Blog - The Eating Academy | Peter Attia, M.D.

How did we come to believe saturated fat and cholesterol are bad for us?

How did we come to believe saturated fat and cholesterol are bad for us?
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There aren’t too many topics that really get me riled up anymore.  I’m too old and too busy to care about debating the merits of stem cell research, the legalization of marijuana, or Proposition 8.  Sure, I have strong opinions on all of these topics and more, but they are just that – opinions.  Furthermore, there are enough other people out there, some reasonable, most irrational, already fighting those fights.  So what does get me riled up?  Every time I hear someone “assert” that saturated fat and dietary cholesterol lead to heart disease I have to bite my tongue.  Why do I bite my tongue?

As Frederic Bastiat once said,

“We must admit that our opponents in this argument have a marked advantage over us.  They need only a few words to set forth a half-truth; whereas, in order to show that it is a half-truth, we have to resort to long and arid dissertations.”

This is, unfortunately, quite true.  When I’m at a dinner party and someone starts lecturing the table about the perils of saturated fat (or red meat, or eggs, or fill-in-the-blank), I’m at the point – after years of being kicked under the table by my wife – of just asking the “authority” at the table one question:  Why do you believe this is true?

I figure, put the burden of proof on them, right?  This week, and I apologize for how long overdue this post is, I’m going to get into the details of  how this country (and many others who followed our lead) came to believe one of the most pervasive myths in the entire field of nutrition.

To write it all out would require a tome.  In fact, such a tome already exists.  It’s called Good Calories, Bad Calories. But for most people, especially the “authorities” who already “know” the answer, it’s a complex and lengthy book.  Furthermore, it’s not exactly something you can just whip out at a dinner party.

A few weeks ago I gave a talk at the UCSD medical school.  I was asked to give a talk about “ethics.”  While I have no professional training as an ethicist, I still think I have a good idea about what is and is not ethical.  As I’ve learned more and more about this topic, it appears to me that the state of our current nutritional environment, with food policies based on just about everything but rigorous, experimental science, couldn’t make much ethical sense.  I’m pretty sure if Plato, Aristotle, and Nietzsche were still around they’d be disgusted with how we got here.  So, I was happy to take this opportunity to speak with a group of thought leaders on this important topic.

Below is a video combining the audio of my talk with my slide presentation.  It’s about an hour long. But as Bastiat essentially said, if you want to overturn half-truths, you can’t do it with bumper stickers. Hopefully you’ll find this talk informative and useful for your dinner party discussions.

Dr. Peter Attia: The limits of scientific evidence and the ethics of dietary guidelines — 60 years of ambiguity from Peter Attia on Vimeo.

The link to this video can also be found here, for those reading this post on email or those wishing to view it in a larger format.

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About the Author:

Peter Attia, M.D., is the co-founder and President of the Nutrition Science Initiative (NuSI), a non-profit based in San Diego, CA. He received his B.Sc. from Queen's University in Canada and his M.D. from Stanford Medical School in California. After his surgical residency in general surgery at Johns Hopkins he worked as a consultant at McKinsey & Company. He founded NuSI with scientific journalist Gary Taubes in 2012.

Discussion

  1. Mike H  July 17, 2012

    Quick question—does your talk still make sense without the slides? I ask because I might listen while walking when I can’t watch a screen.

    I think the saturated fat thing illustrates how most people form their opinions, or at least “learn truths”. They hear a piece of information enough times, assume those repeating it have done their due diligence, and therefore it must be right by its third or fourth airing.

    (reply)
    • Peter Attia  July 17, 2012

      Probably…but then you’ll be stuck focusing on my voice instead of the cool slides.

    • Joshua Wardrop  August 14, 2012

      “They hear a piece of information enough times, assume those repeating it have done their due diligence, and therefore it must be right”

      More regrettably, they falsely respect their government, media and educational institutions to publish correct findings. Once those findings have been misrepresented, even doing your “due diligence” leads you to very official (and seemingly credible) sources repeating the false conclusion. So it often isn’t possible for a layman to find the truth.

  2. jw  July 17, 2012

    Bastiat quotes on a LCHF site?

    It just doesn’t get better than this…

    (reply)
    • Peter Attia  July 17, 2012

      So glad I can teach AND entertain!

  3. Jacob  July 17, 2012

    I’ve had a different experience, too–sometimes, once the conversation has gone on for more than a few minutes, the person (or people) involved say something to the effect of “yeah, I know, it really IS carbs,” often even followed up with “really the only way I’ve ever lost weight is by cutting carbs.” This has happened to me enough times that I think there are a lot of people who, deep down, “get” this–but it’s suppressed by all the flap about saturated fats that we hear daily.

    (reply)
    • Peter Attia  July 17, 2012

      In my experience these are 2 very different conversions. The “carbs-makes-most-people-fat” discussion is a much easier one to have than “there-is-no-good-evidence-saturated-fat-makes-you-fat-or-causes-heart-disease” one.

