3 ms·

Aren't both sugar and saturated fat problemtic, and complementary in contributing to CVD?

kortex 9mo ago
Yes. Sugar (and all of its downstream phenomena - diabetes, insulin resistance, the ease in which sugar adds calories without satiation signals) is well established to contribute to CVD. Long-chain (animal based) sat fat and trans fat is also well established to contribute to CVD. The high calorie density of fatty foods plays a big role, as does the overall palatability and "eatability" of low fiber, high fat, high sugar, delicious foods, making portion control challenging. That should be uncontroversial at this point. The jury is unclear on: - How the chain length of sat fats impact things (medium-chain triglycerides seem to be protective, but the boundary between medium and long is fuzzy) - How the ratio of the various omega-N (3/6/9) unsat fats impacts health, particularly inflammation - The whole "seed oil" thing is probably MAHA/conspiracy style false signal at the end of the day, but it hasn't been fully debunked and there are almost certainly facets of truth to it (seed oils are a form of ultra-processed food, and all UPFs are problematic) Confounders, confounders everywhere. This whole field is just extremely challenging and noisy.
- andor 9mo ago
  Sugar doesn't cause insulin resistance or (type 2) diabetes. Both are a result of being overweight. Of course, you can get overweight by eating too much sugar, but it's really about not eating too many calories long-term, regardless of the source. And of course, refined sugar isn't healthy at all and consumption should be kept to a minimum, outside of exercise.
  - tsimionescu 9mo ago
    There are many people with type 2 diabetes that are not overweight; and also many people with overweight and even obesity who do not develop type 2 diabetes. The estimate is that around 537 million people have diabetes worldwide, while overweight and obesity is estimated to affect 1.1 billion people.
  - aldarion 9mo ago
    Carbohydrates do cause insulin resistance and diabetes. India has average BMI of 21,9, yet has very high incidence of diabetes - largely thanks to its carbohydrate-based diet.
aldarion 9mo ago
High-fat high-carb diet certainly is. There is however no conclusive data that high-fat low-carb diet OR low-fat high-carb diet contribute to CVD.
- matthewkayin 9mo ago
  I wonder if this is because it has less to do with fat and carbs and more to do with processed foods. The Mediterranean diet is regarded as quite healthy by many health professionals but, it is also high in carbs and fat. But these are healthy, unprocessed carbs and fats. Whole grains and olive oil. People going for high fat, low carb / low fat, high carb are usually doing so while also sticking to real foods.
  - themk 9mo ago
    When people say "fat" is bad for you, they mean saturated fat. Mediterranean diet is quite low on saturated fat, while still having the good fats.
    - D-Machine 9mo ago
      Cochrane systematic reviews should make you seriously question whether the Mediterranean diet really is much good at all - hard data is inconclusive and low quality [1]. In general we really even barely have enough nutritional knowledge to say if the term 'good fats' even makes much scientific sense, but broad and vague things like "Mediterranean diet" are just total nonsense, from the standpoint of serious nutrition science. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6414510/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6414510/
      - themk 9mo ago
        That seems to be searching for RCT's, which, I'm not surprised would struggle to replicate. Most of these had a duration of less than 5 years, while dietary related health outcomes are the result of decades of following a pattern. It's possibly also unethical, in some cases (i.e. the existence of effective LDL lowering medication would likely complicate things). Many people seem to disregard epidemiology, especially when it comes to nutrition (I think because it tends to support unpopular positions). But epidemiology has performed some excellent feats in the name of public health: cholera, smoking, pfao. It is unfortunate that the large time-lines on these things make more rigor difficult, but I wouldn't throw out the epidemiology.

Yes. Sugar (and all of its downstream phenomena - diabetes, insulin resistance, the ease in which sugar adds calories without satiation signals) is well established to contribute to CVD. Long-chain (animal based) sat fat and trans fat is also well established to contribute to CVD. The high calorie density of fatty foods plays a big role, as does the overall palatability and "eatability" of low fiber, high fat, high sugar, delicious foods, making portion control challenging. That should be uncontroversial at this point. The jury is unclear on: - How the chain length of sat fats impact things (medium-chain triglycerides seem to be protective, but the boundary between medium and long is fuzzy) - How the ratio of the various omega-N (3/6/9) unsat fats impacts health, particularly inflammation - The whole "seed oil" thing is probably MAHA/conspiracy style false signal at the end of the day, but it hasn't been fully debunked and there are almost certainly facets of truth to it (seed oils are a form of ultra-processed food, and all UPFs are problematic) Confounders, confounders everywhere. This whole field is just extremely challenging and noisy.

andor 9mo ago
Sugar doesn't cause insulin resistance or (type 2) diabetes. Both are a result of being overweight. Of course, you can get overweight by eating too much sugar, but it's really about not eating too many calories long-term, regardless of the source. And of course, refined sugar isn't healthy at all and consumption should be kept to a minimum, outside of exercise.
- tsimionescu 9mo ago
  There are many people with type 2 diabetes that are not overweight; and also many people with overweight and even obesity who do not develop type 2 diabetes. The estimate is that around 537 million people have diabetes worldwide, while overweight and obesity is estimated to affect 1.1 billion people.
- aldarion 9mo ago
  Carbohydrates do cause insulin resistance and diabetes. India has average BMI of 21,9, yet has very high incidence of diabetes - largely thanks to its carbohydrate-based diet.

aldarion 9mo ago

High-fat high-carb diet certainly is. There is however no conclusive data that high-fat low-carb diet OR low-fat high-carb diet contribute to CVD.

matthewkayin 9mo ago
I wonder if this is because it has less to do with fat and carbs and more to do with processed foods. The Mediterranean diet is regarded as quite healthy by many health professionals but, it is also high in carbs and fat. But these are healthy, unprocessed carbs and fats. Whole grains and olive oil. People going for high fat, low carb / low fat, high carb are usually doing so while also sticking to real foods.
- themk 9mo ago
  When people say "fat" is bad for you, they mean saturated fat. Mediterranean diet is quite low on saturated fat, while still having the good fats.
  - D-Machine 9mo ago
    Cochrane systematic reviews should make you seriously question whether the Mediterranean diet really is much good at all - hard data is inconclusive and low quality [1]. In general we really even barely have enough nutritional knowledge to say if the term 'good fats' even makes much scientific sense, but broad and vague things like "Mediterranean diet" are just total nonsense, from the standpoint of serious nutrition science. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6414510/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6414510/
    - themk 9mo ago
      That seems to be searching for RCT's, which, I'm not surprised would struggle to replicate. Most of these had a duration of less than 5 years, while dietary related health outcomes are the result of decades of following a pattern. It's possibly also unethical, in some cases (i.e. the existence of effective LDL lowering medication would likely complicate things). Many people seem to disregard epidemiology, especially when it comes to nutrition (I think because it tends to support unpopular positions). But epidemiology has performed some excellent feats in the name of public health: cholera, smoking, pfao. It is unfortunate that the large time-lines on these things make more rigor difficult, but I wouldn't throw out the epidemiology.