13 ms·

New model could explain old cholesterol mystery

168 points by shadykiller 6y ago

doganengin 6y ago
Good article, thanks for sharing
hpoe 6y ago
This is why I have three things I never trust the experts in. - How to be healthy - How to educate - How to raise kids It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out, and this time we know we are right because we have fancier gadgets and more citations in our name. From Frued to the Food Pyramid it seems that the experts always have just finally figured it out.
- wnevets 6y ago
  I'm always confused when I read/hear people say things like this. Do people think there is a skyscraper downtown with a giant sign on it that says Expert HQ on it or something where they release their findings from?
  - hpoe 6y ago
    I understand that science is multi-facted discipline and there are a lot of people who have dedicated their lives to their craft and discovering truth because of their desire to solve human suffering and figure out how the world works. I also think there are a bunch of "scientists" that like the veneer that comes with the title like to spend their time talking on TV, going to parties, chairing committees and stealing credit from people doing work. They are aided and abetted in this endevour by the popular media and politicians who just want to slap out some new "discovery" to get clicks. The first group is anxious for their work to be peer reviewed, tries to explain things simply, and will do what they do even if there was no reward and no one appreciated their work. They have qualifications. The second group uses jargon to try and confuse people, hate when people call them on things, use their influence to restrict funding to others and publicly deride their opponents who disagree with them. They have credentials. Unfortunately, society generally listens to the 2nd group over the first group because they often tell them what they want to hear.
    - Retric 6y ago
      Doctors learn the results of science, but generally aren’t scientists. People doing science outreach are generally in that same category where their knowledgeable, but speak outside their specialty. Simply because being able to do original research today means a very narrow focus. Beyond that, the best available information isn’t always that clear. Low salt diets for example where prompted based on very limited information that suggested they where slightly more likely to be useful than pointless. Unfortunately, we rarely have unambiguous data which gives clear guidance. Vitamin C for example is mandatory, but you can have zero vitamin C for 2 weeks without issue or quickly excrete excess. For more subtle interactions it’s just difficult to figure out what’s going on.
  - sgtnoodle 6y ago
    I think a lot of people think that sociopaths and narcissists have a tendency to rise to power in politics, business and media over time, as well as have a tendency to lie and cheat to the general population to advance their agenda. "Science" is one of the topics that the average person reveres but doesn't really understand, and so is readily weaponized for less than altruistic reasons. As a recent relevant example with the pandemic, there was a widespread effort by the media and politicians to discredit various well understood, several decade old drugs known to effectively regulate inflammatory problems. The primary objection was an appeal to "science" claiming that the drugs were untested for their effectiveness specifically against covid, and sensational claims that they are dangerous. Meanwhile, you have pharmaceutical companies injecting mRNA purposefully designed to essentially cause a temporary auto-immune disease into anyone they can, enjoying the fact that they were able to skip a decade of best practices for vetting new treatments. It just seems like maybe there's some unscientific human bias in there...
- arkitaip 6y ago
  So who do you trust on these matters?
  - hpoe 6y ago
    Generally common sense, good wisdom, and my own understanding of the situation as well as my personal investigation. Like everything I need to know about nutrition is "eat food, but not too much, try and get a variety, generally plants are better for you than sugar, fast regularly and get exercise."
  - tomkat0789 6y ago
    I've personally be satisfied with what I'll call "informed" common sense. An example from health is the documentary "In Defense of Food" where the journalist uses a little science and history to create the heuristic: "Eat food, mostly plants, not too much." None of those insights are really surprising, the only exception maybe being the "mostly plants part". A downside of depending on complicated theories from experts is that it makes a "priesthood" of people telling you what to think all the time. I think there are enough examples from health, environmental, and privacy policy making to demonstrate that the "priests" don't always have the public's best interests in mind.
  - 2OEH8eoCRo0 6y ago
    Whoever sells the most books.
  - lazyasciiart 6y ago
    Most people end up trusting their family historical wisdom.
- throwaway2245 6y ago
  I learned recently that the Food Pyramid was created by the Department of Agriculture in the US, i.e. not by the Department of Health. So, not experts. (Not in the field they were claiming).
  - ncmncm 6y ago
    It's worse. It was created by the Dairy Council as a way to promote dairy products, and then distributed to schools by the DoA.
- munificent 6y ago
  > - How to be healthy - How to educate - How to raise kids I think it's interesting that all of three of these hinge on the same problem: human variability. I strongly suspect that humans are much more variable internally than conventional science and journalism accounts for. The scientific method uses statistics which is important for showing aggregate effects but can also obscure variability. And journalists have an incentive to offer simplified guidance that is as widely applicable as possible. The end result of a lot of information like "Do X" when what it should really be is "If you are like Y do X, if you are like W do Z." This is a pattern I think of as "the missing parameter" that I see just about everywhere people give advice once I started looking for it. Examples: - "(Static/dynamic) types don't help programming." For what kinds of programs? Developed by whom? At what scale and timeframe? - "You (should/should not) use a schemaless database." How big is your dataset? What is the relative fraction of reads/writes? What kind of data? How many users? How much money do you have? What are your failure modes? - "People should move (to/out) of cities." Which cities? What is the city's transit like? Which people? What activities do they prefer? Do they have kids? What's their economic status? Age? How important is it to be near a hospital? - "You should eat less salt." For people of what age? Activity level? Diet? - "Teach by example not generalities." Teach what material? To whom? How important is their understanding? How long should they retain it? - "Children should go outdoors on their own more." What age? What personality do they have? Where do they live? Whenever I see people arguing about some generality, what is often happening is that each party has implicitly filled in those parameters with different values, so they are all correct but talking past each other. When I see this happening now, I try to take a step back and figure out what implicit parameters they are assuming and see if there's a higher-level parameterized stance that unifies their arguments.
- MPSimmons 6y ago
  You're describing several feedback loops that are decades long to test. I suspect that's why they all have problems with conclusive results.
- didibus 6y ago
  > It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out I think you're being unfair. Most of the time, it's not a major 180, it tends to be smaller course corrections, refinements over current understanding of data, and the discovery of even more correlated complexities. The issue is people want simple answers, easy to follow guidelines, and guaranteed results. The science just isn't at the point where it can deliver those. So people make up best guesses for them each decade based on where the science is at that point.
elhudy 6y ago
I am close with someone who has chronic high cholesterol, in addition to a 6-pack abs. She exercises 5x/week and eats .5kg of animal products/week at most, usually white meat. She just visited her heart Dr and was told that her cholesterol is too high and that she needs to cut out animal products entirely as a next step. I am thinking...is this really the modern answer to someone's high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with? It doesn't add up to me. It's amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I'm excited to read and share this ongoing research. Thank you for posting this.
- nofnziti 6y ago
  There are many more dietary sources of saturated fats than just meat.
  - elhudy 6y ago
    Edited to say "animal products" rather than meat.
