I so appreciate this episode! My daughter and her boyfriend have recently fallen under the Saladino spell. I really don’t know how to get through to them. I too got into keto and lots of coconut oil found out my cholesterol was 330 now I’m vegan again and back down to 215. Total cholesterol after just three months. What’s really sad is her dad died of heart disease when he was only 53. Anyway, thanks for doing what you do!
Sorry to hear that Diana, I wish you and your family the best. I have a similar family situation with my brother. Without going into too much detail we've never had a good sibling relationship with a one-sided competition on his side, and when I went vegan he went the opposite direction toward the low carb/"bro" science/Saladino types, and I'm worried for him. I think Alan's point about Saladino's personality is really key though, moreso than the evidence he's a charismatic narcissist and that's a big part of why people fall under his spell. Introducing your daughter to podcasts such as this one could be good, IF she's open to it, but I would be very careful not to come across as critical of Saladino because that could actually feed into the cult of personality. Try coming at it sideways--be open to info she gives you, but ask some thoughtful questions and give her space to explore on her own, and maybe introduce her to more of the psychology of narcissism and personality cults. Understanding how Saladino communicates is more important than what he actually says. Best of luck!!
:(that man is dangerous. I cannot believe he appeals to ppl. It saddens me and I have seen to many follow him blindly. Hopefully your daughter and her bf will watch this and use their critical minds to research instead of just follow Saladino 🙏
Honestly she will find her way when the tide of info changes and she is exposed to more and more info. I think people fall under these things because they’re seeking more info. As long as she’s still seeking more info for her health I’m optimistic that her and others will see the totality of evidence points in the opposite direction. It’s the folks whose feeling of “joining a contrarian’s club” is greater that stick around in those fringe communities.
Does your daughter like me describe (after moving from low fat to low carb) being at a healthy weight for the first time in decades, having higher HDL, lower triglycerides, healthy insulin response (A1c) normal blood pressure and, more subjectively, more energy than I have had since 30 years ago. I have two brothers in law who both have severe heart problems. most of those markers are in the problem zone. They both eat low fat high carb one has normal ldl the other is high so that does not seem to matter. They are both overweight, lack energy and take statins after their heart attacks. I think I will go with what is working.
Great episode. I can definitely relate. I was a huge low-carb adherent from 2000 to 2014. I'd actually come across Ornish and another low-fat vegan guy, Dr. Gabe Merkin back in the 90s but was never able to pull off their rather extreme approach to plant-based diets, at least in my 20's at that time. About the best I could accomplish was becoming pescatarian, which I did for 6 years. But then someone suggested I read Protein Power and that and it's sequal got me hooked on the low-carb narritive. I would say it is kind of an ideology, which is not that dissimilar to low-fat WFPB diets, but with the added emphasis of being able to eat the rich foods that the "diet scolds" tell you you shouldn't eat. Whereas the WFPB low-fat approach is kind of the opposite of that! Unfortunately back in the early 2000s there were not a lot of voices like Alan, Danny and Simon, let alone real social media for most of that decade, so I just had the echo chamber of fellow Protein Power dieters on the author's online forum to converse with. It all ended quite badly. I ended up having to get a stent placed in 2014 (my LDL initially got as high as 250, but then leveled off to a "low" 155-190, lol), which finally snapped me out of my self-delusion that I was somehow removing my hereditary high risk of heart disease by avoiding fruit, grains, and beans. Unfortunately, I ended up back in the same situation but with the low-fat vegan doctors - specifically Esselstyn - and unfortunately after 1.5 years strictly following his plan, ended up with an NSTEMI. I don't blame the diet itself, I blame my decision that doing the diet meant I didn't need to take statins and my LDL with that diet was generally under 80, which, according to Esselstyn made me "heart attack proof". Apparently the blockage that caused the heart attack was due to the initial stent not being placed all the way into the diagonal artery, and protruding into the LAD, this causing "turbulence" according to the doctor who did the second procedure (to stent the LAD after the NSTEMI) which then caused particles to build up around the piece of the stent that was poking out into the LAD. It took me another 2.5 years of reading and watching/listening to saner voices in the plant-based world, like Simon, Dr. Carvalho, and Avi Bitterman, along with non-plant-based scientists like Alan, Danny, Nick Hiebert, etc. to realize that science is nuanced and most of the vegan doctors are highly biased. After all of that, though, I still follow a low-fat plant-based diet, not because I think it's the only or best way to eat, but it works for me and I'm used to it. I lost huge amounts of weight on it and have maintained a 22-23 BMI for 5 years now. While this may not seem appealing to many, when you eat this way for a couple of years, your tastebuds adjust and it just becomes normal, so not a big deal to continue, and it does help a lot with weight maintenance. Anyway, just wanted to relate my experiences around some of the topics you discussed - from someone whose done both ends of the spectrum, and not for short periods of time! Thanks again for the great episode!
@@doddsalfa there's never a "good reason" for bias. You should always be open to new evidence and never attached so much to your favorite theory so as to ignore evidence to the contrary. I've had to face the fact that some people have a VERY different experience than I have eating the same way. We are not all identical clones, and while there my be a majority of people who will do well on a given diet, even when you look at studies that suggest a diet's benefit, there are plenty of outliers who do not do as well, or cannot follow the diet because it's not sustainable for them. If you rigidly adhere to a single ideology, whether that's around politics or diet, that's a recipe for tyranny and delusion.
@@dvdmon according to dr.Esselstyn “coronary artery disease is a toothless paper tiger that need never exist “ so somewhere in time your experience makes you bias
51:00 He's right about speaking with conviction that Saladino does. It's crazy because you watch one of his videos that somehow went viral and there is not much substance in what he's saying (like saying that its used as engine lubricant, therefore bad), yet somehow it has this effect where it feels like he said something profound and so clear-cut. I also think part of the issue is that there is a breakdown in trust in all levels of society so it only takes a little bit of sophistry to convince the average person to distrust a narrative, whereas in past generations there was a pretty strong trust/bond between people. Lastly, there's the obvious effect where since certain foods appeal to people (like greasy meat), it is much easier to accept something that is in line with one's passions are drawing them to.
Another great episode Simon. Your podcast has been excellent and I’ve learned a lot. Would love to see these maybe 3-4 x per year with Alan & Danny as a regular check in.
Another great episode. While living a whole food plant based diet, it is nice to hear how to help some of my friends refine their omnivore diets to better help with their health. Yes I’m the 60 year old nerd in my crowd
Excellent discussion and questions around cholesterol. It’s helped me understand so much more about the subject without all the noise we hear from other influencers. Thank you!!
This is amazing, thankyou for bringing me the truth😉😂 But seriously, this is the best explanation of cholesterol structure and function I've ever heard, cheers!
As someone done Keto and great result reversing high HbA1C, but with high LDL, I am listening and will add back carbs based on Portfolio Diet. Thank you.
Completely agree on putting out the correct evidence rather getting stuck in an interview with Saladino where they can rubbish the evidence and the messenger. Carry on with what you’re doing because it’s fabulous.
wow..I've been reading/listening to podcasts/interviews for years (Attia/Dr. Patrick, Huberman etc) trying to get a handle on the whole cholesterol topic and this is by far the most easily understood, comprehensive info I have come across! I finally 'get' the whole HDL/LDL issue and how cholesterol actually works in the body (great analogies of the 'ship' with cargo/cranes off loading the 'ships', Simon!! Thanks for that!). Such a shame that in 20 years there will be a whole slew of people struggling with disease caused from following bad advice..and when that happens, people like Paul S should be charged with reckless endangerment .This is SUCH an important podcast..I'll be passing it along!
This was so very interesting, educational and informative. The only equivalent I came across on TH-cam was an interview Dr Gill Carvalho hosted with Cardioligist Philip Ovadia to hash out their differences re: importance of Apo B vs importance of total metabolic health. While the discussion was very cordial , sadly I doubt any minds were changed as a result. Many thanks for hosting this Simon and a super big thanks to your hosts, much appreciated!
Thank you Simon for another outstanding comprehensive podcast. As a retired internist with lipidology certification I found your ‘questions’ and the input of Alan and Daniel to be spot on yet educational for me as well. The misinformation promulgated by those podcasters, who have agendas quite distinct from truly scientific education, is unfortunate and part of the pairing of false narratives with those who are drawn to it in a sort of co-dependency relationship. I suspect that the ‘stupiding down’ that this represents (as the prolific phenomenon it represents) will be part of the reality of free speech for some time to come, unfortunately.
Fantastic episode, possibly my favorite one to date. We observe at my (very cardiac-focused) hospital that the old paradigm of “you want your HDL:LDL ratio to be 1:2 and you’ll be fine” essentially goes out the window even when the LDL creeps up over 100-120ish (purely observational). This gives credence to that blossoming opinion. Have you ever done an episode on natto/nattokinase supplementation? It would potentially piggyback onto this discussion if there is adequate information to pore over … I’m finding SOME, but not a ton yet, in my general internet travels.
I believe the whole arteries vs veins issue, relative to atherosclerosis, is due to the fact that arteries are a high-pressure vascular environment, whereas veins are low-pressure. When veins are used for grafting in bypass surgeries, they too can develop atherosclerosis.
I would recommend for anyone interested to watch Professor Bart Kays video on atherosclerosis. He gives a clear mechanistic explanation on how atherosclerosis develops in arteries. Hint: it has nothing to do with LDL particle count or ApoB gene.