    • Jacob  July 17, 2012

      That’s a fair point. It’s probably not a good thing, but in my (and my friends’) age group (25-35), the latter doesn’t come up in everyday conversation much. I can usually allay any concerns that do come up by pointing people to your blog. (As you’ve said, don’t be afraid to outsource to the qualified!)

    • Ash Simmonds  July 18, 2012

      I hate it when the carbs this carbs that discussion comes up, it’s all a bunch of wank and in the end people go “ooh he’s on a low carb diet”. Well that’s not how I look at it, I also don’t eat glass or Nokia phones, so does that mean I’m on a low-glass/low-Nokia diet? No. I simply eat lots of fatty red meat, and the occasional veggie.

      So yeah, unless someone bugs me about the metabolic stuff, I opt out of the carb conversations, however I do try to ask how/why someone thinks fat/meat is bad – and just like the reports in the media, I’ve never once heard an even slightly rational answer.

      Wven my GF doesn’t know I’m “actively LC/HF/ketogenic”, she just sees me eating a lot of steak and when she cuts the fat/skin off her meat/chicken/fish I yoink it and devour it, which now and then leads to light-hearted discussions of “unhealthy fat” and stuff, but she’s quite open to my (mostly throwaway) observations on the subject. Then last night she actually ate the skin from her fish, I – with pouty face at missing out – asked her if it was any good, she was like “yeah delicious, and I figure it’s probably good for me”. So… win?

    • mhikl  February 11, 2013

      You are so right, Jacob. I followed Atkins but ate too much protein and too much so didn’t lose as fast as I should have, but I did succeed. I also new in my heart that carbs were dangerous but did Ornish (spit) four months in 1999 and gained 40lbs (didn’t over eat either; I’m a determined person, but in my defence, the bugger claimed such would happen and then would fall off)- fat intake was below 10%- hard to do better as even an apple has some fat in it. Tri’s went from boarder line to dangerous; Cholesterol the same. My MD handed me a bag of bad and a prescription, both of which joined burger rappers on my way to the car. Returned to the arms of Atkins, a saint, and lost it again. Still had my doubts until I saw the movie “First Do No Harm” on a ketogenic diet staring another saint, Meryl Streep. Bless her heart to do a TV movie she must have believed in.
      The media and M.D.’s (Good Peter an exception) are powerful agents of evil.

  4. Dana Law  July 17, 2012

    Dr. Attia,
    I appreciate your thoughtful essay. This is a difficult subject. We want people to throw away their old fears in a convincing simple way.
    I subscribe to Dr. Conversation. A blog about ,well, better conversation. Recently he mentioned this very subject.
    Not boring people with information but getting the gist across and planting a seed for more.
    In my case I’m hiking the entire Pacific Crest Trail over many years in sections. I’ve bored a lot of people over the last nine years with my adventure. Confused most of them. Finally I’ve come up with an elevator pitch. “I’m walking to Canada. I’ve gone all the way to southern Oregon.”
    This of course isn’t as difficult as saying “Everything you’ve heard about nutrition is wrong” but it’s a start.
    You’ve picked a challenging subject for your life. Well worth it. I’m excited to be receiving your blog.
    I’m thrilled to hear you’re in San Diego. I’m in El Cajon. I’ve got a daughter starting her residency in Pediatrics at Loma Linda. She eats low carb most of the time to control her weight. I’m forwarding your talk to her.
    Magically,
    Dana Law

    (reply)
    • Peter Attia  July 17, 2012

      Thanks, Dana. I’m still working on my 30-second version. I’m 1/120-th of the way there!

  5. FrankG  July 17, 2012

    Nicely done presentation Dr Attia. Thanks. I was only disappointed that we did not get to hear the Q&A session.

    (reply)
    • Peter Attia  July 17, 2012

      It was very long. The Q&A was another 90 minutes! Perhaps another time.

    • Han Solo  July 18, 2012

      I would love to hear the Q&A session. It would be very enlightening to hear the kind of reactions from those who’s groupthink popculture world vision was just challenged.

    • Peter Attia  July 18, 2012

      The Q&A was actually the best part, but it was somewhere between 90 and 120 minutes! People asked really great — and provocative — questions. Also, we only had my audio recorded, and not that of the questioners. Sorry…

    • Joshua Wardrop  August 14, 2012

      I agree completely, please please please if you record more lectures catch the Q&A, its always the best part. Typically someone filled with the exact information you are disproving steps up with some novel piece of information, and the lecturer has a great ‘real world’ counterpoint. It’s something we yearn for to use in our real life conversations with these types of people in our families, among friends and co-workers, etc.

    • Peter Attia  August 14, 2012

      Will try.

    • Paul  September 17, 2012

      Yes, PA, please post a link to the Q&A at some point. It’s too bad the questioners didn’t get recorded but I for one would love to hear it.

