr Greger and Dr Bergman. They have videos on the topic of RA. These guys base their advice on science. Then there is the, not so well scientifically supported, next level (first eat "clean" for a while) and that is detoxing. This basically starts by a colon cleanse and "getting your kidneys to filter". Dr Robert Morse is your guy here. This will involve some types of fasting for most people. Once your colon and kidneys can properly eliminate waste, you lymph system will be able to drain the acidic waste from you inflamed joints and your body will heal you RA, naturally. G'luck! You can fix this 100%. With the emphasis on you, as your condition is due to a lack of some pharmaceutical (patented medicine). It is MOST probably due to your body's been obstructed in fixing itself somehow.

jbb67 9y ago

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

Someone 9y ago
https://en.wikipedia.org/wiki/Mediterranean_diet https://en.wikipedia.org/wiki/Mediterranean_diet: The Mediterranean diet is a diet inspired by the eating habits of Greece, Southern Italy, and Spain in the 1940s and 1950s. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of non-fish meat products.
- tonyedgecombe 9y ago
  Important to note that list doesn't include Pasta and Pizza :)
  - jbb67 9y ago
    I guess this is my problem, I understand the principle of Mediterranean diet, I just don't know _specifically_ what food to make.,
    - jaclaz 9y ago
      >I guess this is my problem, I understand the principle of Mediterranean diet, I just don't know _specifically_ what food to make., What do you mean? Do you need a (say) weekly example? Mind you this would greatly depend on where you live, and which products you can find (and the actual quality/originality of those products). Personally I am an advocate of the Mediterranean Diet (not really as "coded" by the various scientists, but more like traditional eating), but you need to have "real", "good" ingredients not the kind of stuff that you can normally buy at a supermarket - say - in the UK (with no offence intended to the British or to their supermarkets, of course, only an example) if you want to have the "right" experience, at least regarding taste, but I suspect that also the (supposed) health benefits come from fresh, genuine ingredients. And I would add - OT but connected to other recent discussions on HN about Vitamin D and sun - that most probably part of the generic Mediterranean good health might come from eating "right" while living in the "right" climate.

cryptokush 9y ago

Dr Aseem Malhotra is a well known low carb high fat shill and has many books to sell on this, he has a strong bias and agenda against the saturated fat and cholesterol consensus. This is garbage.

carbocation 9y ago

The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. Much of what is written here is accepted widely: that many types of fats are not really the issue driving heart disease; that fructose and other sugars are problematic; that lifestyle interventions can have a real impact; that stenting stable atherosclerosis has no benefit; and that atherothrombosis is the killer. The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. That LDL is a primary contributor to cardiovascular disease, myocardial infarction, and death is supported by human genetic data and by hundreds of thousands of individuals followed in clinical trials, as well as millions of people in post marketing monitoring. The casual dismissal in this article by referring to low quality, confounded evidence (observational studies) is not responsible and it taints an otherwise useful summary.

riahi 9y ago
Agree. To give context, this is an editorial in a sports medicine journal. It's not a trial, meta-analysis, or even a systematic review.
- abainbridge 9y ago
  No, but the first reference is to, "A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults." Which you can find here: http://www.bmj.com/content/351/bmj.h3978 http://www.bmj.com/content/351/bmj.h3978
  - YeGoblynQueenne 9y ago
    The reference concludes that trans fats are bad for you and that the evidence for saturated fats not being bad for you is not complete: Conclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. Note "but the evidence is heterogeneous with methodological limitations" and "Trans fats are associated with all cause mortality, total CHD, and CHD mortality"

vanderZwan 9y ago

> Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions Doesn't saturated fat trigger inflammation? Because if I remember that correctly, then this is a "guns don't kill people, bullets do" argument. Similarly, doesn't it also cause arterial stiffening? It is not the same process as arterial clogging but definitely makes it worse and is part of heart disease. Again, I may be misremembering this - I could be confusing fat and meat, for example. Either way it boils down to "eat mostly plants"

weego 9y ago
Wouldn't that suppose that you're not doing progressive damage by slowly clogging arteries over long periods of time and that eating saturated fat is something you can cycle/regulate? Still being bad for you is one thing, but the manner in which it is bad for you seems like it would have some wider implications.
- vanderZwan 9y ago
  Perhaps, but that is not the language used in the headline nor in the article: > It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat.
cageface 9y ago
You're correct. Both saturated fat and animal protein are inflammatory, which certainly contributes to their effect on CVD. http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-to-avoid-limit/food-ingredients-and-inflammation-3.php http://www.arthritis.org/living-with-arthritis/arthritis-die...
- vanderZwan 9y ago
  Every time food is discussed on this site, someone downvotes everyone who says excessive meat is unhealthy. I don't know who it is but it's pretty sad.

billmalarky 9y ago

For those interested in supplementing Omega-3 oil in their diet (which should probably be everyone), don't get Omega-3 off the rack at the store. Most Omega-3 supplements (even at GNC/Vitamin Shoppe/etc) consist of a small amount of Omega-3, and a lot of filler "fish oil" which does nothing for you. Furthermore, in order to get the levels of Omega-3 you need to really see benefits (roughly 500mg DHA and 500mg EPA per day, 1000mg DHA/1000mg EPA if you have heart disease - but ask your doctor) you would need to consume so much of this filler you will really start to see side effects (fishy breath, gastrointestinal distress, etc). Here's an example of what you will see at the store: https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels/dp/B00MGNMMHI/ref=sr_1_7_s_it?s=hpc&ie=UTF8&qid=1520870949&sr=1-7&keywords=omega%2B3%2Bfish%2Boil&dpID=51eg6Tzy3DL&preST=_SY300_QL70_&dpSrc=srch&th=1 https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels... Notice there's 1000mg of fish oil there, but only 300 mg Omega-3 (only 250mg of which is actually DHA/EPA) and they don't even give you the ratio of DHA to EPA in that 250mg - you need an even split to see best benefits as they work together. What you need to look for is pharmaceutical grade Omega-3, which is basically just concentrated so you don't get the filler oils. I'm a huge evangelist for OmegaVia (https://omegavia.com/ https://omegavia.com/), since they also use a enteric coating on the pills so they do not dissolve until they hit your small intestine. As a result there are zero fish breath/burp side effects. Give it a try, it's a game changer.

toss1 9y ago
Also working on substitution in the diet of Omega-6s to Omega-3s. It's actually very difficult, as almost everything is swamped with O-6s. I've literally given up on Mayo for sandwiches, just using high O-6 olive oil for now. I've provisionally concluded that this is because of shelf life -- the O-6s have good shelf life, but the O-3s do not, so essentially need to be made fresh or kept in special containers, cooled, etc. I feel like supplements can be good as a supplement, but I'm looking to improve my eating system. Any suggestions welcome!
- Scaevolus 9y ago
  I think it's cost more than shelf stability. Canola oil actually has the best n-6:n-3 ratio (2:1) of the common vegetable oils [1], and you can buy (or make!) canola oil mayonnaise easily. Beef fat has much better ratios when grass fed than grain fed as well [2]! [1]: http://www.susanallport.com/images/Dietfatchart_8_.jpg http://www.susanallport.com/images/Dietfatchart_8_.jpg [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/table/T2/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/table/T...

watertom 9y ago

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

toddh 9y ago

Dr. Malcolm Kendrick has a good over 40 part series on What causes heart disease? https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-disease/ https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-d.... It may be of interest.