@@healthcoachjoff ye... I'm fine thanks. As you said: mechanistic. Science mechanicism is the behavior that leads dishonest folks like Saladino to claim stupid stuff like the ones exposed during this podcast
@@TenTempeh yep each to their own. But let me ask you this, can you refute the fact that there are no scientific experiments in humans that can inform cause and effect of cholesterol/LDL/saturated fat intake on cardiovascular disease? If not, then what science can you justify your reasoning?
@@healthcoachjoff i have some science for that matter yes. Studies relating saturated fat intake with dementia/Alzheimer, with metabolic diseases, with cardiovascular events... Dude, this video you are commenting on provides many studies on that topic... Lmao
Love your podcast Simon! Thanks for all of the info you provide. I was hoping you could do a podcast on those of us stuck in the middle on heart disease prevention. My husband and I are both WFPB, lowish fat, no sugar, lowish salt, low oil (just a little olive oil), low saturated fat. Our cholesterol has decreased by a lot. Mine from 200 down to 160 (my husband even more), but my LDL still hovers in the 90s, not really changing much from before I went WFPB. ApoB is 83. So my LDL and ApoB are not in the nice range that everyone recommends (below 70 for LDL, below 80 maybe for ApoB?). I'm too low to be prescribed statins, but too high to be considered really low risk. What do people like myself do? Would love some recommendations. It seems that some of us just make more cholesterol than others. But this likely puts us at higher risk. I've tried ideas from the portfolio diet, still no change to LDL.
Whew, this was a marathon of goodness. I've got so many responses but first let me say "thank you". This past summer I had a MINOCA heart attack, meaning it was not caused by an obstruction. It has thrown me for quite a loop and I've been exploring the Portfolio diet. As a lifelong vegetarian, who embraced an unrefined vegan lifestyle 20 years ago, it's been an easy transition and I'm looking forward to seeing if it's supportive to my health. I was hoping your guests were going to talk a bit about that particular diet as well as MINOCA events. Maybe I missed it and I'm going to go back into your podcast to listen to some sections again. As an aside, for many years I followed the dietary protocals of Drs Ornish and Esselstyn... actually the day before my heart attack I had borrowed the book Prevent and Reverse Heart Disease from my local library. I don't think a low-fat vegan diet caused my heart attack it's just a coincidence that I find amusing. Again, many thanks for your podcast. I'm a new listener and subscriber.
Can you share what a day of eating was like for you before you had your heart attack? I have high Lp(a) and went plant-based once I found out in hopes that it will lower my chances of having a heart attack but reading your comment has me stressed again lol
Great video. Listen to it from start to finish. At the end, you denounced Esselstyn diet. That surprised me because right through the 2 hours long discussion, you are encouraging very low fat diet. Please explain this to me as I am on this diet. Many thanks
I feel the emphasis wasn't on a low fat diet across the board, more of a low saturated fat diet. Polyunsaturated fats and monounsaturated fats are beneficial to cardiovascular health. I think some of the criticism of Esselstyns paper is that is less of a study and more of a case study presentation. It doesn't give the same degree of clarity that a well designed study might.
@@TheProofWithSimonHill Absolutely, so many types of diet can be healthy if we pay attention to some of the finer details like saturated fat to polyunsaturated fat ratios, fibre etc. And if a low fat diet that is vegan gets you there, that's great. If a higher fat diet with low saturated fat does it, that's great too, omnivore or vegan. Ideology is such a roadblock at times, whether it comes from the hard-core carnivore or the die hard vegan side. I really appreciated the objective conversation on this podcast.
@@TheProofWithSimonHill Great episode! Look forward to the "are low fat vegan diets best for CVD?" Please focus on PUFAs vs Whole plant foods (Dr Esselstyn's recommendations) also rather than just PUFAs vs Saturated fats or refined carb (which is not Dr esselstyn's recommendations)
Hi Simon, Firstly I want to thank you for the amazing amount of time and effort you put into your work. More importantly, though, I love your grace and genuine interest in finding goodness. I have a couple of comments about different aspects of this episode and I've split them up so you can ignore the ones you aren't interested in. Firstly, about PCSK9 inhibitors. I might have missed something, but if the amount of cholesterol we need in cells is low but PCSK9 inhibitors up-regulate LDL receptors to jam more cholesterol into cells isn't that likely to cause problems inside the cell where the extra cholesterol isn't needed? Or, if it works exclusively on hepatocytes, and the receptors are in the liver, why would the liver produce LDL to remove it again? Next, high cholesterol is described as a population disorder that requires drugs. Primates and traditional hunter-gatherer populations all appear to have normal cholesterol levels and low levels of atherosclerosis. What is it about our western populations that causes high cholesterol? Suppose it's something we're eating or not eating, doing or not doing, experiencing or not experiencing. Why do we need to contemplate gene therapy on children to rectify it or drugs as the only option in vast hordes of people? I realise this is not particularly scientific, but it doesn't pass my sniff test. Thirdly, while I have enormous admiration for your approach, some of the comments of your guests in this episode were playing the man and not the ball. Characterising anyone even asking questions about the topic as narcissistic fame-grabbers was disappointing. There's absolutely no reason why people like Dave Feldman can't be genuinely interested in progressing their understanding of the topic. If you flip it around and look at someone like Dr Flannagan who's a popular, informed and valuable commentator you could equally say he's just in it for the clicks because he's popular. By the way, I'm very grateful to all your guests for their time and knowledge. My issue with all this, and the reason I like your approach so much, is that as soon as the mud-slinging starts, the learning stops. People can be genuine, rational, and intelligent and still be wrong partially or wholly. Of course, there is a huge range from people who are just a little misguided to people who latch onto demonstrably nonsensical stuff, like flat Earth and we have to navigate that, but most people are not flat-Earthers. There is a fabulous chap by the name of David MacRaney who has spent a huge amount of time and effort trying to understand this kind of thing. He's like a version of you who focuses on why we think the way we do and how to change our minds. His podcast, You are not so Smart youarenotsosmart.com/podcast/, is great. He also has a couple of books, the latest being How Minds Change www.davidmcraney.com/howmindschangehome. Thanks for everything and I hope this comment isn't too long and sorry it's late. I listen to podcasts on the way too and from work at 2x speed to try to get through them, but I'm still about 5 months behind :)
Thank you! Your questions and comments are valid and important! I appreciate you and agree. Some of this podcast stank of propaganda. But I held my nose and listened anyway, in hopes of gleaning some honest useful info.❤
Very interesting when revisiting pathophysiology, always great to go back to basics. The slow pace of speech really worked for me, and the clean graphics so helpful, thank you! I'm trying to clarify.. if the HDL compounds are so dense in proteins that they have no capacity to carry TG, then how would they be able to "collect" lipids in their role as reverse transport lipoproteins?
this is the absolute best channel addressing nutrition. nutrition made simple coming in second. seams to me that the crux of the cholesterol denialists arguments is that ldl\apo b particles have to be oxidized to initiate the formation of arterial plaque. therefore, if one avoids consuming seed oils and the dreaded pro inflammatory refined carbs, you cant eat red meat, butter and cheese without risk of damaging ones arteries. a whole episode tackling that specific claim that oil and carbs are the root cause of heart disease or the dismissal of the heart health hypothesis would be important. maybe i just missed it
Very informative. I have found Doctors are very reluctant to test APOB. It was explained to me as unecessary unless I was in high risk category even though I have a weight issue.
My back of the envelope calculation is that adding an ounce of nuts / seeds to each of 3 meals would take a McDougall / China Study type diet to something more like 25% at 2000 Cal, or 20% at 2500 Cal.
I suppose my big question is the same as it was 10 years ago. All plants, or a small amount of animal based foods. I am not considering other approaches.
I really enjoyed this marathon conversation. I will point out your discussion of healthy fats (olives, nuts, seeds, oils) and heart disease omitted the high calorie density of these foods. For many people struggling with obesity related hypertension or metabolic disease, following a diet of very low fat high complex carbohydrate foods low in calorie density is the easiest, tastiest and most efficacious way to lose weight.
I've recently been pulled out of carnivore circle. My apob is 93 when I was 135 ldl. I'm 117 ldl currently but not sure apob haven't checked, I'm 50 trigs and 63 hdl. Crp 0.46, lp(a) 32.3 nmol. I've been trying to remodify my diet, I just found this channel but I got snapped out of it by a channel called nutrition made simple.
we watched the whole episode. very brilliant. one thing i would say concerns refined oils. we've been omitting it in favour of whole nuts and seeds (wfpb) as we have found they lead to weight gain pretty easily and they are an opportunity cost to get a whole fat source. i guess it depends on age, activity level, propensity to gain weight etc. but this hack we found helped drop weight and the food is actually better tasting as whole seeds and nuts taste better. for us this was a super useful hack. anyhow, great episode!
Edit: After listening to the Sigma Nutrition podcast I’ve realized these guys are doing a great service to the public by bringing us the truth of nutrition science amidst all the bluster and pseudoscience of the more vociferous influencers. Thank Simon, Danny and Alan for opening my eyes. Alan does seem a bit grumpy though.