  6. Andrew Lyon  July 17, 2012

    Perhaps this is a shameless plug, but I find it funny that I posted something just a few days ago that also considers such things in an ethical light: http://lyongroup.net/2012/07/14/the-importance-of-being-self-critical/. Clearly, your presentation is far more detailed, but I am very concerned about how the bias apparent in much of the history you present is becoming prevalent in experimental basic science research. Note that the intended audience of my post was graduate students in our PhD program, thus its particular tone – I am not a health and diet blogger by any stretch of the imagination. Anyway, nice job – I enjoyed the presentation tremendously and plan on disseminating this to my graduate students as an additional cautionary note.

    (reply)
    • Peter Attia  July 17, 2012

      Andrew, great timing. I like your post a lot. Very important and I hope some of the readers here can make the time to read it, too.

  7. Travis Koger  July 17, 2012

    I have been trying to think of an appropriate bumper sticker and just keep coming back to Praise the LARD. In my case it is more Beef Dripping than Lard though.

    Loved the video, watched it during my lunch break. I am looking forward to questioning my GP on why they think that Sat Fat is bad. But then I tend to ignore nearly everything my GP says.

    I am reminded of my wife’s Health Check when watching and reading your info on Cholesterol. Here in the UK, once you turn 40 you get a free health check by the NHS and as part of it, they test your cholesterol… using the standard method of course. Anyhow, my wife was asking what the Health Check looks for and instead of the health nurse saying we check your cholesterol, she actually said we check if you need to go on statins or not. Seriously!

    I bet the big pharma loves the way this is heading.

    (reply)
    • bill  July 21, 2012

      Eating Fat is Where It’s At!

    • Peter Attia  July 21, 2012

      One more time!

    • Nick Curry  September 2, 2012

      Travis,

      Praise the Lard-witty!

      An interesting posting.

      Incidentally, I took myself off statins, they were turning me psycho, short tempered-more than usual(!), aggressive and antagonistic.

      I wonder if others have noticed this?

      Regards,

      Nick Curry

  8. Brad  July 17, 2012

    I recently came across your site and am grateful to you for your clear explanations and good use of metaphor. I am a 50-year-old active male (work out 4-5 times a week, hang glider pilot), and no matter how carefully I monitor calories, I’m overweight (6’1, 235). I am hoping that ketosis is the answer for me. Thanks again for making such a compelling case for it.

    (reply)
  9. Brad  July 17, 2012

    And one question, before my first comment has even been approved! (Sorry.) I know out there in the “paleosphere” there is much discussion that insulin/carbs/sugar is not at all the entire story, especially as they pertain to weight loss. Much of the discussion centers around either “food reward” or “gut bacteria” as the major players. I wonder what your thoughts are on these topics? Are these “second tier” concerns that we maybe ought to be worrying about only after “first tier” problems are addressed? Thanks!

    (reply)
    • Peter Attia  July 17, 2012

      These issues are not mutually exclusive, but we must keep Occam’s Razor in mind. What is driving the change to sub-optimal gut biota? What is triggering the food reward system? What is driving the hormone that drives fat accumulation? Furthermore, keep the idea of “ordered terms” in mind.

  10. lorraine  July 17, 2012

    Your talk and slides are a really great tool to disseminate to folks who have read Why We Get Fat, but who couldn’t read GCBC because of the snooze it gave them in the first section. I always tell people that if they can get through that first section, it’ll piss them off enough about the impact on their health to read the rest, but most don’t. I’m always looking for a way to effectively convey this story because it’s been my experience that until people actually understand what happened in the science and public policy around low-fat and cholesterol, they can’t drop their fear of fat, which is DEEPLY conditioned. In spite of how few people currently trust doctors or the government, they still believe in the authority of low fat, and none of the other great low-carb diet books are effective enough in making the case. The movie Fathead did a good job, but your presentation is shorter and brings more gravitas to the examination of the studies I will be sharing your presentation a lot and thank you. I, too, would have liked to hear the Q&A.

    While watching, I remembered what it was like to be in the middle of this jacked-up scientific consensus going on in the background while this freight train of the first food pyramid and the low-fat diet industry was taking over the country. Ornish published while I was in grad school, and those angiograms stopped everybody cold. How could you dispute those pictures? Even my department, which was really full out neurotic that we be critical thinkers about methodology, pitched Ornish’s findings as though they resulted from low fat, low cholesterol. My first job out of school was in a hospital obesity department, where we used Medifast, a ketogenic diet. The impact of carbs was obvious both on people’s weight problems and on weight loss, and led us to understand the problem with all of these new low fat foods as being high carb (I used to start my seminars by asking how much weight have you gained on the No-fat Snack Wells Diet?). But we were still keeping our ketogenic diets low fat, so they ended up being very high protein and low fat. People lost weight, and while they did not suffer hunger, they lacked vitality, many experienced depression in the latter phases of their weight loss when body fat was low and thought they had emotional issues related to their weight (rather than metabolic issues causing depression related to the low fat diet we had them on), and they did not maintain. I always thought we should have transitioned them off Medifast (which is still low-fat, btw) onto Atkins, because pretty much everybody came into the department acknowledging that it was their bread, pasta and sweets diet that made them gain weight and drove their hunger, but that was blashphemy. I wish I knew then what I know now about fat.