    - nofnziti 6y ago
      I wasn't trying to nitpick your comment. Even excluding animal products it's still possible to eat a diet high in saturated fat.
      - hn_throwaway_99 6y ago
        But dietary cholesterol itself only comes from animal products, which is probably why the Dr. said to cut out all animal products.
        nofnziti 6y ago
        And saturated fats are linked to higher LDL. What are we disagreeing about?
blakesterz 6y ago
It'll be interesting to see how this theory stands up. It seems like they're on the right path, tying together several things that seem to be problems. The homeoviscous adaptation to dietary lipids (HADL) model explains controversies over saturated fat, cholesterol, and cardiovascular disease risk https://academic.oup.com/ajcn/article-abstract/113/2/277/6104795?redirectedFrom=fulltext https://academic.oup.com/ajcn/article-abstract/113/2/277/610... "Corresponding with the model, we suggest alternative contributing factors to the association between elevated LDL cholesterol concentrations and ASCVD, involving dietary factors beyond SFAs, such as an increased endotoxin load from diet–gut microbiome interactions and subsequent chronic low-grade inflammation that interferes with fine-tuned signaling pathways."
chihuahua 6y ago
I find this article quite fascinating. It provides a bit of a glimpse into how science can work, and how difficult it is to gain valid knowledge on some topics. It's also a reminder that "science" isn't just a simple process that you follow to find the truth. Sometimes people ask the wrong question, or draw the wrong conclusion from experiments. It seems that research related to nutrition and health has a fair amount of this. It reminds me of my own experience earlier this week where I needed to call a certain service. The API has 2 parameters. I thought that one was required and one was optional. But whenever I called the service with 1 parameter, it failed. Eventually I thought "maybe both parameters are required" and called the service with 2 parameters, and it worked. So I concluded "both parameters are required". But later I discovered that the service was just flaky and it was a coincidence that it started working just at the moment when I added the second parameter. After that experience it's difficult to know what to trust, when everything could be due to randomness and unreliability.
- deleted 6y ago
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josefresco 6y ago
I have an auto-immune disease. The medication prescribed has the side effect of making my "bad" LDL cholesterol skyrocket. I tried everything from diet, to exercise to bring it back down but nothing worked. I'm now on a Statin medication which solved the issue but I'm not thrilled about yet another medication. Before my disease I ate like an average American (sugar, meat, dairy etc.) and my LDL cholesterol was high. I was diagnosed, changed my diet and my LDL dropped to healthy levels. Later I started a new medication (JAK inhibitor) and it jumped back up, but my diet did not change. I read this article twice and have no idea how it applies to my situation.
- 1_player 6y ago
  I'm no doctor, so take what I'm about to say with a ton of salt. Your doctor might disapprove, but salt ain't so bad in reality. High LDL or high cholesterol doesn't mean anything, per se. The HDL:LDL ratio is a little more important but not so much. Triglycerides and glucose levels are a much bigger indicator of health. Inflammation is the biggest indicator, but AFAIK we do not have ways to measure it directly. HDL, LDL, cholesterol, triglycerides are fats, but are often not directly correlated with dietary fat. There is more and more evidence triglycerides increases as sugar and refined carbs increase in your diet. This is the biggest misconception in dietary history and we're 20 years away from science and doctors to integrate this new piece of information.
wtetzner 6y ago
The idea that animal products are unhealthy seems to be misguided. It seems more likely that the supposedly "heart healthy" seed oils are causing heart disease. The Carnivore Code has some very good insights (at least in my opinion) [1] And this talk on how seed oils are destroying our health is also pretty interesting: https://www.youtube.com/watch?v=7kGnfXXIKZM https://www.youtube.com/watch?v=7kGnfXXIKZM [1] https://www.amazon.com/Carnivore-Code-Unlocking-Returning-Ancestral/dp/1734640707 https://www.amazon.com/Carnivore-Code-Unlocking-Returning-An...
- 2OEH8eoCRo0 6y ago
  It's what the science says so far. It's amazing that since there are gaps in our knowledge people readily jump over to woo woo fad diets.
  - nradov 6y ago
    The science in this area is actually pretty low quality from a strict evidence-based medicine standpoint. It mostly consists of poorly controlled observational studies, which are only one step above the woo woo fad diets. We still don't have a solid theoretical framework for how all the pieces fit together.
    - Pulcinella 6y ago
      We (and by we I mean the government) just need to bite the bullet and and pay for a multi billion dollar study where we pay tens of thousands of people to control* and monitor what they eat, exercise, etc for 20 years and just figure this out. None of this “well we had 20 grad students journal what they did for 6 months and this is the result” low quality studies. *Morally correct and ethically of course. I’m not saying we force people into large hamster cages.
      - nradov 6y ago
        Unfortunately such a study still wouldn't produce valid results. The problem is that study subjects don't report accurate data. They lie because they're ashamed of their choices, or they forget, or they just don't know how to accurately count what they eat. Consider a hypothetical study subject who goes to watch the game at his local bar, drinks 7 beers, eats a plate of hot wings, and then stops at Taco Bell for nachos on the way home. When he wakes up the next morning what do you suppose he'll enter on the form?
sradman 6y ago
PROBLEM #1: High saturated fat diet correlated to high serum cholesterol ANSWER #1: Serum cholesterol is transferred back-and-forth between the blood and cell membranes to maintain a constant cell rigidity; normal behavior PROBLEM #2: High serum cholesterol correlated to cardiovascular disease ANSWER #2: Chronic inflammation associated with metabolic disorders upsets the various regulatory systems I find the second answer unsatisfactory. Any chronic condition that damages arteries leads to plaque and this, in my opinion, accounts for all the other associations. The arterial wall damage can be due to excess blood sugar, oxidation, or pathogens (SARS-CoV-2?). The damage causes an inflammatory response and extra serum cholesterol is needed to repair the damage (forms the plaque). The chronic plaque formation reduces the arterial cross-section and reduces elasticity which both increase blood pressure. The underlying cause is arterial wall damage. This can be measured non-intrusively using the Ankle-Brachial Pressure Index: https://en.wikipedia.org/wiki/Ankle–brachial_pressure_index https://en.wikipedia.org/wiki/Ankle–brachial_pressure_index
- graeme 6y ago
  > This can be measured non-intrusively by measuring the Ankle-Brachial Pressure Index Huh. Is this something one’s GP could do or does it require specialized training? The article says it’s unpopular at general practitioner’s offices.
  - jpxw 6y ago
    Most GPs (or at least all GPs I’ve ever visited) don’t have ultrasound machines. However I imagine they’d be able to perform a simplified version, just measuring the BP at the arm and the ankle and dividing. Presumably using the ultrasound just allows you to get a more precise reading.
  - sradman 6y ago
    You can do it at home with a standard blood pressure monitor with an arm (brachial) cuff but not a wrist one. Ask your GP.
- beowulfey 6y ago
  I think it is more: PROBLEM #2: high serum cholesterol is correlated to cardiovascular disease, but eating high saturated fat-diets is not. ANSWER #2: It appears that studies that assess the effect of a particular diet depends a lot upon the health of the individual prior to the study start; thus, using a random population results in non-significant results. Note that I agree with you otherwise. I would suspect that a diet high in saturated fats without any supplemental unsaturated fats would result in cell walls becoming so stiff that removal of cholesterol can no longer benefit the cell walls; if this happens in arteries, you get hardened arteries that can lead to heart disease.
qw3rty01 6y ago
So the new model seems to be suggesting that high LDLs are not a cause for heart disease, but rather a symptom. Have other studies tying high LDLs to heart disease taken this into account, or did their main findings just show a correlation with high LDLs and heart disease?
PragmaticPulp 6y ago