Thank you for another smart conversation on an important topic 👏🏼. I'm so glad I heard about you on Rich Roll's podcast, I'm really enjoying yours now too. Keep it up, we need these kinds of clarification and debunking 🙏🏽. I once had a doctor tell me my HDL was 200 and the highest of anyone he'd ever seen. I asked what that meant and he said he didn't know but my other numbers were great so it wasn't anything bad, but it seemed so odd I've always wondered. I've asked a few people and no one knows, any idea why HDL might be so high?
@@TheProofWithSimonHill I have retested after that but was never told that again. I haven't retested since I've been more into health education over the past few years because cholesterol has never been a concern for me but that always stuck with me. I might request one soon just to get a new baseline.
Listened to this as a novice, is the measurement of LDL in a B/T a snapshot, or does it stretch over say a 6 month period more like an Hba1c ? Also how does menopause affect LDL cholesterol levels and does HRT’s protective cardiovascular benefits affect LDL cholesterol in a positive way?
Thank you all, this was a very balanced discussion. I do agree that Dr. P. Saladino's Opinion on plants is so skewed, couldn't say anything good about many plants or berries that are known to have high antioxidants, however I believe the Keto diet is different from Carnivore diet as described in the book of P. S, I agree Carnivore could be Mediterranean with low carb and smart selection of plants with antioxidants and polyphenols. I agree with so much evidence against "saturated fats", it is best be smart about choice of fat in "balanced for age protein, sensible fat and low glycemic carbs" diet. However, I still sense an industry bias when docs highly recommend "statins or all meds that lowers elements of lipids", while the majority of people , even those "Leanmass Hyepr-responders" if they just eat a little more sensibly with low glycemic, high fiber carbs and have a smarter choice of fat than saturated fats from red meat, can lower their Cholesterol. LDL, etc. I highly respect Dr. T. S, and fascinated by his knowledge and experience but isn't if fair to ask him the question on those 3 podcast this year, "what are your disclosures when it comes to Pharma and lipid lowering agents? Simon can you please ask him this question. Also some the agents Dr. T.D explained were developed over the years and some failed, like bile acid sequestrants or Cholesterol absorption blocking agent that works great Ezetimibe, does it really doing the job of fiber? has it been compared to dietary fibers to see if is superior. Another factor raises suspicion is the comment "on life long exposure to high LDL and need for ? lifelong tx with antilipids thus? While all these experts say "measure Apo B particles", one needs to do a retro studies of how many were started on Statins or other antilipid agents without measuring or even monitoring for ApoB? How many were offered dietary changes to more favorable diet high fiber low glycemic carbs and moderate protein and Pufa and Mufa fats first to see if they ever needed statins or the like meds ? I see bias on all sides of the arguments. while these docs talk about "life time exposure to high APOB/high LDL", has there been studies that actually monitor these specific elements apoB for example in those who receive tx for first 5 years and then stop and keep their levels down with diet lets say for 5 more years vs a different group who took the drugs for 10 years and look at the adverse events [ like heart attacks or stroke ]instead of the levels of LDL or ApoB. I do agree with the panel and excellent presentation and clear explanations.
I didn't eat meat for 12 months my LDL dropped by 22% but my HDL also dropped by 12% trying to figure out why?. I fell in love with sweet potatoes and beans during this time. good conversation
Simon, I greatly appreciate the work you are doing and I'm really enjoying your channel. No matter how many years go by and no matter how many studies into coronary artery disease, cancer, stroke, high blood pressure (the list goes on) the message from the results of these studies point us to the same diet every time: eat more plants, eat less meat (or better still none at all), ditch dairy (or reduce it to almost zero), ditch eggs, avoid seed oils, reduce your salt intake. Look at us humans. look at our teeth, the dexterity of our hands, our gut structure, the way our gut microbes influence our whole body and how our gut microbiome works best when we eat fibre (which you can't get from meat, dairy and eggs). our teeth are perfect for eating plants, our hands are perfect for gathering 'fruits and roots', our stomach and intestines are perfect for breaking down plants and absorbing plant nutrients. we need to accept who we are as humans....we are fruit and veg eating primates. We're not cats.
Great interview but sometimes difficult to follow because of so many terms that unless you are an expert on the subject you can loose track of your questions
Still curious about the claim that any oil destroys endothelium cells, as Dr. Esselstyn has claimed. Simon, have you gotten any cogent responses to this question from any of the people you have interviewed?
Love how your show and the people you have on explains things in depth. I believe it is necessary to hear the science in order for many of us to escape the brain washing many doctors and scientists have passed off to us. I can't believe the irresponsibility of the quacks out there. Hopefully, I can undo any damage these doctors have helped me perpetrate upon myself.
😢how can we find the truth,from the un correct being sold us or old ideas that we now know aren't right not being passed on when health profession know but won't pass it on because of cost or coruption of knowledge to keep jobs or profits ,,
Thank you for this informative video. I've been following a largely whole food plant based diet for a few years but have come to see a little overzealousness if not bias with some of its proponents. I try to synthesize information so I figure an occasional piece of salmon or a teaspoon or so of olive oil is probably not going to be as detrimental as some of the plant based docs lead us to believe. I also have come to see that diet and exercise alone may not be the answer, particularly if you've inherited some nasty genes or are getting a later start with lifestyle improvements. This said, if I had to adhere to one strict dietary approach, a whole food plant based diet which includes copious amounts of vegetables and legumes as well as a reasonable amount of nuts and seeds appears to be a good choice, for heart health and beyond.
I was Keto, LDL of >250 for over 5y, got a scan expecting all to be good. It wasn’t. What you described about the Keto community is correct, but it’s correct of any community. The question is not, is high LDL bad, the question is, is high LDL bad for me. Get a cheap scan please.
If high CRP or insulin resistance accelerates the irrefutable effect of high apoB, could low levels decelerate it? I wish they would think of this as additive versus multiplicative effects to help explain and make a case.
1:35:00 As a chemical engineer it seems obvious: Arteries = high pressure and plasma velocity Veins = low pressure and plasma velocity All things being equal artery walls should be penerated by plasma to a greater degree than vein walls.
Is it true that higher thyroid hormone can lead to high cholesterol? I've recently been able to reduce cholesterol levels by reducing animal product consumption and introducing plant sterols. However, reviewed last three blood tests and noticed high thyroid hormone. Booked in for specific hormone test shortly. Thanks
Paul saladino is probably not a candidate to offset the lipid hypothesis, and thus an easy target to shoot down, Being metabolic healthy is a good argument what is actually meant by that but it would not be low statin level
In 1990, Dr. Dean Ornish conducted a study titled "Can lifestyle changes reverse coronary heart disease?" and submitted it to The Lancet, a prestigious and long-standing peer-reviewed general medical journal. The study revealed that adopting a plant-based diet could effectively reverse heart disease. The Lancet is recognized as one of the world's oldest and most esteemed general medical journals. Notably, the beef, pork, and poultry industries, worth billions of dollars, have never sponsored research indicating that their products can reverse or impede the progression of heart disease. Such industries would be negatively affected if a study funded by them revealed that their products contribute to heart disease. While these industries possess abundant financial resources, their reluctance to support such studies stems from their doubt regarding the safety of their products. Until scientific evidence emerges to demonstrate that an animal-based diet can reverse heart disease, there remains no basis for debate.
I was not very impressed with some "arguments" here. First of all to spend so much attention on personal disliking of Dr. Saladino and talking about his narcissism certainly can not contribute to rigorous scientific discussion. If you want to criticize him, focus on scientific studies. Another thing I did not like was the general talking about so called scientific consensus. Wasn't the "scientific consensus" about low fat high carb (food pyramid) completely wrong? The other thing is the obsession with LDL cholesterol. They agree that the main culprit are actually APO-B related small LDL particles, but they still are pushing for lowering LDL just based on the whole LDL marker and even recommend taking statins as soon as possible to allegedly prevent a heart disease. That is wrong approach, which ignores serious side effects of statins. The ideal case if LDL is high would be to measure APO-B, which is unfortunately very often not feasible for various reasons (cost is one of them). Then there is a possibility to test CAC score. If that is not possible either and all other markers (HDL, Trigs, CRP) are really good so the likelihood that elevated LDL is a problem is quite low, in that case just to be really on the save side you might consider a change of diet. I was personally able to lower my LDL switching from butter to olive oil by 50% in several months. And on the top of it I was even eating lots of coconut oil. So I doubt that all saturated fat is an equal "evil" when it comes to LDL as these guys are trying to suggest. There is a study Dr. P. Mason mentioned in one of his videos, where they tested coconut oil and butter and they found huge differences in LDL levels when consuming coconut oil vs. butter. Butter was in orders of magnitude worse and that questions the whole premise about all saturated fats being so bad. Actually I do not think that even butter is bad if all other markers are really good. I would try first everything possible to avoid statins. That would be the last thing I would consider if nothing else worked. To rely that an invented drug is harmless and should be taken for many years or even for the rest of our lives sounds really crazy to me. And unfortunately that is the first thing almost every doctor suggests once he sees high LDL cholesterol. I had to convince my doctor to try to change my diet first and it worked fine. But had I just listened to him I would have been on statins already for years.