    One of my favorite slides in your presentation, though, was the early one about health care costs. People talk about that a lot, but to see it in that graphic form is impressive for the argument to reform healthcare, and especially to lower obesity.

    (reply)
    • Peter Attia  July 17, 2012

      One thing I forgot to mention in my post…can’t believe I forgot this! After my talk at UCSD a woman in the audience commented that she was one of the people in the 1984 NIH consensus led by Basil Rifkind. She said they were TOLD what the “consensus” was going to be while locked down in the room for 30 hours. In other words, Rifkind had his mind made up before the “consensus” meeting got under way. I couldn’t believe it, but I did some background checking and it checked out. Unreal…

    • lorraine  July 17, 2012

      @Peter, well I can only say from personal experience that the perpetration of that fraud and the power of authority brought to it by the government getting involved in food policy was mind bending for a lot of really smart people (me included) who were trying to help during that time. I mean, I understood the biochemistry of ketosis, but under the influence of all that authority, we missed connecting all the dots, and instead turned ketosis into something that got rid of all fat (because of the bias) rather than just recognized its ability to reduce the amount of unwanted body fat. Consequently, we hurt people, possibly even as much as their obesity was hurting them, maybe even more. And what’s worse, we turned them loose back to low fat prescriptive diets. I experienced a lot of cognitive dissonance about that, and frustration with the lack of maintenance. So I don’t work in hospitals anymore :)………and, my colleagues who are staff Diabetes Educators suffer the same. Even if and when they get it (which I have found takes a lot longer than you would think it would take smart people to see the reality of the basic science, but that institutional bias is insidious), they can’t implement it on the job because it violates the protocol. And you know, we can’t have that.

  11. Victoria  July 17, 2012

    The best response to any conversation implying saturated fat or cholesterol is bad for you is to simply state that it is good for you. If the other person is a zealot, it’s the easiest way to get under their skin and put them on the defense. If the other person is someone who is just reiterating an “authoritative” statement, it is much more persuasive to demonstrate a dissenting opinion by the simple, mild expression of it.

    (reply)
  12. David Nelsen  July 17, 2012

    Excellent talk. I was reading a book about Fats & Oils by Mary Eades. In one section she talked about how the liver creates different SFA’s for use in the body as fuel. It occurred to me that if the body is making them, then why is there such a big fuss about eating them? Even if you don’t eat them (Ornish) your body makes them anyway. Your body knows what it is doing and wouldn’t be making these molecules on purpose if they were harmful to you. If that was the case, the epidemic of CHD would not be such a recent (last couple hundred years) type phenomenon.

    (reply)
  13. Mira  July 17, 2012

    I’m a family physician in Israel and have been recommending low carb diets since I read Gary Taubes’ books, other books on low carb science and your blog.
    Thank you for this lecture! It really will make it rasier to explain this to my patients and friends, and maybe also to my colleagues. As you’ve probably experienced many times it’s really difficult to talk to other physicians about low carb high fat diets.
    One comment – It would have been easier to follow the lecture if there had been some more slides on things you talked about but didn’t show on slides, like some more studies you mentioned. This is especially true for non native English speakers.

    (reply)
    • Peter Attia  July 17, 2012

      Mira, this was the very first time I gave this presentation. Hopefully, the more I give this talk, the better I can make it, especially if I can spruce up the slides a bit. Of course, you know what’s coming next, right? I just don’t have the time time….

  14. Bill  July 17, 2012

    Brad, No intent to hijack but if you cut your carbs to 20g/day, you WILL lose weight.

    I’m 46 and dropped 20lbs in 5 wks ! Pretty efortlessly. No more stomach problems among

    other things.

    (reply)
    • lorraine  July 17, 2012

      @Bill, eh maybe not always if you’re a postmenopausal female, and I quite appreciate Peter delineating that metabolic universe in his talk.

    • Brad  July 17, 2012

      Bill, Thanks….I appreciate the encouragement.

  15. lupo  July 17, 2012

    Peter, as much as I like your well-structured talks and especially the very content, please consider taking a look at state-of-the-art slide creation, i.e. as in “Presentation Zen” or “slide:ology”. Even if you have (chronically) little time on your hands, thinking about presentation design will really benefit you (and your listeners) in the long term.

    (reply)
    • Peter Attia  July 17, 2012

      I could use all the help imaginable… Hopefully once NuSI is up and running, I can have a person working on this full time.

    • lupo  July 18, 2012

      Godspeed to NuSI! :)

  16. Mark  July 17, 2012

    I am am between MS1 and MS2, and it is atrocious the way medicine and nutrition are taught. First, we had PhDs teach our entire physiology course (except the maternal fetal section, which an MD taught very well). The GI lectures (and for that matter each organ system) did not integrate well with the Endocrine lectures, but it was possible to step back and see the big picture. Sadly, that was not tested and many of my less health-conscience classmates did not get the message of carbs, fats, insulin etc or spend the extra time to ask what it means practically. Biochemistry and metabolism was just as bad because we only looked at pathways and cells, not really understanding how they integrated.