I think it was a mistake to focus public health discussions around the finer details of work in progress research. The ambiguities and unknowns have opened the door for fitness gurus and health product grifters to turn this into a sort of holy war. It’s sad to see how many people have been convinced they are “healthy” because they follow a couple out of context fragments of the overall health picture. I know too many people who think they are doing everything right because they avoid gluten, or don’t eat dairy products, or minimize saturated fat. Yet they go on to consume excessive amounts of sugar, or drink copious amounts of alcohol, or eat 4000+ calories per day of their chosen healthy foods.
j16sdiz 6y ago
I just love how the author use a few paragraphs to explain the weakness of this model and why it need more research. Most pop science articles just dont have it
ve55 6y ago
I'm glad to see new approaches to this problem being discussed, because even after researching about lipids for quite awhile, I was unable to come to a full conclusion on them myself. There's so many confounding variables, and attempting to control for all of them just isn't really feasible in an RCT (not to mention most studies are correlational and nowhere near an RCT to begin with). I think it's likely the case that sometimes high LDL is good, and sometimes it is bad, and this may depend on many other factors related to yourself and your diet. But disentangling these cases is very difficult, and the food supply of nations has changed so much that we keep seeing very misleading correlations. These misleading correlations are why we sometimes hop onto bandwagons like 'fat is bad for you', 'high salt is bad for you', or 'animal products/red meat are bad for you', and then after more research and RCTs, we realize that this is not the case (if the press would stop reporting correlations to everyone as important research that you need to act on right now, that would certainly be nice). I'm looking forward to more progress here, but until then I don't mind eating saturated fats myself, although I do avoid certain sources of them, such as in fried oils high in linoleic acid. I also don't focus a ton on LDL precisely, but rather some other related measures (different types of cholesterol, low inflammation, and coronary calcium scans if possible)
- imsofuture 6y ago
  I believe the focus on LDL as 'bad' has been misguided. It's an improvement from 'all cholesterol is bad', but we just don't understand very much about how it all works, and so as we discover more, we slowly refine our understanding. A lot of the theory about why LDL is 'bad' is based on the fact that arterial damage is repaired with the stuff, causing plaque. There's no evidence that LDL is causing the damage, just that it has a role in how it's fixed (in an ultimately detrimental way).
chiefalchemist 6y ago
Correct me if I'm wrong, but wasn't one of the founding / influencial "cholesterol is bad" studies found to be bad science, and that ultimately it was the result of "financing" by Big Sugar? They were Harvard profs / researchers I believe. The point being, much of collective knowledge on this subject is based on misleading / false assumptions. That is, you're going to struggle to find results that align with conventional wisdom because that wisdom is flawed.
dcolkitt 6y ago
It's an interesting hypothesis. But it seems contradicted by Mendelian randomization studies, which find that LDL cholesterol levels to be causally associated with heart disease. https://pubmed.ncbi.nlm.nih.gov/26780009/ https://pubmed.ncbi.nlm.nih.gov/26780009/
didibus 6y ago
> saturated fat in the vast majority of people increases their LDL and that this in turn will increase their risk of cardiovascular disease I still don't understand this. I thought the cause and effect had never been proven, but only the correlation. Like people who have heart disease often have high cholesterol. But was it shown that if they lower their level of cholesterol they can revert their condition? Or was it shown that it was the increase which led to heart disease?
rafaelero 6y ago
I can't help but think that there is active effort to halt our understanding of nutrition. I mean, if we still can't say at least that saturated fat is causally related to heart disease, then this whole field is in a very bad place. My hypothesis though, is that this finding has already been established but people keep coming back to this subject to try to adjust it to their lifestyle choices.
- nradov 6y ago
  Your hypothesis is incorrect, or at least not justified by the data. The whole field of human nutrition actually is in a very bad place. Most of what we think we know comes from low quality observational studies which don't rate well on the evidence based medicine scale. By all means let's continue research. But people generally shouldn't rely upon most of it when making dietary choices. A better approach is to conduct your own n=1 informal experiments and determine empirically what works best for you.
  - rafaelero 6y ago
    But you see, I don't agree that these conclusions are based on low quality data. These conclusions are not merely based on observational studies, as you pointed. This question is being asked for more than 70 years and a lot of different types of designs have been tried: putting people on strictly monitored diets and seeing what happens to their biomarkers, finding people with weird mutations that lower their LDL cholesterol, etc. By the way, the only type of data that disagrees with the expert's conclusion are, you guessed it, observational data. And that is simply because there are so much individual variation that these studies end up always underpowered. If you track the same individual and changes his/her diet, the conclusion is inescapable: saturated fat increases LDL cholesterol. And LDL cholesterol is causally linked to heart disease. I don't mean to say that this narrative can't be pushed back, but these articles comes from the [wrong] premise that these findings are not solid. They are. It's the same as trying to advance the idea that trans fat is not dangerous to someone's health: you surely could try, but the prior should be low. That's is why I advanced the hypothesis that people are craving for these types of news that validate their lifestyles: they don't seem to be properly calculating their priors and are dismissing too quickly solid evidence.
flowerlad 6y ago
The idea that it is inflammation, not cholesterol, that is causing heart disease, is not new. See here: https://www.bloomberg.com/news/articles/2008-04-15/heart-disease-not-about-cholesterol-businessweek-business-news-stock-market-and-financial-advice https://www.bloomberg.com/news/articles/2008-04-15/heart-dis... Also see collection of links at bottom of this article: https://medium.com/@petilon/cholesterol-and-statins-e7d9d8eea983 https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee... Cholesterol reduction is big business. Pfizer’s Lipitor alone raked in $125 billion between 1996 to 2012. This amount of money can be very corrupting. It’s almost impossible to find experts who are not influenced by money from industry.
- mark-r 6y ago
  I've always wondered if the reason a daily aspirin prevents heart attacks isn't because it prevents clotting, but because it's an anti-inflammatory.
  - flowerlad 6y ago
    If true then aspirins may be just as useful as statins while being cheaper and safer. (But you won't see anyone funding a clinical trial to prove this, any time soon!)
    - mark-r 6y ago
      If you can't patent it, you can't fund it. I don't know if aspirin ever had a patent, but if it did it ran out 100 years ago.
dpoochieni 6y ago
High cholesterol, low thyroid function. Simple, but the details and how this maps to lifestyle and diet changes it gets very tricky. That's why we have vegan and vegetarians with high cholesterol, (extremely hard to keep a healthy metabolism, let alone on a plant-based diet, most people confuse the temporary surge in stress hormones with an sustainably energetic metabolism.)
Geee 6y ago
This guy has been arguing for years that it is sugar (fructose actually) that increases the "bad" LDL in your blood stream https://www.youtube.com/watch?v=dBnniua6-oM https://www.youtube.com/watch?v=dBnniua6-oM
- ncmncm 6y ago
  Robert Lustig is right that fructose (half of common sugar) is responsible for a variety of ills: exactly the ones Americans die of, by the millions. There is a lot of Lustig material on youtube, all of it excellent, all thoroughly grounded in rigorous experimental science. We need more Robert Lustigs. The normal metabolic route is that excess fructose, beyond what the liver can afford to process immediately or store itself, is carried wrapped in cholesterol to fat cells to be stored. If you take statins, excess fructose gets dumped into your bloodstream not wrapped in cholesterol, which is much worse. It causes oxidation of blood lipids, which have long been known to cause heart and circulatory problems.
  - hammock 6y ago
    Can you share a good article about the misconceptions of cholesterol and the dangers of statins? I've been looking for a decent source. I have a family member on a statin now.
    - 1_player 6y ago