@@TheProofWithSimonHill Doesn't it matter on the percentage of ApoB particles within all LDL particles? The fact that 80% of people have ApoB doesn't automatically mean that all of them have higher risk of heart disease. Many of them have low level of ApoB and putting them on statins just as a precaution can cause worse health risks. LDL could be reasonable surrogate marker if we knew that the level of ApoB can be reliably predicted and derived from the LDL marker even without directly measuring it and I do not think it is the case. BTW, Dr. P. Mason showed in one of his videos a chart from one study where it was clear that large (healthy) LDL particles are corelated with low triglycerides. th-cam.com/video/rdgS3PuSuyg/w-d-xo.html
I really enjoy listening to your videos and in general the great work you do. It would be however great to see more women-related content or even seeing more women as guests on your channel. Sometimes it feels that the target group you are trying to reach are men only.
From the interview it sounded like LDL is the primary risk factor that, so getting that down would be the first goal, but that doesn't mean you can't try to do both.
@@dvdmon thanks for clarifying. it did sound that way. I suspect the focus on LDL is premature. Some studies (e.g., Weng et al, PLos ONE 2017) indicated that both triglyceride and HDL ranked higher than LDL on the impact on CVD risk.
No, the video clearly states ApoB as the superior CVD risk marker. It is the only causal one. Trigs and HDL are risk modifiers only, they are minor and non-causal players in the context of high ApoB.
@@robertusga I went back to listen 14:00-17:00. It sounds like, but not clear, that not every LDL particle carries apoB. Also not clear is if lowering LDL with statins also lowers apoB.
went full Carnivore for 3 weeks as an elimination diet after being miserable eating mainly vegan for months. My labs were normal, but I was taking a statin. I stopped all sugars, alcohol, and processed foods and I slowly added back and removed various other foods to see how my body reacted. I consider myself a ketovore now, 12 weeks into the diet. I love veggies, but I really loved how my body responded to carnivore. I lost 25 lbs and 3" off my waist in 3 months, had a ton more energy, had improved skin with no new skin tags...I could go on and on and on and on about everything I loved about carnivore. I started adding back other foods mainly because I was only going to the bathroon 1-3 times each week, and I figure that isn't really so good for me with a family history of colon issues. But, if I could stay on carnivore forever, I wouldn't mind at all. As far as the carnivore community and influencers go, hearing people attack the messenger and not the message and makes me not want to listen to anything these guest speakers are saying. If you want to convince me to not eat saturated fat, the last thing you want to do is to tell me that those who tell me to eat it are narcissists. It makes me want to tell you to look in a mirror. If you are concerned about a loved one who is eating carnivore, I would say, don't be. Let them eat however they want. You do realize that carnivore eliminates processed foods, sugars, and alcohol, right? I would bet money they are starting to work out. Carnivore also reverses insulin resistance and eliminates seizures. Those things alone will significantly improve their health. So, they take a few years off of their lives with saturated fats and add years back on for all of the new healthy living aspects of the diet they now have. I'd say it is a great trade off, especially if they are happier in theur skin....oh, it pretty much eliminates depression and anxiety too...yep, it sure does. So, no, we are not just blindly following a "cult of personalities" on the internet. We are actually feeling better than we have in decades and most of us actually tried plant based and were miserable on those diets. So, let us experiment with our diets without giving us grief. If you want to see who lives longer on different diets, do studies that compare true carnivores to other groups, not people who have a higher fat American diet. True carnivores are actually health minded exercising folks who eat 1-3 meals each day with no sugars, processed foods, or alcohol. I will wait for those study results. In the meantime, I will continue to eat ketovore and be happy not feeling miserable as I did on the S.A.D. and vegan diets.
I think focusing on Saladino as your primary focus related to this conversation is the major error to begin with. This dude promotes eating 200+ grams of carbs via fruit per day as if that level of fructose and its impact in the body isn’t clearly known. This is a major problem before even having the cholesterol and ldl debate. You should engage with folks like Dr. Anthony Chaffee for instance amongst many other before wrapping the “community” around Saladino. 🤷🏻♂️👍
Mediterranean keto is a good option for diabetics & people who want to lose weight. Just about everyone will benefit from getting rid of the bad processed foods/ carbs with unhealthy fats ie pastries, pies, pizza etc. I eat meat, chicken liver, pulses, lentils, barley, tofu & fish, I eat dairy ( yoghurt, kefir, cheese & full fat milk) coconut & olive oil so far my lipids are in the healthy range at age 60. I want to keep eating a very diet that I enjoy. I do worry about the chemicals that put on the vegetables ( roundup ) organic is nearly double the price with a lot of food items in the UK.
This is what where is me sprayed on fruits and vegetables Glyphosate (N-(phosphonomethyl)glycine I would appreciate a conversation on this channel on this subject
This guy's too smug for my taste. He may have something good to say but His attitude completely turns me off. His attitude of I'm right and you're wrong and then laughing about it doesn't win over converts in the middle. I cannot eat 150 to 200 g of carbohydrates every day and keep my blood sugar in check. He said nothing to cause someone to consider what he's talking about as being valid. I'm just a regular guy not a learned scholar. His message may be good but his approach is terrible. I'm sure he's not talking to me. I'm done!!
Disappointed by this episode. I came expecting scientific references and an in-depth explanation of the mechanisms at work. Instead I heard ad hominem attacks on those presenting conflicting arguments without any attempt to engage with the arguments themselves (indeed a desire to avoid such conversations!), a labelling of others touting « scientific truth » as narcissists (while doing the same themselves?), and several pertinent questions where the response amounted to simply affirming the reverse without substantiating the claim made. The arrogance of the whole discussion is quite overwhelming. I much prefer to listen to scientists willing to question *themselves* and discuss the limits of the scientific studies they appeal to.
@@TheProofWithSimonHill A comment is not really the space for this... - Why not highlight the fact that LDL and CVD are very tightly *correlated* but that strict *causality* has not been shown? (The source in the show notes only shows multiple qualities of correlation, but no causative mechanism...) - Given the limits of our knowledge in this area, your treatment of the LMHR phenotype is dismissive at best. What's interesting about this phenotype is not the personality of Dave Feldman(?!), but the fact that these individuals can present with LDL levels previously only ever seen in cases of FH, while simultaneously having excellent HDL and triglyceride levels. We don't understand why. Seems worth studying to me. - More evidence that we don't understand everything in this field: the hypercholesterolemia "paradox" where "a history of hypercholesterolemia was associated with a reduced rather than elevated hazard ratio for [all-cause mortality]" (www.sciencedirect.com/science/article/abs/pii/S0033062022001062?via%3Dihub) - Why no mention of the U-curve found between total cholesterol levels and *all-cause mortality* with the sweet spot being around 200-240mg/dL and higher levels being strictly more protective than lower levels (see pubmed.ncbi.nlm.nih.gov/30733566/)? - No mention either of higher levels of cholesterol being more protective in old age >80 (e.g. pubmed.ncbi.nlm.nih.gov/25602855/)? Unsubstantiated: - Asked about whether LDL could cause plaque without prior damage to the endothelium, the interviewees affirm LDL is sufficient alone without supporting evidence. - Interviewees suggest reducing saturated fat and increasing PUFAs to reduce your CVD risk, but "Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes." (pubmed.ncbi.nlm.nih.gov/27071971/) - Suggestion that cholesterol supports immune function (and Covid in-patients typically have low cholesterol levels) countered with the affirmation that cholesterol levels fall when an individual is sick... again, nothing in the show notes to support this. - Interviewees suggest very low levels of cholesterol (down to 30mg/dL) perfectly healthy, though recent study found "a significant association between lower LDL-C and higher risk of [stroke] when LDL-C was
I so appreciate this episode! My daughter and her boyfriend have recently fallen under the Saladino spell. I really don’t know how to get through to them. I too got into keto and lots of coconut oil found out my cholesterol was 330 now I’m vegan again and back down to 215. Total cholesterol after just three months. What’s really sad is her dad died of heart disease when he was only 53. Anyway, thanks for doing what you do!
Share this type of content with her. Maybe point the minuts of this podcast where Saladino's points are debunked.
Good luck :)
Sorry to hear that Diana, I wish you and your family the best. I have a similar family situation with my brother. Without going into too much detail we've never had a good sibling relationship with a one-sided competition on his side, and when I went vegan he went the opposite direction toward the low carb/"bro" science/Saladino types, and I'm worried for him. I think Alan's point about Saladino's personality is really key though, moreso than the evidence he's a charismatic narcissist and that's a big part of why people fall under his spell. Introducing your daughter to podcasts such as this one could be good, IF she's open to it, but I would be very careful not to come across as critical of Saladino because that could actually feed into the cult of personality. Try coming at it sideways--be open to info she gives you, but ask some thoughtful questions and give her space to explore on her own, and maybe introduce her to more of the psychology of narcissism and personality cults. Understanding how Saladino communicates is more important than what he actually says. Best of luck!!
:(that man is dangerous. I cannot believe he appeals to ppl. It saddens me and I have seen to many follow him blindly. Hopefully your daughter and her bf will watch this and use their critical minds to research instead of just follow Saladino 🙏
Honestly she will find her way when the tide of info changes and she is exposed to more and more info. I think people fall under these things because they’re seeking more info. As long as she’s still seeking more info for her health I’m optimistic that her and others will see the totality of evidence points in the opposite direction. It’s the folks whose feeling of “joining a contrarian’s club” is greater that stick around in those fringe communities.
Does your daughter like me describe (after moving from low fat to low carb) being at a healthy weight for the first time in decades, having higher HDL, lower triglycerides, healthy insulin response (A1c) normal blood pressure and, more subjectively, more energy than I have had since 30 years ago.