    All that said, the worst was nutrition. Medical school sucks at nutrition, everyone knows that, but we were taught by the nutrition students! It was a non-tested “extra” set of lectures. They railed off guidelines by government think-tanks (with shady ties to the agricultural industry, but conspiracy theories aside). I am certain they don’t understand the difference between equality and causality and how the former makes for very bad science. I guarantee they don’t understand anthropology or the implications of the agricultural revolution on the human body.

    You inspire me, though at this point (in my naivety) I still want to do patient care. Specifically, I want to do primary care because this message needs to be given by the GP. My current summer research is on the prescribing tendencies of family physicians with respects to LDL, and while I loved your multipart series on cholesterol, proper understandings of the integration and implementation of physiology, biochemistry, and nutrition would do more good than even the greatest statin.

    P.S.
    I am sure Bastiat would agree that a misconception this ingrained is the product of a government too involved in the agricultural, medical, and basic science industry. He would commend people like you, striving to give the gospel of evidence based (and properly interpreted) knowledge in action.

    (reply)
    • Peter Attia  July 17, 2012

      Mark, if it makes you feel any better, every 2 years I need to re-certify my medical license by taking CME courses. Can you imagine what I have to emotionally go through on the “nutrition” section? I actually have to take an exam and knowingly answer questions incorrectly.

      BUT…don’t lose sight of the fact that you and your classmates are the future of medicine. Challenge your professors. Get your peers to do the same. Demand the best of your education and never lose sight of why you’re doing what you’re doing.

  17. lorraine  July 17, 2012

    Wait, there were bumper stickers in Bastiat’s day? You must be mixing metaphors!

    (reply)
  18. lockard  July 17, 2012

    Dr. P. Attia,
    I am a Type 1 Diabetic and have been learning more in the last month from your site than 11 years of doctor visits. Thank you. I first came here through Mark’s Daily Apple and have been reading both blogs daily for several hours while standing at work (I have catching up to do) . Since going primal/high fat and training in Ketosis I have enjoyed awesome blood sugar levels (1st time in …forever). I ran 18 miles for the first time this weekend and did not need any carbs to maintain my blood sugar levels. In fact I left the house at 69 and had my CGM on and stayed rock solid. Your information is impacting my health in a very big way and I wanted to say thank you so much. I am very excited to see you up-and-coming blog on T1D.

    (reply)
    • Peter Attia  July 17, 2012

      You just made my day. This is remarkable! One thing…please don’t get upset at me if your boss gets upset for your use of work time!

    • lorraine  July 17, 2012

      Wow, that is just the best!

    • Jennifer  July 22, 2012

      That is so fabulous! Do you think you could write up your story as a testimonial for MDA or Robb Wolf’s blog? Sometimes in the comments of these blogs I’ve seen readers assert that type 1 diabetics just need to throw away their insulin and eat a ketogenic diet and they will be fine, and I worry that some day someone will actually follow that advice and get into serious jeopardy or even die. I know people get really excited about this stuff but I feel like we demonize insulin too much–it’s not that insulin is out to kill us, it’s all about eating too much carbs. Some of the blog readers seem not to realize that type 1 is very different than type 2. Anyway, it’s great that you are doing so well!

    • Peter Attia  July 22, 2012

      I second that.

  19. Ryality34  July 17, 2012

    Its perfect that you quoted Bastiat, makes sense. Have you read “The law”?

    (reply)
    • Peter Attia  July 17, 2012

      Ha, funny you should ask! Just bought for my ipad. I assume you approve and recommend? Does it warrant getting bumped up in the line?

  20. lockard  July 17, 2012

    Don’t worry, I am a paper pusher for the Gov. and my boss is an Attorney who would allow me to make my case that this is time well spent in that it is increasing my health and longevity and therefor ensuring the quality of his employee and keeping health care costs for the tax paying people lower.

    (reply)
  21. Catherine  July 17, 2012

    I just finished it, RP claims it is one of his favorite
    Great presentation!
    Great to have the clean overview and ponder the politics of food
    You really have to watch the press with their headlines.

    (reply)
    • Peter Attia  July 17, 2012

      VERY important take-away from this. Hope others picked up on this, also.