      There are some interesting talks about keto and zero carb on Youtube about fat metabolism, cholesterol, fructose, etc. Off the top of my head, I remember the "zero carb down under" channel where some are hosted, including Lustig's talks. /r/KetoScience delves into the research, if you are so inclined.
  - tsimionescu 6y ago
    But aren't statins successful in preventing heart disease, in clinical trials? My understanding was that other classes of medicine that reduce serum cholesterol levels have shown no effects on heart disease in clinical trials.
superqd 6y ago
So much nutrition research is all correlation and no causation. Statements like this, which over-infer, kill me: "There is little doubt that people with high cholesterol have an increased risk of disease." It's just as valid to say that people with heart disease are more likely to have high cholesterol. When all you have is correlation, there is a heart disease group, and a high cholesterol group, and all you shown with correlation is that there is a third overlapping group of people with both. With only correlation, you don't know how/why, or even if, members of one group transform into the other. Which is partly the underpinning of the article. It's possible that high cholesterol is a result of underlying heart disease (which the article says is possible), rather than a cause. But what shocks me is that people, even researchers, seem surprised to realize such possibilities.
- 123409871234 6y ago
  We know that high cholesterol is a cause of heart disease rather than a mere correlation because people with genetic Hypercholesterolemia have a rate of heart disease 10-20x that of the general population, independent of other risk factors: https://www.acc.org/latest-in-cardiology/articles/2020/06/01/13/54/familial-hypercholesterolemia https://www.acc.org/latest-in-cardiology/articles/2020/06/01...
  - tsimionescu 6y ago
    Do we know that people with hypercholesterolemia don't just have a heart/blood vessel/metabolic defect that also causes high cholesterol?
    - rictoo 6y ago
      By definition, Familial Hypercholesterolemia is a genetic defect of the receptor responsible for clearing cholesterol-containing droplets from the blood.
      - tsimionescu 6y ago
        I understand that, but my point was that it's in principle possible that the exact effects of a particular genetic disease are hard to discover. Serum cholesterol is easy to measure, so it could be just the easiest to notice sign of a more complex metabolic modification induced by the specific genes. I doubt we are at a point where we can look at a gene and say exactly what it affects in the entire body.
deleted 6y ago
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ncmncm 6y ago
We have known for many decades that it is oxidized blood cholesterol that correlates with heart disease. Fred Kummerow showed this back in the '50s, 60+ years ago. But you can't get a blood test for oxidized cholesterol. Fred Kummerow spent his whole working life getting trans fats out of the US food pipeline. He proved trans fat was poison in 1957, and finally in 2009, under compulsion of a lawsuit, the FDA declared it toxic. Then, they issued no regulations restricting their use until forced by another lawsuit, in 2014. Then, they gave vendors 3 more years to put poison in stuff being sold as if it were food. In 2018 it was supposed to be illegal to sell trans fats as food, but a number of companies still do, under waivers. He died in 2017, at age 102. He spent the final two years of his life working on Parkinson's, which had taken his wife, since trans fats had (he thought) finally been outlawed. He was a great hero of experimentally-grounded health science. https://www.drmirkin.com/histories-and-mysteries/fred-kummerow-hero-of-the-trans-fat-battle.html https://www.drmirkin.com/histories-and-mysteries/fred-kummer... India and Brazil are still struggling to get it outlawed. The big corporations have resisted because selling poison as if it were food remains profitable. We are still confused about fats. But a takeaway should be that nobody has ever found any evidence of harm from eating saturated fat, or benefit from eating unsaturated fat, despite decades trying.
mrkeen 6y ago
A: saturated fats B: LDL cholesterol C: heart disease studies show saturated fats increase LDL cholesterol A => B People who get heart disease are more likely to have high LDL cholesterol C => B > Researchers have thus drawn a logical conclusion: a lot of saturated fat in the diet produces more cholesterol, which in turn increases the risk of heart disease. A => B /\ B => C > But this has been surprisingly difficult to prove. You don't say?
- robwwilliams 6y ago
  Great book on this topic: Judea Pearl’s Book of Why. He discusses causal models in great depth. And a highly amusing read. Mendelian randomization can sometimes “rescue” causality from large epidemiological studies. Pearl explains how.
- andybak 6y ago
  If I'm reading you correctly - this is the classic false syllogism?
  - mrkeen 6y ago
    I think so. The author wrote "People who get heart disease are more likely to have high LDL cholesterol". Had she written "People who have high LDL cholesterol are more likely to get heart disease" then the argument would have been valid.
andybak 6y ago
High cholesterol and hypertension here. Anyone want to give me a tl'dr? The obvious and constant advice to date is: drink less alcohol, exercise more and eat less saturated fat. Tackling all three at once is quite a challenge so it would be lovely if someone threw me a bone here. ;-)
hammock 6y ago
Not sure how "new" this model is, it's just not well-known in the mainstream. Dr. Rhona Patrick has been explaining this very clearly for years. Go watch any of her podcasts with Joe Rogan.
troll_v_bridge 6y ago
Reminds me of this FoD vid: https://www.youtube.com/watch?v=5Ua-WVg1SsA https://www.youtube.com/watch?v=5Ua-WVg1SsA
basicplus2 6y ago
Cholesterol is is not the problem. HDL and LDL differences not withstanding. Cholesterol is used by the body to patch damaged arterial walls which can cause clogging if the there is excessive damage to the arteries. The problem is high sugar levels in the blood by eating high sugar content foods and high glycemic index foods like highly processed carbohydrates which turn to sugar quickly raising blood suggar levels. High sugar levels cause damage to the arterial walls and bodies response is to patch the damage. https://www.adwdiabetes.com/articles/repeated-sugar-spikes-damage-arteries https://www.adwdiabetes.com/articles/repeated-sugar-spikes-d... Other issues interfere with the ability of lipids entering the wall properly in the repair process and cause the atherosclerosis exaserbated by ldl presence also caused by high sugar levels amongst others https://pubmed.ncbi.nlm.nih.f https://pubmed.ncbi.nlm.nih.f gov/1222702/ Unfortunately all these issues get conflated together to produce misunderstanding and alot of misunderstanding
Syzygies 6y ago
This is parallel to the question of vitamin D and COVID. There's a strong correlation between vitamin D deficiency and COVID mortality, yet taking vitamin D doesn't help. Conjecturally, it's the genetic cause of vitamin D deficiency that increases COVID mortality. I had been taking Clemastine and vitamin D. I asked a former student now a doctor at the center of the COVID response whether these would interfere with my vaccine. She said to stop Clemastine on the off chance that one study was on to something, but there was no reason to take or stop taking vitamin D.
wuwuno 6y ago
The cholesterol theory doesn't hold water. The claim is that cholesterol is so sticky that is clogs up the largest arteries of the body, is almost laughable. If cholesterol is as truly sticky as claimed then it should be clogging up the tiny capillary vessels in the lungs, but it doesn't do that. Linus Pauling discovered the basis for heart disease, but his theory has been 'discredited' by scientists who have bought and paid for by big pharma.
twic 6y ago
> When we eat more polyunsaturated fat, the cells incorporate more polyunsaturated fat into the cell membrane, making it more fluid. That seems like an absolutely wild idea to me. So the cell just grabs whatever lipids arrive from the diet and turns them into phospholipids and puts them in the membrane? I know nothing about this process, but my biochemist's intuition tells me to be skeptical. Is there research on this?
known 6y ago
NICE no longer specifies target cholesterol levels for people with diabetes. Your doctors will use a calculator, called QRISK2, to work out your risk of heart disease using a number of factors such as age, BMI, gender, blood pressure levels, cholesterol levels and which type of diabetes you have. If you want a general guide of how healthy your cholesterol levels are, find out your total cholesterol-to-HDL ratio To find this, take your total cholesterol figure and divide it by your HDL figure. A result of less than four is healthy https://www.diabetes.co.uk/Diabetes-and-cholesterol.html https://www.diabetes.co.uk/Diabetes-and-cholesterol.html