I have two brothers in law who both have severe heart problems.
most of those markers are in the problem zone. They both eat low fat high carb one has normal ldl the other is high so that does not seem to matter.
They are both overweight, lack energy and take statins after their heart attacks.
I think I will go with what is working.
Great episode. I can definitely relate. I was a huge low-carb adherent from 2000 to 2014. I'd actually come across Ornish and another low-fat vegan guy, Dr. Gabe Merkin back in the 90s but was never able to pull off their rather extreme approach to plant-based diets, at least in my 20's at that time. About the best I could accomplish was becoming pescatarian, which I did for 6 years. But then someone suggested I read Protein Power and that and it's sequal got me hooked on the low-carb narritive. I would say it is kind of an ideology, which is not that dissimilar to low-fat WFPB diets, but with the added emphasis of being able to eat the rich foods that the "diet scolds" tell you you shouldn't eat. Whereas the WFPB low-fat approach is kind of the opposite of that! Unfortunately back in the early 2000s there were not a lot of voices like Alan, Danny and Simon, let alone real social media for most of that decade, so I just had the echo chamber of fellow Protein Power dieters on the author's online forum to converse with.
It all ended quite badly. I ended up having to get a stent placed in 2014 (my LDL initially got as high as 250, but then leveled off to a "low" 155-190, lol), which finally snapped me out of my self-delusion that I was somehow removing my hereditary high risk of heart disease by avoiding fruit, grains, and beans.
Unfortunately, I ended up back in the same situation but with the low-fat vegan doctors - specifically Esselstyn - and unfortunately after 1.5 years strictly following his plan, ended up with an NSTEMI. I don't blame the diet itself, I blame my decision that doing the diet meant I didn't need to take statins and my LDL with that diet was generally under 80, which, according to Esselstyn made me "heart attack proof". Apparently the blockage that caused the heart attack was due to the initial stent not being placed all the way into the diagonal artery, and protruding into the LAD, this causing "turbulence" according to the doctor who did the second procedure (to stent the LAD after the NSTEMI) which then caused particles to build up around the piece of the stent that was poking out into the LAD.
It took me another 2.5 years of reading and watching/listening to saner voices in the plant-based world, like Simon, Dr. Carvalho, and Avi Bitterman, along with non-plant-based scientists like Alan, Danny, Nick Hiebert, etc. to realize that science is nuanced and most of the vegan doctors are highly biased.
After all of that, though, I still follow a low-fat plant-based diet, not because I think it's the only or best way to eat, but it works for me and I'm used to it. I lost huge amounts of weight on it and have maintained a 22-23 BMI for 5 years now. While this may not seem appealing to many, when you eat this way for a couple of years, your tastebuds adjust and it just becomes normal, so not a big deal to continue, and it does help a lot with weight maintenance.
Anyway, just wanted to relate my experiences around some of the topics you discussed - from someone whose done both ends of the spectrum, and not for short periods of time! Thanks again for the great episode!
Thank you for sharing your unbiassed experience.
They are highly biased because of good reasons
@@doddsalfa there's never a "good reason" for bias. You should always be open to new evidence and never attached so much to your favorite theory so as to ignore evidence to the contrary. I've had to face the fact that some people have a VERY different experience than I have eating the same way. We are not all identical clones, and while there my be a majority of people who will do well on a given diet, even when you look at studies that suggest a diet's benefit, there are plenty of outliers who do not do as well, or cannot follow the diet because it's not sustainable for them. If you rigidly adhere to a single ideology, whether that's around politics or diet, that's a recipe for tyranny and delusion.
@@dvdmon they said that probably about smoking decades ago
@@dvdmon according to dr.Esselstyn “coronary artery disease is a toothless paper tiger that need never exist “ so somewhere in time your experience makes you bias
51:00 He's right about speaking with conviction that Saladino does. It's crazy because you watch one of his videos that somehow went viral and there is not much substance in what he's saying (like saying that its used as engine lubricant, therefore bad), yet somehow it has this effect where it feels like he said something profound and so clear-cut. I also think part of the issue is that there is a breakdown in trust in all levels of society so it only takes a little bit of sophistry to convince the average person to distrust a narrative, whereas in past generations there was a pretty strong trust/bond between people. Lastly, there's the obvious effect where since certain foods appeal to people (like greasy meat), it is much easier to accept something that is in line with one's passions are drawing them to.
Another great episode Simon. Your podcast has been excellent and I’ve learned a lot. Would love to see these maybe 3-4 x per year with Alan & Danny as a regular check in.
Sounds good to me!
Another great episode. While living a whole food plant based diet, it is nice to hear how to help some of my friends refine their omnivore diets to better help with their health. Yes I’m the 60 year old nerd in my crowd
Excellent discussion and questions around cholesterol. It’s helped me understand so much more about the subject without all the noise we hear from other influencers.
Thank you!!
A great interview by specialists for specialists.
This is amazing, thankyou for bringing me the truth😉😂 But seriously, this is the best explanation of cholesterol structure and function I've ever heard, cheers!
As someone done Keto and great result reversing high HbA1C, but with high LDL, I am listening and will add back carbs based on Portfolio Diet. Thank you.
I love Alan's commentary! I'm only partway through this and I'll probably have to relisten because there's a lot here, but wonderful show.
Completely agree on putting out the correct evidence rather getting stuck in an interview with Saladino where they can rubbish the evidence and the messenger.
Carry on with what you’re doing because it’s fabulous.
wow..I've been reading/listening to podcasts/interviews for years (Attia/Dr. Patrick, Huberman etc) trying to get a handle on the whole cholesterol topic and this is by far the most easily understood, comprehensive info I have come across! I finally 'get' the whole HDL/LDL issue and how cholesterol actually works in the body (great analogies of the 'ship' with cargo/cranes off loading the 'ships', Simon!! Thanks for that!). Such a shame that in 20 years there will be a whole slew of people struggling with disease caused from following bad advice..and when that happens, people like Paul S should be charged with reckless endangerment .This is SUCH an important podcast..I'll be passing it along!
This was so very interesting, educational and informative. The only equivalent I came across on TH-cam was an interview Dr Gill Carvalho hosted with Cardioligist Philip Ovadia to hash out their differences re: importance of Apo B vs importance of total metabolic health. While the discussion was very cordial , sadly I doubt any minds were changed as a result. Many thanks for hosting this Simon and a super big thanks to your hosts, much appreciated!
Thank you Simon for another outstanding comprehensive podcast. As a retired internist with lipidology certification I found your ‘questions’ and the input of Alan and Daniel to be spot on yet educational for me as well.
The misinformation promulgated by those podcasters, who have agendas quite distinct from truly scientific education, is unfortunate and part of the pairing of false narratives with those who are drawn to it in a sort of co-dependency relationship.
I suspect that the ‘stupiding down’ that this represents (as the prolific phenomenon it represents) will be part of the reality of free speech for some time to come, unfortunately.
Excellent in depth, nuanced discussion! Thank you for the deep dive into the research.
Please share with everyone you know, such great information for people to hear
Having watched saladino’s ‘debate’ with dr alo you predicted almost word for word how it would go 😂
Great episode. This presented the clearest understanding of the issues around LDL that I’ve seen Verry helpful to the average eater.
Fantastic episode, possibly my favorite one to date. We observe at my (very cardiac-focused) hospital that the old paradigm of “you want your HDL:LDL ratio to be 1:2 and you’ll be fine” essentially goes out the window even when the LDL creeps up over 100-120ish (purely observational). This gives credence to that blossoming opinion.
Have you ever done an episode on natto/nattokinase supplementation? It would potentially piggyback onto this discussion if there is adequate information to pore over … I’m finding SOME, but not a ton yet, in my general internet travels.
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I believe the whole arteries vs veins issue, relative to atherosclerosis, is due to the fact that arteries are a high-pressure vascular environment, whereas veins are low-pressure. When veins are used for grafting in bypass surgeries, they too can develop atherosclerosis.
I wonder if shear force in arteries could be a factor, especially when endothelial dysfunction is at play
I would recommend for anyone interested to watch Professor Bart Kays video on atherosclerosis. He gives a clear mechanistic explanation on how atherosclerosis develops in arteries. Hint: it has nothing to do with LDL particle count or ApoB gene.
@@healthcoachjoff ye... I'm fine thanks. As you said: mechanistic. Science mechanicism is the behavior that leads dishonest folks like Saladino to claim stupid stuff like the ones exposed during this podcast
@@TenTempeh yep each to their own. But let me ask you this, can you refute the fact that there are no scientific experiments in humans that can inform cause and effect of cholesterol/LDL/saturated fat intake on cardiovascular disease? If not, then what science can you justify your reasoning?
@@healthcoachjoff i have some science for that matter yes. Studies relating saturated fat intake with dementia/Alzheimer, with metabolic diseases, with cardiovascular events...
Dude, this video you are commenting on provides many studies on that topic... Lmao
Love your podcast Simon! Thanks for all of the info you provide. I was hoping you could do a podcast on those of us stuck in the middle on heart disease prevention. My husband and I are both WFPB, lowish fat, no sugar, lowish salt, low oil (just a little olive oil), low saturated fat. Our cholesterol has decreased by a lot. Mine from 200 down to 160 (my husband even more), but my LDL still hovers in the 90s, not really changing much from before I went WFPB. ApoB is 83. So my LDL and ApoB are not in the nice range that everyone recommends (below 70 for LDL, below 80 maybe for ApoB?). I'm too low to be prescribed statins, but too high to be considered really low risk. What do people like myself do? Would love some recommendations. It seems that some of us just make more cholesterol than others. But this likely puts us at higher risk. I've tried ideas from the portfolio diet, still no change to LDL.