  22. Sheryl G.  July 17, 2012

    Hi Peter,
    I am just discovering you through your website and seeing Gary Taubes on Dr. Oz a few months back (a show I never watch but the promo with Mr. Taubes intrigued me). I watched and something that I have known in my gut (literally as well as figuratively) to be true for a few years now was confirmed by Mr. Taubes. I started to follow his posts and found you.
    I am a 54 year old woman and I have always been overweight with the typical fluctuations that career dieters go through. In Sept 2009 something changed and I could actually feel the difference. It’s hard to describe but my stomach felt like it had gone from being soft and pliable to rigid and inflexible, it’s like I have a brick for a stomach now. I feel bloated all the time, my stomach hurts often and I am so tired I can barely drag myself out of bed and it’s only getting worse.
    I believe all of these problems are the result of a half century of American eating. I was raised on processed foods, high sugar, and lots of carbs. I sought medical help to find an answer and solution to my problem and my doctor; in an effort to find out what was ailing me did every test under the sun. I was told repeatedly that the tests were normal, they couldn’t find anything wrong with me. When my doctor scheduled the very last test for Gastroparesis he told me up front that if that test came back normal there was nothing more he could do for me. That was three years ago and I have been searching for an answer on my own ever since. After observing cause and effect with the things I eat I am more convinced than ever that it is the sugar and carbohydrate heavy diet of mine that is killing me.
    Something I read on your Blog really hit home “When you are overweight, it’s not because you’re eating too many calories – it’s because your fat cells are storing too much fat. These are not the same thing” I know people think I’m lying when I tell them I really do not eat a lot but I have tracked my calorie intake and I consume typically around 1500 a day. Your comment was a great encouragement to me.
    So Today I began a full hearted commitment to try to eliminate carbs and sugar in an attempt to try and feel normal again. I always feel so much better when I do this, the results are almost immediate with me but I just can’t seem to keep from falling back to old habits. Society, friends, work all seem to frustrate my efforts, either intentionally or unintentionally but either way the result is the same. I want to be healthy, what I’m doing is not living, it’s dying a slow death!
    I have subscribed to your email feed and I look forward to all the information you make available. I am embarking on what I hope will be, a transformative journey to a permanently healthier me. Any personal tips you might have for me would be very much appreciated.
    Thank you, thank you, thank you for devoting your time and efforts to this cause.

    (reply)
    • Peter Attia  July 17, 2012

      Sheryl, I hear your pain and I can tell you that many others do, too. I hope that resources like this and many others will continue to provide you with the support you need to make the decisions every day that will lead to you living a healthier and happier life. As you realize, this is a lifestyle change, not a diet. You’ll have good days and bad days. Over time, hopefully more of the former.

    • Travis Koger  July 18, 2012

      Sheryl,

      Good luck with your journey into the land of No Carb/Low Carb bliss. I started 18 months ago after reading Gary Taubes and continued almost six months ago after see Peter’s blog. So far I have lost 93lbs and love the way I feel now. You will never look back once you see the benefits this will bring to you.

      Try and read every single article on this site and the extremely valuable reader’s contributions. I have learnt so much from Peter and this community that has helped me in my journey.

    • Laura Babbitt  July 18, 2012

      Sheryl, I’m sorry for your suffering. Since Dr. Attia mentioned he hoped his blog and other resources might help you with your recovery, I thought I’d mention two other resources that have helped me. Laura Dolson, the Low Carb Diet guide at About.com has some great tips on how to make substitutes for traditional foods, and good advice on how to ease into the diet. There is a forum there where you can connect with other people following a low carb diet for support. I haven’t joined that community because I was already a member of Livestrong.com, where I have made a lot of friends, and get great support. I learned about Good Calories, Bad Calories, the Low Carb guide at About.com, and Dr. Attia’s blog from my friends on Livestrong.

      Lifestyle changes are not easy for all the reasons you mentioned, and more. Reaching out to others who share your experience can help. Best wishes for your journey back to health.

    • Sheryl G.  July 26, 2012

      Hi Peter,

      I thought I’d let you know that I am on day 10 of no sugar and low carbs (no processed carbs). I have been drinking tons of water (in fact it is the only beverage I’ve had in 10 days because I realized all the drinks I loved were loaded with sugar or sugar substitutes). The first few days were a nightmare, fatigue so bad I could hardly stay awake at work, sweats, headache 24 hours a day for the first three days that I thought was going to kill me but on that 4th day I woke up feeling almost normal again, something I haven’t felt in years! Each day I’ve felt stronger and happier. I’ve emptied my house of any foods that might be a temptation and I only have healthy foods that I like (I’m not trying to expand my tastes just yet, I don’t want to get frustrated and give up). I’ve dropped snacking at night, no more cravings or hunger to try and satisfy. I take public transportation to work and the station is about a 10 minute walk from my house so I’ve started walking to and from the station as well as on my lunch hour – because I really want to now, I mean I want to get out and move!! I’ve even convinced my sister, who has Diabetes to give this a try : ) Here is a list of what I’ve observed since I’ve started this –

      No more constant bouts of dizziness
      Clearer thinking
      Swollen feeling in my entire body gone
      Hard distended stomach used to hurt when pushed now soft and no pain
      Severe stomach bloating gone
      Pain in knees gone (I can walk up and down stairs now, which I’m doing for the extra exercise)
      Stiffness when getting up from lying or sitting down gone (I used to move like a 90 year old in the morning)
      Extreme fatigue gone

      I know these results are from this new lifestyle and not from weight loss (I know I’ve lost some but not enough for results this drastic).

      I even had a co-worker tell me the other day that I looked like I was glowing :)
      Every time I’m tempted (which surpsingly is not often) I think of the “promise” of those poisonous foods, that good feeling, happiness (for the moment) then I think of the “reality” of those foods, dying a slow death, lack of mobility and energy and the self loathing.