168 points by shadykiller 6y ago

Good article, thanks for sharing

hpoe 6y ago

This is why I have three things I never trust the experts in. - How to be healthy - How to educate - How to raise kids It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out, and this time we know we are right because we have fancier gadgets and more citations in our name. From Frued to the Food Pyramid it seems that the experts always have just finally figured it out.

wnevets 6y ago
I'm always confused when I read/hear people say things like this. Do people think there is a skyscraper downtown with a giant sign on it that says Expert HQ on it or something where they release their findings from?
- hpoe 6y ago
  I understand that science is multi-facted discipline and there are a lot of people who have dedicated their lives to their craft and discovering truth because of their desire to solve human suffering and figure out how the world works. I also think there are a bunch of "scientists" that like the veneer that comes with the title like to spend their time talking on TV, going to parties, chairing committees and stealing credit from people doing work. They are aided and abetted in this endevour by the popular media and politicians who just want to slap out some new "discovery" to get clicks. The first group is anxious for their work to be peer reviewed, tries to explain things simply, and will do what they do even if there was no reward and no one appreciated their work. They have qualifications. The second group uses jargon to try and confuse people, hate when people call them on things, use their influence to restrict funding to others and publicly deride their opponents who disagree with them. They have credentials. Unfortunately, society generally listens to the 2nd group over the first group because they often tell them what they want to hear.
  - Retric 6y ago
    Doctors learn the results of science, but generally aren’t scientists. People doing science outreach are generally in that same category where their knowledgeable, but speak outside their specialty. Simply because being able to do original research today means a very narrow focus. Beyond that, the best available information isn’t always that clear. Low salt diets for example where prompted based on very limited information that suggested they where slightly more likely to be useful than pointless. Unfortunately, we rarely have unambiguous data which gives clear guidance. Vitamin C for example is mandatory, but you can have zero vitamin C for 2 weeks without issue or quickly excrete excess. For more subtle interactions it’s just difficult to figure out what’s going on.
- sgtnoodle 6y ago
  I think a lot of people think that sociopaths and narcissists have a tendency to rise to power in politics, business and media over time, as well as have a tendency to lie and cheat to the general population to advance their agenda. "Science" is one of the topics that the average person reveres but doesn't really understand, and so is readily weaponized for less than altruistic reasons. As a recent relevant example with the pandemic, there was a widespread effort by the media and politicians to discredit various well understood, several decade old drugs known to effectively regulate inflammatory problems. The primary objection was an appeal to "science" claiming that the drugs were untested for their effectiveness specifically against covid, and sensational claims that they are dangerous. Meanwhile, you have pharmaceutical companies injecting mRNA purposefully designed to essentially cause a temporary auto-immune disease into anyone they can, enjoying the fact that they were able to skip a decade of best practices for vetting new treatments. It just seems like maybe there's some unscientific human bias in there...
arkitaip 6y ago
So who do you trust on these matters?
- hpoe 6y ago
  Generally common sense, good wisdom, and my own understanding of the situation as well as my personal investigation. Like everything I need to know about nutrition is "eat food, but not too much, try and get a variety, generally plants are better for you than sugar, fast regularly and get exercise."
- tomkat0789 6y ago
  I've personally be satisfied with what I'll call "informed" common sense. An example from health is the documentary "In Defense of Food" where the journalist uses a little science and history to create the heuristic: "Eat food, mostly plants, not too much." None of those insights are really surprising, the only exception maybe being the "mostly plants part". A downside of depending on complicated theories from experts is that it makes a "priesthood" of people telling you what to think all the time. I think there are enough examples from health, environmental, and privacy policy making to demonstrate that the "priests" don't always have the public's best interests in mind.
- 2OEH8eoCRo0 6y ago
  Whoever sells the most books.
- lazyasciiart 6y ago
  Most people end up trusting their family historical wisdom.
throwaway2245 6y ago
I learned recently that the Food Pyramid was created by the Department of Agriculture in the US, i.e. not by the Department of Health. So, not experts. (Not in the field they were claiming).
- ncmncm 6y ago
  It's worse. It was created by the Dairy Council as a way to promote dairy products, and then distributed to schools by the DoA.
munificent 6y ago
> - How to be healthy - How to educate - How to raise kids I think it's interesting that all of three of these hinge on the same problem: human variability. I strongly suspect that humans are much more variable internally than conventional science and journalism accounts for. The scientific method uses statistics which is important for showing aggregate effects but can also obscure variability. And journalists have an incentive to offer simplified guidance that is as widely applicable as possible. The end result of a lot of information like "Do X" when what it should really be is "If you are like Y do X, if you are like W do Z." This is a pattern I think of as "the missing parameter" that I see just about everywhere people give advice once I started looking for it. Examples: - "(Static/dynamic) types don't help programming." For what kinds of programs? Developed by whom? At what scale and timeframe? - "You (should/should not) use a schemaless database." How big is your dataset? What is the relative fraction of reads/writes? What kind of data? How many users? How much money do you have? What are your failure modes? - "People should move (to/out) of cities." Which cities? What is the city's transit like? Which people? What activities do they prefer? Do they have kids? What's their economic status? Age? How important is it to be near a hospital? - "You should eat less salt." For people of what age? Activity level? Diet? - "Teach by example not generalities." Teach what material? To whom? How important is their understanding? How long should they retain it? - "Children should go outdoors on their own more." What age? What personality do they have? Where do they live? Whenever I see people arguing about some generality, what is often happening is that each party has implicitly filled in those parameters with different values, so they are all correct but talking past each other. When I see this happening now, I try to take a step back and figure out what implicit parameters they are assuming and see if there's a higher-level parameterized stance that unifies their arguments.
MPSimmons 6y ago
You're describing several feedback loops that are decades long to test. I suspect that's why they all have problems with conclusive results.
didibus 6y ago
> It seems like every decade we find out everything we did last decade was bad and wrong but now we've finally for sure got it figured out I think you're being unfair. Most of the time, it's not a major 180, it tends to be smaller course corrections, refinements over current understanding of data, and the discovery of even more correlated complexities. The issue is people want simple answers, easy to follow guidelines, and guaranteed results. The science just isn't at the point where it can deliver those. So people make up best guesses for them each decade based on where the science is at that point.

elhudy 6y ago

I am close with someone who has chronic high cholesterol, in addition to a 6-pack abs. She exercises 5x/week and eats .5kg of animal products/week at most, usually white meat. She just visited her heart Dr and was told that her cholesterol is too high and that she needs to cut out animal products entirely as a next step. I am thinking...is this really the modern answer to someone's high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with? It doesn't add up to me. It's amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I'm excited to read and share this ongoing research. Thank you for posting this.

nofnziti 6y ago
There are many more dietary sources of saturated fats than just meat.
- elhudy 6y ago
  Edited to say "animal products" rather than meat.
  - nofnziti 6y ago
    I wasn't trying to nitpick your comment. Even excluding animal products it's still possible to eat a diet high in saturated fat.
    - hn_throwaway_99 6y ago
      But dietary cholesterol itself only comes from animal products, which is probably why the Dr. said to cut out all animal products.
      - nofnziti 6y ago
        And saturated fats are linked to higher LDL. What are we disagreeing about?