Below 50 apob for adults they say. You could try like 2.5mg of cresto weekly instead of normal 20mg.
Whew, this was a marathon of goodness. I've got so many responses but first let me say "thank you". This past summer I had a MINOCA heart attack, meaning it was not caused by an obstruction. It has thrown me for quite a loop and I've been exploring the Portfolio diet. As a lifelong vegetarian, who embraced an unrefined vegan lifestyle 20 years ago, it's been an easy transition and I'm looking forward to seeing if it's supportive to my health. I was hoping your guests were going to talk a bit about that particular diet as well as MINOCA events. Maybe I missed it and I'm going to go back into your podcast to listen to some sections again. As an aside, for many years I followed the dietary protocals of Drs Ornish and Esselstyn... actually the day before my heart attack I had borrowed the book Prevent and Reverse Heart Disease from my local library. I don't think a low-fat vegan diet caused my heart attack it's just a coincidence that I find amusing. Again, many thanks for your podcast. I'm a new listener and subscriber.
Can you share what a day of eating was like for you before you had your heart attack? I have high Lp(a) and went plant-based once I found out in hopes that it will lower my chances of having a heart attack but reading your comment has me stressed again lol
How has Portfolio diet helped you? Restored cholesterol? Interested as starting that now after having high LDL from Keto
Interesting you don’t think it was caused by diet.
Excellence on TH-cam…. We need more. Thank you.
Great video. Listen to it from start to finish.
At the end, you denounced Esselstyn diet. That surprised me because right through the 2 hours long discussion, you are encouraging very low fat diet.
Please explain this to me as I am on this diet.
Many thanks
I feel the emphasis wasn't on a low fat diet across the board, more of a low saturated fat diet. Polyunsaturated fats and monounsaturated fats are beneficial to cardiovascular health. I think some of the criticism of Esselstyns paper is that is less of a study and more of a case study presentation. It doesn't give the same degree of clarity that a well designed study might.
@@TheProofWithSimonHill Absolutely, so many types of diet can be healthy if we pay attention to some of the finer details like saturated fat to polyunsaturated fat ratios, fibre etc. And if a low fat diet that is vegan gets you there, that's great. If a higher fat diet with low saturated fat does it, that's great too, omnivore or vegan. Ideology is such a roadblock at times, whether it comes from the hard-core carnivore or the die hard vegan side. I really appreciated the objective conversation on this podcast.
@@TheProofWithSimonHill Great episode! Look forward to the "are low fat vegan diets best for CVD?" Please focus on PUFAs vs Whole plant foods (Dr Esselstyn's recommendations) also rather than just PUFAs vs Saturated fats or refined carb (which is not Dr esselstyn's recommendations)
Hi Simon,
Firstly I want to thank you for the amazing amount of time and effort you put into your work. More importantly, though, I love your grace and genuine interest in finding goodness. I have a couple of comments about different aspects of this episode and I've split them up so you can ignore the ones you aren't interested in.
Firstly, about PCSK9 inhibitors. I might have missed something, but if the amount of cholesterol we need in cells is low but PCSK9 inhibitors up-regulate LDL receptors to jam more cholesterol into cells isn't that likely to cause problems inside the cell where the extra cholesterol isn't needed? Or, if it works exclusively on hepatocytes, and the receptors are in the liver, why would the liver produce LDL to remove it again?
Next, high cholesterol is described as a population disorder that requires drugs. Primates and traditional hunter-gatherer populations all appear to have normal cholesterol levels and low levels of atherosclerosis. What is it about our western populations that causes high cholesterol? Suppose it's something we're eating or not eating, doing or not doing, experiencing or not experiencing. Why do we need to contemplate gene therapy on children to rectify it or drugs as the only option in vast hordes of people? I realise this is not particularly scientific, but it doesn't pass my sniff test.
Thirdly, while I have enormous admiration for your approach, some of the comments of your guests in this episode were playing the man and not the ball. Characterising anyone even asking questions about the topic as narcissistic fame-grabbers was disappointing. There's absolutely no reason why people like Dave Feldman can't be genuinely interested in progressing their understanding of the topic. If you flip it around and look at someone like Dr Flannagan who's a popular, informed and valuable commentator you could equally say he's just in it for the clicks because he's popular. By the way, I'm very grateful to all your guests for their time and knowledge.
My issue with all this, and the reason I like your approach so much, is that as soon as the mud-slinging starts, the learning stops. People can be genuine, rational, and intelligent and still be wrong partially or wholly. Of course, there is a huge range from people who are just a little misguided to people who latch onto demonstrably nonsensical stuff, like flat Earth and we have to navigate that, but most people are not flat-Earthers.
There is a fabulous chap by the name of David MacRaney who has spent a huge amount of time and effort trying to understand this kind of thing. He's like a version of you who focuses on why we think the way we do and how to change our minds. His podcast, You are not so Smart youarenotsosmart.com/podcast/, is great. He also has a couple of books, the latest being How Minds Change www.davidmcraney.com/howmindschangehome.
Thanks for everything and I hope this comment isn't too long and sorry it's late. I listen to podcasts on the way too and from work at 2x speed to try to get through them, but I'm still about 5 months behind :)
Thank you! Your questions and comments are valid and important! I appreciate you and agree.
Some of this podcast stank of propaganda. But I held my nose and listened anyway, in hopes of gleaning some honest useful info.❤
Very interesting when revisiting pathophysiology, always great to go back to basics. The slow pace of speech really worked for me, and the clean graphics so helpful, thank you! I'm trying to clarify.. if the HDL compounds are so dense in proteins that they have no capacity to carry TG, then how would they be able to "collect" lipids in their role as reverse transport lipoproteins?
I loved the graphics in this as well!!
Great episode. Alan & Danny are the best in the business.
this is the absolute best channel addressing nutrition. nutrition made simple coming in second.
seams to me that the crux of the cholesterol denialists arguments is that ldl\apo b particles have to be oxidized to initiate the formation of arterial plaque. therefore, if one avoids consuming seed oils and the dreaded pro inflammatory refined carbs, you cant eat red meat, butter and cheese without risk of damaging ones arteries. a whole episode tackling that specific claim that oil and carbs are the root cause of heart disease or the dismissal of the heart health hypothesis would be important. maybe i just missed it
they actually did,lol
Very informative. I have found Doctors are very reluctant to test APOB. It was explained to me as unecessary unless I was in high risk category even though I have a weight issue.
Just realized ; through your podcast, you are on TH-cam ! Stoked
Tyvvm 😊
Compelling video, thanks. Saving it to one of my favorites folders.
Nailed it on Paul Saladino...
A truly great episode thank you. ❤
Where did the idea of the HDL/ LDL ratio come from?
My back of the envelope calculation is that adding an ounce of nuts / seeds to each of 3 meals would take a McDougall / China Study type diet to something more like 25% at 2000 Cal, or 20% at 2500 Cal.
I suppose my big question is the same as it was 10 years ago. All plants, or a small amount of animal based foods. I am not considering other approaches.
What approach do you effectively apply?
I really enjoyed this marathon conversation. I will point out your discussion of healthy fats (olives, nuts, seeds, oils) and heart disease omitted the high calorie density of these foods. For many people struggling with obesity related hypertension or metabolic disease, following a diet of very low fat high complex carbohydrate foods low in calorie density is the easiest, tastiest and most efficacious way to lose weight.
Thanks for sharing your knowledge. 🙏🏼
I've recently been pulled out of carnivore circle. My apob is 93 when I was 135 ldl. I'm 117 ldl currently but not sure apob haven't checked, I'm 50 trigs and 63 hdl. Crp 0.46, lp(a) 32.3 nmol. I've been trying to remodify my diet, I just found this channel but I got snapped out of it by a channel called nutrition made simple.
we watched the whole episode. very brilliant. one thing i would say concerns refined oils. we've been omitting it in favour of whole nuts and seeds (wfpb) as we have found they lead to weight gain pretty easily and they are an opportunity cost to get a whole fat source. i guess it depends on age, activity level, propensity to gain weight etc. but this hack we found helped drop weight and the food is actually better tasting as whole seeds and nuts taste better. for us this was a super useful hack. anyhow, great episode!
In ship, container and anchor analogy, what's Lp(a) in all this please? Extra flag/anchor or different ship altogether?
Edit: After listening to the Sigma Nutrition podcast I’ve realized these guys are doing a great service to the public by bringing us the truth of nutrition science amidst all the bluster and pseudoscience of the more vociferous influencers. Thank Simon, Danny and Alan for opening my eyes. Alan does seem a bit grumpy though.
Thank you for another smart conversation on an important topic 👏🏼. I'm so glad I heard about you on Rich Roll's podcast, I'm really enjoying yours now too. Keep it up, we need these kinds of clarification and debunking 🙏🏽.
I once had a doctor tell me my HDL was 200 and the highest of anyone he'd ever seen. I asked what that meant and he said he didn't know but my other numbers were great so it wasn't anything bad, but it seemed so odd I've always wondered. I've asked a few people and no one knows, any idea why HDL might be so high?