      Thank you again for your mission
      and thanks Travis and Laura for the encouragement! : )

    • Peter Attia  July 28, 2012

      Sheryl, thanks so much for sharing this great story with folks. There will be struggles ahead, but you’re thinking of this the right way — it’s not just about the speed of weight loss — it’s the compete set of changes and the commitment to a lifestyle change that moves the needle.

    • Sheryl G.  August 22, 2012

      Hi Peter,

      I just wanted to check in again. It’s been 38 days of no sugar, no processed foods and low carbs and I feel 10 years younger! I’ve lost 28 pounds, I have more energy, no cravings, physically, although my mind still thinks about the sweets and carbs from time to time but fortunately since my body isn’t screaming for them as well it’s easy enough to move on to other thoughts : )

      I am telling everyone about this and the whole Marketing Department where I work is going low carb! I feel like a whole new world has been opened up to me. I’m currently reading “Wheat Belly” and in a word I am stunned.

      A million thanks for your work, perseverance and dedication to educating people with the truth. Keep the information coming!!

    • Peter Attia  August 23, 2012

      Wow, that’s a remarkable response. Keep up the great work.

  23. Margaretrc  July 17, 2012

    Thanks for posting this video so others can see what I had the pleasure of seeing in person. It was and is an awesome summary of a long trip down a very wrong road. I will bookmark this page and link it to anyone who continues to rail about the dangers of sat fat. I often get dismissed because I am not a doctor (though I do have an advanced degree in chemistry, which doesn’t seem to make a difference). Perhaps they’ll listen to an articulate, well spoken doctor! Perhaps.

    (reply)
    • Peter Attia  July 17, 2012

      One step at a time. I’m optimistic that one day NuSI will create an on-line resource second to none that will do much more than this.

  24. Axel F  July 17, 2012

    Dr. Attia. Thanks for presenting your fantastic lecture on your website. I found very interesting. The historical approach is very informative and helps us understand a bit how we came to where we are now.

    For years I have recommended my patients to stay away from saturated fats. This is what I learned in medical school and during my training as a cardiologist. It was always presented as a fact, the studies were never discussed.

    It was not until a few years ago that I started digging into the literature and have my own doubts. I wrote a blog myself recently on the issue in an article called “The Case Against Saturated Fat”.

    The history of the “saturated fat issue” is very interesting from a scientific and public health point of view. It teaches us how conclusions can be drawn and recommendations made from very soft data. When the wheels are turning, it can be very hard to turn back. Suddenly scientists and public health authorities have a hypothesis to defend. That´s when we tend to ignore or even not publish data that contradict our believes, and when we interpret scientific results we try to fit them into predetermined concepts. A very interesting story indeed. Hopefully we will learn from it.

    (reply)
    • Peter Attia  July 17, 2012

      One of the tragedies of our system is that doctors like you — who are willing to admit they were wrong, and who have the intellectual curiosity to find the truth — are not in the majority. Keep at it!

  25. Jordan Wiegand  July 17, 2012

    This is a great talk, thank you for making it available.
    I recommend Dr. Lustig’s sugar lecture, and Dr. Taubes’ “Why we get fat” lecture to my low-carb-hater friends. Now there are three videos I can have people watch before continuing to argue with them about my diet.

    (reply)
    • Peter Attia  July 17, 2012

      Wow…very cool to be in the top 3 with those other two excellent talks! Thanks. BTW – I have a link to both on my Media page for easy reference.

  26. steve  July 17, 2012

    It appears that sat fat increases LDL levels depending upon the level of carbs eaten. Any data regarding how low the carb contribution must be to avoid this. Additionally none of the studies addresses LDL-P or hyperabsorption of cholesterol.
    I would further note your stating that when some of the trials went beyond several weeks you see the low fat groups frequently increasing fat intake and the carb restricted groups increased their carb intake is indicative to me of something: neither of the diets is sustainable over a long period of time. So, while a carb restricted diet is desirable, being under 50grams per day and in ketosis is not sustainable for many.

    (reply)
    • Peter Attia  July 18, 2012

      To your first question, see Part IX of the cholesterol post. To your second question, it’s a fair point. I do wonder, though, if the sustainability has more to do with food “infrastructure” and a constant bombardment of bad information. However, the first-order question should be about mechanism of action. Once we understand that, by all means we should have the discussion about how to implement it.

    • Paul  September 17, 2012

      Actually to contrary I find nutritional ketosis fairly easy to sustain. My experience is that I went on a really unstructured and uninformed low-carb diet and lost lots of weight but it I found it became much easier when I recognized the role of increasing fat and not getting stuck on protein keeping protein levels high. I am grateful for the advice about how to make the choice of which type of fats (stress saturated and monounsaturated and avoid PUFA’s except for omega-3’s) optimally healthy. Eating foods with fat content is wonderfully satisfying and enjoyable. I think nutritional ketosis is pretty easy, and I find myself just as fit even though I exercise less (not a deliberate choice, but I find how much longer my fitness level sustains itself very intriguing).