blakesterz 6y ago

It'll be interesting to see how this theory stands up. It seems like they're on the right path, tying together several things that seem to be problems. The homeoviscous adaptation to dietary lipids (HADL) model explains controversies over saturated fat, cholesterol, and cardiovascular disease risk https://academic.oup.com/ajcn/article-abstract/113/2/277/6104795?redirectedFrom=fulltext https://academic.oup.com/ajcn/article-abstract/113/2/277/610... "Corresponding with the model, we suggest alternative contributing factors to the association between elevated LDL cholesterol concentrations and ASCVD, involving dietary factors beyond SFAs, such as an increased endotoxin load from diet–gut microbiome interactions and subsequent chronic low-grade inflammation that interferes with fine-tuned signaling pathways."

chihuahua 6y ago

I find this article quite fascinating. It provides a bit of a glimpse into how science can work, and how difficult it is to gain valid knowledge on some topics. It's also a reminder that "science" isn't just a simple process that you follow to find the truth. Sometimes people ask the wrong question, or draw the wrong conclusion from experiments. It seems that research related to nutrition and health has a fair amount of this. It reminds me of my own experience earlier this week where I needed to call a certain service. The API has 2 parameters. I thought that one was required and one was optional. But whenever I called the service with 1 parameter, it failed. Eventually I thought "maybe both parameters are required" and called the service with 2 parameters, and it worked. So I concluded "both parameters are required". But later I discovered that the service was just flaky and it was a coincidence that it started working just at the moment when I added the second parameter. After that experience it's difficult to know what to trust, when everything could be due to randomness and unreliability.

deleted 6y ago
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josefresco 6y ago

I have an auto-immune disease. The medication prescribed has the side effect of making my "bad" LDL cholesterol skyrocket. I tried everything from diet, to exercise to bring it back down but nothing worked. I'm now on a Statin medication which solved the issue but I'm not thrilled about yet another medication. Before my disease I ate like an average American (sugar, meat, dairy etc.) and my LDL cholesterol was high. I was diagnosed, changed my diet and my LDL dropped to healthy levels. Later I started a new medication (JAK inhibitor) and it jumped back up, but my diet did not change. I read this article twice and have no idea how it applies to my situation.

1_player 6y ago
I'm no doctor, so take what I'm about to say with a ton of salt. Your doctor might disapprove, but salt ain't so bad in reality. High LDL or high cholesterol doesn't mean anything, per se. The HDL:LDL ratio is a little more important but not so much. Triglycerides and glucose levels are a much bigger indicator of health. Inflammation is the biggest indicator, but AFAIK we do not have ways to measure it directly. HDL, LDL, cholesterol, triglycerides are fats, but are often not directly correlated with dietary fat. There is more and more evidence triglycerides increases as sugar and refined carbs increase in your diet. This is the biggest misconception in dietary history and we're 20 years away from science and doctors to integrate this new piece of information.

wtetzner 6y ago

The idea that animal products are unhealthy seems to be misguided. It seems more likely that the supposedly "heart healthy" seed oils are causing heart disease. The Carnivore Code has some very good insights (at least in my opinion) [1] And this talk on how seed oils are destroying our health is also pretty interesting: https://www.youtube.com/watch?v=7kGnfXXIKZM https://www.youtube.com/watch?v=7kGnfXXIKZM [1] https://www.amazon.com/Carnivore-Code-Unlocking-Returning-Ancestral/dp/1734640707 https://www.amazon.com/Carnivore-Code-Unlocking-Returning-An...

2OEH8eoCRo0 6y ago
It's what the science says so far. It's amazing that since there are gaps in our knowledge people readily jump over to woo woo fad diets.
- nradov 6y ago
  The science in this area is actually pretty low quality from a strict evidence-based medicine standpoint. It mostly consists of poorly controlled observational studies, which are only one step above the woo woo fad diets. We still don't have a solid theoretical framework for how all the pieces fit together.
  - Pulcinella 6y ago
    We (and by we I mean the government) just need to bite the bullet and and pay for a multi billion dollar study where we pay tens of thousands of people to control* and monitor what they eat, exercise, etc for 20 years and just figure this out. None of this “well we had 20 grad students journal what they did for 6 months and this is the result” low quality studies. *Morally correct and ethically of course. I’m not saying we force people into large hamster cages.
    - nradov 6y ago
      Unfortunately such a study still wouldn't produce valid results. The problem is that study subjects don't report accurate data. They lie because they're ashamed of their choices, or they forget, or they just don't know how to accurately count what they eat. Consider a hypothetical study subject who goes to watch the game at his local bar, drinks 7 beers, eats a plate of hot wings, and then stops at Taco Bell for nachos on the way home. When he wakes up the next morning what do you suppose he'll enter on the form?

sradman 6y ago

PROBLEM #1: High saturated fat diet correlated to high serum cholesterol ANSWER #1: Serum cholesterol is transferred back-and-forth between the blood and cell membranes to maintain a constant cell rigidity; normal behavior PROBLEM #2: High serum cholesterol correlated to cardiovascular disease ANSWER #2: Chronic inflammation associated with metabolic disorders upsets the various regulatory systems I find the second answer unsatisfactory. Any chronic condition that damages arteries leads to plaque and this, in my opinion, accounts for all the other associations. The arterial wall damage can be due to excess blood sugar, oxidation, or pathogens (SARS-CoV-2?). The damage causes an inflammatory response and extra serum cholesterol is needed to repair the damage (forms the plaque). The chronic plaque formation reduces the arterial cross-section and reduces elasticity which both increase blood pressure. The underlying cause is arterial wall damage. This can be measured non-intrusively using the Ankle-Brachial Pressure Index: https://en.wikipedia.org/wiki/Ankle–brachial_pressure_index https://en.wikipedia.org/wiki/Ankle–brachial_pressure_index

graeme 6y ago
> This can be measured non-intrusively by measuring the Ankle-Brachial Pressure Index Huh. Is this something one’s GP could do or does it require specialized training? The article says it’s unpopular at general practitioner’s offices.
- jpxw 6y ago
  Most GPs (or at least all GPs I’ve ever visited) don’t have ultrasound machines. However I imagine they’d be able to perform a simplified version, just measuring the BP at the arm and the ankle and dividing. Presumably using the ultrasound just allows you to get a more precise reading.
- sradman 6y ago
  You can do it at home with a standard blood pressure monitor with an arm (brachial) cuff but not a wrist one. Ask your GP.
beowulfey 6y ago
I think it is more: PROBLEM #2: high serum cholesterol is correlated to cardiovascular disease, but eating high saturated fat-diets is not. ANSWER #2: It appears that studies that assess the effect of a particular diet depends a lot upon the health of the individual prior to the study start; thus, using a random population results in non-significant results. Note that I agree with you otherwise. I would suspect that a diet high in saturated fats without any supplemental unsaturated fats would result in cell walls becoming so stiff that removal of cholesterol can no longer benefit the cell walls; if this happens in arteries, you get hardened arteries that can lead to heart disease.

qw3rty01 6y ago

So the new model seems to be suggesting that high LDLs are not a cause for heart disease, but rather a symptom. Have other studies tying high LDLs to heart disease taken this into account, or did their main findings just show a correlation with high LDLs and heart disease?