@@TheProofWithSimonHill I have retested after that but was never told that again. I haven't retested since I've been more into health education over the past few years because cholesterol has never been a concern for me but that always stuck with me. I might request one soon just to get a new baseline.
Listened to this as a novice, is the measurement of LDL in a B/T a snapshot, or does it stretch over say a 6 month period more like an Hba1c ? Also how does menopause affect LDL cholesterol levels and does HRT’s protective cardiovascular benefits affect LDL cholesterol in a positive way?
Thank you all, this was a very balanced discussion. I do agree that Dr. P. Saladino's Opinion on plants is so skewed, couldn't say anything good about many plants or berries that are known to have high antioxidants, however I believe the Keto diet is different from Carnivore diet as described in the book of P. S, I agree Carnivore could be Mediterranean with low carb and smart selection of plants with antioxidants and polyphenols. I agree with so much evidence against "saturated fats", it is best be smart about choice of fat in "balanced for age protein, sensible fat and low glycemic carbs" diet. However, I still sense an industry bias when docs highly recommend "statins or all meds that lowers elements of lipids", while the majority of people , even those "Leanmass Hyepr-responders" if they just eat a little more sensibly with low glycemic, high fiber carbs and have a smarter choice of fat than saturated fats from red meat, can lower their Cholesterol. LDL, etc.
I highly respect Dr. T. S, and fascinated by his knowledge and experience but isn't if fair to ask him the question on those 3 podcast this year, "what are your disclosures when it comes to Pharma and lipid lowering agents? Simon can you please ask him this question. Also some the agents Dr. T.D explained were developed over the years and some failed, like bile acid sequestrants or Cholesterol absorption blocking agent that works great Ezetimibe, does it really doing the job of fiber? has it been compared to dietary fibers to see if is superior. Another factor raises suspicion is the comment "on life long exposure to high LDL and need for ? lifelong tx with antilipids thus? While all these experts say "measure Apo B particles", one needs to do a retro studies of how many were started on Statins or other antilipid agents without measuring or even monitoring for ApoB? How many were offered dietary changes to more favorable diet high fiber low glycemic carbs and moderate protein and Pufa and Mufa fats first to see if they ever needed statins or the like meds ? I see bias on all sides of the arguments. while these docs talk about "life time exposure to high APOB/high LDL", has there been studies that actually monitor these specific elements apoB for example in those who receive tx for first 5 years and then stop and keep their levels down with diet lets say for 5 more years vs a different group who took the drugs for 10 years and look at the adverse events [ like heart attacks or stroke ]instead of the levels of LDL or ApoB. I do agree with the panel and excellent presentation and clear explanations.
Wow so definative good job folks
I didn't eat meat for 12 months my LDL dropped by 22% but my HDL also dropped by 12% trying to figure out why?. I fell in love with sweet potatoes and beans during this time. good conversation
@@TheProofWithSimonHill Funny you say that, That was my instinct
Just at the beginning b it wouldn’t increased exercise help boost her HDL - whilst maintaining her diet and lower LDL?
Simon, I greatly appreciate the work you are doing and I'm really enjoying your channel. No matter how many years go by and no matter how many studies into coronary artery disease, cancer, stroke, high blood pressure (the list goes on) the message from the results of these studies point us to the same diet every time: eat more plants, eat less meat (or better still none at all), ditch dairy (or reduce it to almost zero), ditch eggs, avoid seed oils, reduce your salt intake. Look at us humans. look at our teeth, the dexterity of our hands, our gut structure, the way our gut microbes influence our whole body and how our gut microbiome works best when we eat fibre (which you can't get from meat, dairy and eggs). our teeth are perfect for eating plants, our hands are perfect for gathering 'fruits and roots', our stomach and intestines are perfect for breaking down plants and absorbing plant nutrients. we need to accept who we are as humans....we are fruit and veg eating primates. We're not cats.
Exactly my thoughts too
Great interview but sometimes difficult to follow because of so many terms that unless you are an expert on the subject you can loose track of your questions
Excellent interview
Still curious about the claim that any oil destroys endothelium cells, as Dr. Esselstyn has claimed.
Simon, have you gotten any cogent responses to this question from any of the people you have interviewed?
Love how your show and the people you have on explains things in depth. I believe it is necessary to hear the science in order for many of us to escape the brain washing many doctors and scientists have passed off to us. I can't believe the irresponsibility of the quacks out there. Hopefully, I can undo any damage these doctors have helped me perpetrate upon myself.
😢how can we find the truth,from the un correct being sold us or old ideas that we now know aren't right not being passed on when health profession know but won't pass it on because of cost or coruption of knowledge to keep jobs or profits ,,
@@lynlawley8903 I really trust Simon...watch the older episodes... I'll eat animal fats, but I eat a lot of seeds in those days
Thank you for this informative video. I've been following a largely whole food plant based diet for a few years but have come to see a little overzealousness if not bias with some of its proponents. I try to synthesize information so I figure an occasional piece of salmon or a teaspoon or so of olive oil is probably not going to be as detrimental as some of the plant based docs lead us to believe. I also have come to see that diet and exercise alone may not be the answer, particularly if you've inherited some nasty genes or are getting a later start with lifestyle improvements. This said, if I had to adhere to one strict dietary approach, a whole food plant based diet which includes copious amounts of vegetables and legumes as well as a reasonable amount of nuts and seeds appears to be a good choice, for heart health and beyond.
I was Keto, LDL of >250 for over 5y, got a scan expecting all to be good. It wasn’t. What you described about the Keto community is correct, but it’s correct of any community. The question is not, is high LDL bad, the question is, is high LDL bad for me. Get a cheap scan please.
If high CRP or insulin resistance accelerates the irrefutable effect of high apoB, could low levels decelerate it? I wish they would think of this as additive versus multiplicative effects to help explain and make a case.
1:35:00
As a chemical engineer it seems obvious:
Arteries = high pressure and plasma velocity
Veins = low pressure and plasma velocity
All things being equal artery walls should be penerated by plasma to a greater degree than vein walls.
So, what oils do we eat?
I don't appreciate Flanagan saying the other guy is stupid and narcissistic. He constantly uses divisive terms. He should be a politician
Is it true that higher thyroid hormone can lead to high cholesterol? I've recently been able to reduce cholesterol levels by reducing animal product consumption and introducing plant sterols. However, reviewed last three blood tests and noticed high thyroid hormone. Booked in for specific hormone test shortly. Thanks
Paul saladino is probably not a candidate to offset the lipid hypothesis, and thus an easy target to shoot down,
Being metabolic healthy is a good argument what is actually meant by that but it would not be low statin level
In 1990, Dr. Dean Ornish conducted a study titled "Can lifestyle changes reverse coronary heart disease?" and submitted it to The Lancet, a prestigious and long-standing peer-reviewed general medical journal. The study revealed that adopting a plant-based diet could effectively reverse heart disease. The Lancet is recognized as one of the world's oldest and most esteemed general medical journals. Notably, the beef, pork, and poultry industries, worth billions of dollars, have never sponsored research indicating that their products can reverse or impede the progression of heart disease. Such industries would be negatively affected if a study funded by them revealed that their products contribute to heart disease. While these industries possess abundant financial resources, their reluctance to support such studies stems from their doubt regarding the safety of their products. Until scientific evidence emerges to demonstrate that an animal-based diet can reverse heart disease, there remains no basis for debate.
Blazers sweatshirt is fire!
I’m all for lowering ldl. But has anyone substantiated claims that statins contribute to getting ALS?
I was not very impressed with some "arguments" here. First of all to spend so much attention on personal disliking of Dr. Saladino and talking about his narcissism certainly can not contribute to rigorous scientific discussion. If you want to criticize him, focus on scientific studies. Another thing I did not like was the general talking about so called scientific consensus. Wasn't the "scientific consensus" about low fat high carb (food pyramid) completely wrong?
The other thing is the obsession with LDL cholesterol. They agree that the main culprit are actually APO-B related small LDL particles, but they still are pushing for lowering LDL just based on the whole LDL marker and even recommend taking statins as soon as possible to allegedly prevent a heart disease. That is wrong approach, which ignores serious side effects of statins. The ideal case if LDL is high would be to measure APO-B, which is unfortunately very often not feasible for various reasons (cost is one of them). Then there is a possibility to test CAC score. If that is not possible either and all other markers (HDL, Trigs, CRP) are really good so the likelihood that elevated LDL is a problem is quite low, in that case just to be really on the save side you might consider a change of diet. I was personally able to lower my LDL switching from butter to olive oil by 50% in several months. And on the top of it I was even eating lots of coconut oil. So I doubt that all saturated fat is an equal "evil" when it comes to LDL as these guys are trying to suggest. There is a study Dr. P. Mason mentioned in one of his videos, where they tested coconut oil and butter and they found huge differences in LDL levels when consuming coconut oil vs. butter. Butter was in orders of magnitude worse and that questions the whole premise about all saturated fats being so bad. Actually I do not think that even butter is bad if all other markers are really good.
I would try first everything possible to avoid statins. That would be the last thing I would consider if nothing else worked. To rely that an invented drug is harmless and should be taken for many years or even for the rest of our lives sounds really crazy to me. And unfortunately that is the first thing almost every doctor suggests once he sees high LDL cholesterol. I had to convince my doctor to try to change my diet first and it worked fine. But had I just listened to him I would have been on statins already for years.