PragmaticPulp 6y ago

I think it was a mistake to focus public health discussions around the finer details of work in progress research. The ambiguities and unknowns have opened the door for fitness gurus and health product grifters to turn this into a sort of holy war. It’s sad to see how many people have been convinced they are “healthy” because they follow a couple out of context fragments of the overall health picture. I know too many people who think they are doing everything right because they avoid gluten, or don’t eat dairy products, or minimize saturated fat. Yet they go on to consume excessive amounts of sugar, or drink copious amounts of alcohol, or eat 4000+ calories per day of their chosen healthy foods.

j16sdiz 6y ago

I just love how the author use a few paragraphs to explain the weakness of this model and why it need more research. Most pop science articles just dont have it

ve55 6y ago

I'm glad to see new approaches to this problem being discussed, because even after researching about lipids for quite awhile, I was unable to come to a full conclusion on them myself. There's so many confounding variables, and attempting to control for all of them just isn't really feasible in an RCT (not to mention most studies are correlational and nowhere near an RCT to begin with). I think it's likely the case that sometimes high LDL is good, and sometimes it is bad, and this may depend on many other factors related to yourself and your diet. But disentangling these cases is very difficult, and the food supply of nations has changed so much that we keep seeing very misleading correlations. These misleading correlations are why we sometimes hop onto bandwagons like 'fat is bad for you', 'high salt is bad for you', or 'animal products/red meat are bad for you', and then after more research and RCTs, we realize that this is not the case (if the press would stop reporting correlations to everyone as important research that you need to act on right now, that would certainly be nice). I'm looking forward to more progress here, but until then I don't mind eating saturated fats myself, although I do avoid certain sources of them, such as in fried oils high in linoleic acid. I also don't focus a ton on LDL precisely, but rather some other related measures (different types of cholesterol, low inflammation, and coronary calcium scans if possible)

imsofuture 6y ago
I believe the focus on LDL as 'bad' has been misguided. It's an improvement from 'all cholesterol is bad', but we just don't understand very much about how it all works, and so as we discover more, we slowly refine our understanding. A lot of the theory about why LDL is 'bad' is based on the fact that arterial damage is repaired with the stuff, causing plaque. There's no evidence that LDL is causing the damage, just that it has a role in how it's fixed (in an ultimately detrimental way).

chiefalchemist 6y ago

Correct me if I'm wrong, but wasn't one of the founding / influencial "cholesterol is bad" studies found to be bad science, and that ultimately it was the result of "financing" by Big Sugar? They were Harvard profs / researchers I believe. The point being, much of collective knowledge on this subject is based on misleading / false assumptions. That is, you're going to struggle to find results that align with conventional wisdom because that wisdom is flawed.

dcolkitt 6y ago

It's an interesting hypothesis. But it seems contradicted by Mendelian randomization studies, which find that LDL cholesterol levels to be causally associated with heart disease. https://pubmed.ncbi.nlm.nih.gov/26780009/ https://pubmed.ncbi.nlm.nih.gov/26780009/

didibus 6y ago

> saturated fat in the vast majority of people increases their LDL and that this in turn will increase their risk of cardiovascular disease I still don't understand this. I thought the cause and effect had never been proven, but only the correlation. Like people who have heart disease often have high cholesterol. But was it shown that if they lower their level of cholesterol they can revert their condition? Or was it shown that it was the increase which led to heart disease?

rafaelero 6y ago

I can't help but think that there is active effort to halt our understanding of nutrition. I mean, if we still can't say at least that saturated fat is causally related to heart disease, then this whole field is in a very bad place. My hypothesis though, is that this finding has already been established but people keep coming back to this subject to try to adjust it to their lifestyle choices.

nradov 6y ago
Your hypothesis is incorrect, or at least not justified by the data. The whole field of human nutrition actually is in a very bad place. Most of what we think we know comes from low quality observational studies which don't rate well on the evidence based medicine scale. By all means let's continue research. But people generally shouldn't rely upon most of it when making dietary choices. A better approach is to conduct your own n=1 informal experiments and determine empirically what works best for you.
- rafaelero 6y ago
  But you see, I don't agree that these conclusions are based on low quality data. These conclusions are not merely based on observational studies, as you pointed. This question is being asked for more than 70 years and a lot of different types of designs have been tried: putting people on strictly monitored diets and seeing what happens to their biomarkers, finding people with weird mutations that lower their LDL cholesterol, etc. By the way, the only type of data that disagrees with the expert's conclusion are, you guessed it, observational data. And that is simply because there are so much individual variation that these studies end up always underpowered. If you track the same individual and changes his/her diet, the conclusion is inescapable: saturated fat increases LDL cholesterol. And LDL cholesterol is causally linked to heart disease. I don't mean to say that this narrative can't be pushed back, but these articles comes from the [wrong] premise that these findings are not solid. They are. It's the same as trying to advance the idea that trans fat is not dangerous to someone's health: you surely could try, but the prior should be low. That's is why I advanced the hypothesis that people are craving for these types of news that validate their lifestyles: they don't seem to be properly calculating their priors and are dismissing too quickly solid evidence.

flowerlad 6y ago

The idea that it is inflammation, not cholesterol, that is causing heart disease, is not new. See here: https://www.bloomberg.com/news/articles/2008-04-15/heart-disease-not-about-cholesterol-businessweek-business-news-stock-market-and-financial-advice https://www.bloomberg.com/news/articles/2008-04-15/heart-dis... Also see collection of links at bottom of this article: https://medium.com/@petilon/cholesterol-and-statins-e7d9d8eea983 https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee... Cholesterol reduction is big business. Pfizer’s Lipitor alone raked in $125 billion between 1996 to 2012. This amount of money can be very corrupting. It’s almost impossible to find experts who are not influenced by money from industry.

mark-r 6y ago
I've always wondered if the reason a daily aspirin prevents heart attacks isn't because it prevents clotting, but because it's an anti-inflammatory.
- flowerlad 6y ago
  If true then aspirins may be just as useful as statins while being cheaper and safer. (But you won't see anyone funding a clinical trial to prove this, any time soon!)
  - mark-r 6y ago
    If you can't patent it, you can't fund it. I don't know if aspirin ever had a patent, but if it did it ran out 100 years ago.

dpoochieni 6y ago

High cholesterol, low thyroid function. Simple, but the details and how this maps to lifestyle and diet changes it gets very tricky. That's why we have vegan and vegetarians with high cholesterol, (extremely hard to keep a healthy metabolism, let alone on a plant-based diet, most people confuse the temporary surge in stress hormones with an sustainably energetic metabolism.)

Geee 6y ago

This guy has been arguing for years that it is sugar (fructose actually) that increases the "bad" LDL in your blood stream https://www.youtube.com/watch?v=dBnniua6-oM https://www.youtube.com/watch?v=dBnniua6-oM

ncmncm 6y ago
Robert Lustig is right that fructose (half of common sugar) is responsible for a variety of ills: exactly the ones Americans die of, by the millions. There is a lot of Lustig material on youtube, all of it excellent, all thoroughly grounded in rigorous experimental science. We need more Robert Lustigs. The normal metabolic route is that excess fructose, beyond what the liver can afford to process immediately or store itself, is carried wrapped in cholesterol to fat cells to be stored. If you take statins, excess fructose gets dumped into your bloodstream not wrapped in cholesterol, which is much worse. It causes oxidation of blood lipids, which have long been known to cause heart and circulatory problems.
- hammock 6y ago
  Can you share a good article about the misconceptions of cholesterol and the dangers of statins? I've been looking for a decent source. I have a family member on a statin now.
  - 1_player 6y ago
    There are some interesting talks about keto and zero carb on Youtube about fat metabolism, cholesterol, fructose, etc. Off the top of my head, I remember the "zero carb down under" channel where some are hosted, including Lustig's talks. /r/KetoScience delves into the research, if you are so inclined.
- tsimionescu 6y ago
  But aren't statins successful in preventing heart disease, in clinical trials? My understanding was that other classes of medicine that reduce serum cholesterol levels have shown no effects on heart disease in clinical trials.

superqd 6y ago

So much nutrition research is all correlation and no causation. Statements like this, which over-infer, kill me: "There is little doubt that people with high cholesterol have an increased risk of disease." It's just as valid to say that people with heart disease are more likely to have high cholesterol. When all you have is correlation, there is a heart disease group, and a high cholesterol group, and all you shown with correlation is that there is a third overlapping group of people with both. With only correlation, you don't know how/why, or even if, members of one group transform into the other. Which is partly the underpinning of the article. It's possible that high cholesterol is a result of underlying heart disease (which the article says is possible), rather than a cause. But what shocks me is that people, even researchers, seem surprised to realize such possibilities.

123409871234 6y ago
We know that high cholesterol is a cause of heart disease rather than a mere correlation because people with genetic Hypercholesterolemia have a rate of heart disease 10-20x that of the general population, independent of other risk factors: https://www.acc.org/latest-in-cardiology/articles/2020/06/01/13/54/familial-hypercholesterolemia https://www.acc.org/latest-in-cardiology/articles/2020/06/01...
- tsimionescu 6y ago
  Do we know that people with hypercholesterolemia don't just have a heart/blood vessel/metabolic defect that also causes high cholesterol?
  - rictoo 6y ago
    By definition, Familial Hypercholesterolemia is a genetic defect of the receptor responsible for clearing cholesterol-containing droplets from the blood.
    - tsimionescu 6y ago
      I understand that, but my point was that it's in principle possible that the exact effects of a particular genetic disease are hard to discover. Serum cholesterol is easy to measure, so it could be just the easiest to notice sign of a more complex metabolic modification induced by the specific genes. I doubt we are at a point where we can look at a gene and say exactly what it affects in the entire body.

deleted 6y ago

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ncmncm 6y ago

We have known for many decades that it is oxidized blood cholesterol that correlates with heart disease. Fred Kummerow showed this back in the '50s, 60+ years ago. But you can't get a blood test for oxidized cholesterol. Fred Kummerow spent his whole working life getting trans fats out of the US food pipeline. He proved trans fat was poison in 1957, and finally in 2009, under compulsion of a lawsuit, the FDA declared it toxic. Then, they issued no regulations restricting their use until forced by another lawsuit, in 2014. Then, they gave vendors 3 more years to put poison in stuff being sold as if it were food. In 2018 it was supposed to be illegal to sell trans fats as food, but a number of companies still do, under waivers. He died in 2017, at age 102. He spent the final two years of his life working on Parkinson's, which had taken his wife, since trans fats had (he thought) finally been outlawed. He was a great hero of experimentally-grounded health science. https://www.drmirkin.com/histories-and-mysteries/fred-kummerow-hero-of-the-trans-fat-battle.html https://www.drmirkin.com/histories-and-mysteries/fred-kummer... India and Brazil are still struggling to get it outlawed. The big corporations have resisted because selling poison as if it were food remains profitable. We are still confused about fats. But a takeaway should be that nobody has ever found any evidence of harm from eating saturated fat, or benefit from eating unsaturated fat, despite decades trying.

mrkeen 6y ago

A: saturated fats B: LDL cholesterol C: heart disease studies show saturated fats increase LDL cholesterol A => B People who get heart disease are more likely to have high LDL cholesterol C => B > Researchers have thus drawn a logical conclusion: a lot of saturated fat in the diet produces more cholesterol, which in turn increases the risk of heart disease. A => B /\ B => C > But this has been surprisingly difficult to prove. You don't say?

robwwilliams 6y ago
Great book on this topic: Judea Pearl’s Book of Why. He discusses causal models in great depth. And a highly amusing read. Mendelian randomization can sometimes “rescue” causality from large epidemiological studies. Pearl explains how.
andybak 6y ago
If I'm reading you correctly - this is the classic false syllogism?
- mrkeen 6y ago
  I think so. The author wrote "People who get heart disease are more likely to have high LDL cholesterol". Had she written "People who have high LDL cholesterol are more likely to get heart disease" then the argument would have been valid.

andybak 6y ago

High cholesterol and hypertension here. Anyone want to give me a tl'dr? The obvious and constant advice to date is: drink less alcohol, exercise more and eat less saturated fat. Tackling all three at once is quite a challenge so it would be lovely if someone threw me a bone here. ;-)

hammock 6y ago

Not sure how "new" this model is, it's just not well-known in the mainstream. Dr. Rhona Patrick has been explaining this very clearly for years. Go watch any of her podcasts with Joe Rogan.

troll_v_bridge 6y ago

Reminds me of this FoD vid: https://www.youtube.com/watch?v=5Ua-WVg1SsA https://www.youtube.com/watch?v=5Ua-WVg1SsA

basicplus2 6y ago

Cholesterol is is not the problem. HDL and LDL differences not withstanding. Cholesterol is used by the body to patch damaged arterial walls which can cause clogging if the there is excessive damage to the arteries. The problem is high sugar levels in the blood by eating high sugar content foods and high glycemic index foods like highly processed carbohydrates which turn to sugar quickly raising blood suggar levels. High sugar levels cause damage to the arterial walls and bodies response is to patch the damage. https://www.adwdiabetes.com/articles/repeated-sugar-spikes-damage-arteries https://www.adwdiabetes.com/articles/repeated-sugar-spikes-d... Other issues interfere with the ability of lipids entering the wall properly in the repair process and cause the atherosclerosis exaserbated by ldl presence also caused by high sugar levels amongst others https://pubmed.ncbi.nlm.nih.f https://pubmed.ncbi.nlm.nih.f gov/1222702/ Unfortunately all these issues get conflated together to produce misunderstanding and alot of misunderstanding

Syzygies 6y ago

This is parallel to the question of vitamin D and COVID. There's a strong correlation between vitamin D deficiency and COVID mortality, yet taking vitamin D doesn't help. Conjecturally, it's the genetic cause of vitamin D deficiency that increases COVID mortality. I had been taking Clemastine and vitamin D. I asked a former student now a doctor at the center of the COVID response whether these would interfere with my vaccine. She said to stop Clemastine on the off chance that one study was on to something, but there was no reason to take or stop taking vitamin D.

wuwuno 6y ago

The cholesterol theory doesn't hold water. The claim is that cholesterol is so sticky that is clogs up the largest arteries of the body, is almost laughable. If cholesterol is as truly sticky as claimed then it should be clogging up the tiny capillary vessels in the lungs, but it doesn't do that. Linus Pauling discovered the basis for heart disease, but his theory has been 'discredited' by scientists who have bought and paid for by big pharma.

twic 6y ago

> When we eat more polyunsaturated fat, the cells incorporate more polyunsaturated fat into the cell membrane, making it more fluid. That seems like an absolutely wild idea to me. So the cell just grabs whatever lipids arrive from the diet and turns them into phospholipids and puts them in the membrane? I know nothing about this process, but my biochemist's intuition tells me to be skeptical. Is there research on this?

known 6y ago

NICE no longer specifies target cholesterol levels for people with diabetes. Your doctors will use a calculator, called QRISK2, to work out your risk of heart disease using a number of factors such as age, BMI, gender, blood pressure levels, cholesterol levels and which type of diabetes you have. If you want a general guide of how healthy your cholesterol levels are, find out your total cholesterol-to-HDL ratio To find this, take your total cholesterol figure and divide it by your HDL figure. A result of less than four is healthy https://www.diabetes.co.uk/Diabetes-and-cholesterol.html https://www.diabetes.co.uk/Diabetes-and-cholesterol.html