@@TheProofWithSimonHill Doesn't it matter on the percentage of ApoB particles within all LDL particles? The fact that 80% of people have ApoB doesn't automatically mean that all of them have higher risk of heart disease. Many of them have low level of ApoB and putting them on statins just as a precaution can cause worse health risks.
LDL could be reasonable surrogate marker if we knew that the level of ApoB can be reliably predicted and derived from the LDL marker even without directly measuring it and I do not think it is the case.
BTW, Dr. P. Mason showed in one of his videos a chart from one study where it was clear that large (healthy) LDL particles are corelated with low triglycerides.
th-cam.com/video/rdgS3PuSuyg/w-d-xo.html
I wonder if he watched the Mason video?
My question is, are you all on statins or p9 inhibitors?
I really enjoy listening to your videos and in general the great work you do. It would be however great to see more women-related content or even seeing more women as guests on your channel. Sometimes it feels that the target group you are trying to reach are men only.
@@TheProofWithSimonHill that sounds wonderful! Looking forward to that, thanks!
@@TheProofWithSimonHill Brenda Davis RD might be someone to consider if you want more women on the show.
Great videos, I watch them all...poor Danny got about 7 minutes of talk time in a 2+ hr episode. :/
good content, and Go Blazers
triglyceride >150 vs ldl >100, which is a more imminent threat?
From the interview it sounded like LDL is the primary risk factor that, so getting that down would be the first goal, but that doesn't mean you can't try to do both.
@@dvdmon thanks for clarifying. it did sound that way. I suspect the focus on LDL is premature. Some studies (e.g., Weng et al, PLos ONE 2017) indicated that both triglyceride and HDL ranked higher than LDL on the impact on CVD risk.
@@kennethyuman1940 sorry, having a hart time finding your reference when searching 'Weng et al, PLos ONE 2017'
No, the video clearly states ApoB as the superior CVD risk marker. It is the only causal one. Trigs and HDL are risk modifiers only, they are minor and non-causal players in the context of high ApoB.
@@robertusga I went back to listen 14:00-17:00. It sounds like, but not clear, that not every LDL particle carries apoB. Also not clear is if lowering LDL with statins also lowers apoB.
Oopps, I’m so sorry that this video doesn’t have english subtitles. I’m good at reading but not at listening, since I’m not a native speaker 😢
The subtitles come always around 2,3 days later
I see them
went full Carnivore for 3 weeks as an elimination diet after being miserable eating mainly vegan for months. My labs were normal, but I was taking a statin.
I stopped all sugars, alcohol, and processed foods and I slowly added back and removed various other foods to see how my body reacted. I consider myself a ketovore now, 12 weeks into the diet. I love veggies, but I really loved how my body responded to carnivore. I lost 25 lbs and 3" off my waist in 3 months, had a ton more energy, had improved skin with no new skin tags...I could go on and on and on and on about everything I loved about carnivore. I started adding back other foods mainly because I was only going to the bathroon 1-3 times each week, and I figure that isn't really so good for me with a family history of colon issues. But, if I could stay on carnivore forever, I wouldn't mind at all.
As far as the carnivore community and influencers go, hearing people attack the messenger and not the message and makes me not want to listen to anything these guest speakers are saying. If you want to convince me to not eat saturated fat, the last thing you want to do is to tell me that those who tell me to eat it are narcissists. It makes me want to tell you to look in a mirror.
If you are concerned about a loved one who is eating carnivore, I would say, don't be. Let them eat however they want. You do realize that carnivore eliminates processed foods, sugars, and alcohol, right? I would bet money they are starting to work out. Carnivore also reverses insulin resistance and eliminates seizures. Those things alone will significantly improve their health. So, they take a few years off of their lives with saturated fats and add years back on for all of the new healthy living aspects of the diet they now have. I'd say it is a great trade off, especially if they are happier in theur skin....oh, it pretty much eliminates depression and anxiety too...yep, it sure does.
So, no, we are not just blindly following a "cult of personalities" on the internet. We are actually feeling better than we have in decades and most of us actually tried plant based and were miserable on those diets.
So, let us experiment with our diets without giving us grief. If you want to see who lives longer on different diets, do studies that compare true carnivores to other groups, not people who have a higher fat American diet. True carnivores are actually health minded exercising folks who eat 1-3 meals each day with no sugars, processed foods, or alcohol. I will wait for those study results. In the meantime, I will continue to eat ketovore and be happy not feeling miserable as I did on the S.A.D. and vegan diets.
I think focusing on Saladino as your primary focus related to this conversation is the major error to begin with. This dude promotes eating 200+ grams of carbs via fruit per day as if that level of fructose and its impact in the body isn’t clearly known. This is a major problem before even having the cholesterol and ldl debate. You should engage with folks like Dr. Anthony Chaffee for instance amongst many other before wrapping the “community” around Saladino. 🤷🏻♂️👍
Mediterranean keto is a good option for diabetics & people who want to lose weight. Just about everyone will benefit from getting rid of the bad processed foods/ carbs with unhealthy fats ie pastries, pies, pizza etc. I eat meat, chicken liver, pulses, lentils, barley, tofu & fish, I eat dairy ( yoghurt, kefir, cheese & full fat milk) coconut & olive oil so far my lipids are in the healthy range at age 60. I want to keep eating a very diet that I enjoy.
I do worry about the chemicals that put on the vegetables ( roundup ) organic is nearly double the price with a lot of food items in the UK.
This is what where is me sprayed on fruits and vegetables
Glyphosate (N-(phosphonomethyl)glycine
I would appreciate a conversation on this channel on this subject
Is omega 3 polyunsaturated toxicity real? Someone said yellow fat disease is caused by n3 fats.
Nope!
Don't most cardiologists die or heart disease?
Algo
This guy's too smug for my taste. He may have something good to say but His attitude completely turns me off. His attitude of I'm right and you're wrong and then laughing about it doesn't win over converts in the middle. I cannot eat 150 to 200 g of carbohydrates every day and keep my blood sugar in check.
He said nothing to cause someone to consider what he's talking about as being valid.
I'm just a regular guy not a learned scholar. His message may be good but his approach is terrible. I'm sure he's not talking to me. I'm done!!
I'm for the apoB theory. But these guests are being childish. So they will have the debate but only if the other side will change their mind?😂
Disappointed by this episode. I came expecting scientific references and an in-depth explanation of the mechanisms at work. Instead I heard ad hominem attacks on those presenting conflicting arguments without any attempt to engage with the arguments themselves (indeed a desire to avoid such conversations!), a labelling of others touting « scientific truth » as narcissists (while doing the same themselves?), and several pertinent questions where the response amounted to simply affirming the reverse without substantiating the claim made. The arrogance of the whole discussion is quite overwhelming. I much prefer to listen to scientists willing to question *themselves* and discuss the limits of the scientific studies they appeal to.
There were dozens, if not more, references provided throughout the podcast. Maybe you were listening via audio only?
@@TheProofWithSimonHill
A comment is not really the space for this...
- Why not highlight the fact that LDL and CVD are very tightly *correlated* but that strict *causality* has not been shown? (The source in the show notes only shows multiple qualities of correlation, but no causative mechanism...)
- Given the limits of our knowledge in this area, your treatment of the LMHR phenotype is dismissive at best. What's interesting about this phenotype is not the personality of Dave Feldman(?!), but the fact that these individuals can present with LDL levels previously only ever seen in cases of FH, while simultaneously having excellent HDL and triglyceride levels. We don't understand why. Seems worth studying to me.
- More evidence that we don't understand everything in this field: the hypercholesterolemia "paradox" where "a history of hypercholesterolemia was associated with a reduced rather than elevated hazard ratio for [all-cause mortality]" (www.sciencedirect.com/science/article/abs/pii/S0033062022001062?via%3Dihub)
- Why no mention of the U-curve found between total cholesterol levels and *all-cause mortality* with the sweet spot being around 200-240mg/dL and higher levels being strictly more protective than lower levels (see pubmed.ncbi.nlm.nih.gov/30733566/)?
- No mention either of higher levels of cholesterol being more protective in old age >80 (e.g. pubmed.ncbi.nlm.nih.gov/25602855/)?
Unsubstantiated:
- Asked about whether LDL could cause plaque without prior damage to the endothelium, the interviewees affirm LDL is sufficient alone without supporting evidence.
- Interviewees suggest reducing saturated fat and increasing PUFAs to reduce your CVD risk, but "Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes." (pubmed.ncbi.nlm.nih.gov/27071971/)
- Suggestion that cholesterol supports immune function (and Covid in-patients typically have low cholesterol levels) countered with the affirmation that cholesterol levels fall when an individual is sick... again, nothing in the show notes to support this.
- Interviewees suggest very low levels of cholesterol (down to 30mg/dL) perfectly healthy, though recent study found "a significant association between lower LDL-C and higher risk of [stroke] when LDL-C was
I was listening and switched to You Tube for comments and cites because he noted it at the very beginning of the episode.
Love 😮
how you put up the study highlights!!!🥹💚 thank you for the thoroughness Simon!
You can be responsible and reasonable about carbohydrate intake. Check out @dietdoctor #dietdoctor podcast
Are you talking about cakes and candy?
@@doddsalfa I never mentioned or inferred cakes or candy
@@jwjarv1s but what then?