  27. Richie Graham  July 18, 2012

    I’m curious if you saw this article in today’s Wall Street Journal: http://online.wsj.com/article/SB10001424052702303612804577531092453590070.html?mod=WSJ_hps_MIDDLENexttoWhatsNewsFifth. It’s interesting to me that some are focusing on fighting inflammation now as a justification for a low-fat diet (although part of the diet she says is recommended is actually low-carb, butter and red meat are still considered bad guys). I seem to recall that the recent Ludwig trial found that there was a slight tendency for a low-carb diet to increase c-reactive protein, and, thus, possibly inflammation. Could this be the low-fat camp’s next justification for sticking with their theory or am I reading too much into that? Also, what is your opinion on the c-reactive protein increase that was found in that study? Thanks for your work.

    (reply)
    • Peter Attia  July 18, 2012

      Too painful to even comment on this, sorry. Hopefully someone else can jump in and rescue me. Just keep the following in: the odds of the press getting it right are pretty slim. See previous posts (pleural) for examples.

    • Richie Graham  July 18, 2012

      Okay, fair enough. I was mainly concerned with how to answer my dietician friends when they say (as they inevitably will) that my low-carb diet will trigger inflammation and is therefor harmful. That sounds ridiculous to me, but I’ve already seen bloggers who have made that claim. I’ll look elsewhere on the site to see if you’ve already addressed this topic. Thanks.

    • Margaretrc  July 18, 2012

      Here is Dr. Attia’s answer to your question. He posted this earlier and no doubt didn’t want to repeat. http://eatingacademy.com/books-and-articles/good-science-bad-interpretation?utm_source=rss&utm_medium=rss&utm_campaign=good-science-bad-interpretation

    • Richie Graham  July 18, 2012

      Thank you, Margaretrc. I read the article and understand Peter’s pain now. Turns out my question has been repeatedly asked and fully answered. Good stuff. It’s so interesting to watch the clinical evidence pile up in favor of low carb and see how the establishment reacts.

  28. Tony  July 18, 2012

    I enjoyed that very much! Kind of like the CliffsNotes for “Good Calories, Bad Calories”.

    Arguing nutrition with people who aren’t receptive is very similar to arguing about politics…a waste of your time and energy. If you don’t have the credentials and/or the person isn’t truly interested and open to what you have to say, good luck convincing them of anything. I finally decided that I am the ultimate skeptic and if I’ve done enough to convince myself, that’s all that really matters.

    One other thought that I had, if you don’t have M.D., PhD, R.D., etc. behind your name, then the next best is possibly to just be “ripped” and then tell people that you eat bacon and butter! Might buy you some credibility.

    (reply)
    • Peter Attia  July 18, 2012

      Sad that those are the only 2 states that warrant having an informed opinion on the subject.

    • Jon  July 18, 2012

      If you talk to an R.D. (or even a DTR) about this stuff, pointing out that it comes from someone with an M.D. often times doesn’t even help!

  29. steve  July 18, 2012

    I read XI of cholosterol series but must have missed how low carbs need to go. Will look again. Food infrastructure maybe, but the desire for sweet tasting foods, i believe is ingrained in people Hunter-gatherers sought out fruit, and tubers. Also, many feel better with some level of starch in the diet. In my own diet the only carbs I eat (other than veggies) consist of rice, potatoes; not much mind you, but a small potato or 1/2 cup of cooked rice if i feel like it.
    Am not sure of the marginal benefit from moving from my low carb diet to sub 50grams/ ketosis.
    From an NMR- LDL-P with zero starch my LDL-P has been around 620- all large, and with some starch it has ranged from 568 to 650, but small LDL-P can be almost as half with trgs of only 50. As you have clearly pointed out, size does not matter in LDL-P so I again i am not sure of the marginal benefit to getting lower on the carb curve. Should mention I have to take a statin and zetia to get this low. Have gone zero carb, but still produce close to 2,000 particles LDL-P. I think i must produce to many smaller cholesterol poor particles. I have learned this from your work and Lecture Pad!
    Thanks for excellent, informative and most helpful work. Now in early 60’s I have time to work on health!

    (reply)
  30. Matt  July 18, 2012

    I didn’t read through all the comments yet, and I haven’t finished watching, but I want to ask this before I forget. In Framingham they couldn’t find a correlation in the extremes of total cholesterol with intake of dietary saturated fat (which is to be expected from a biochemistry standpoint). My question is, if you look at those two groups but ask whether there is a correlation with carbohydrate intake is it found?

    (reply)
    • Peter Attia  July 18, 2012

      Great question. I would need to go back and look at the primary data (not just the studies). My hunch is that they did not necessarily record that info at the necessary granularity to draw much conclusion.

    • Paul  September 17, 2012

      This is off the cuff, but I’ve read in more than one place about people taking these observational studies, re-running the data, and finding correlations between disease and carb intake. I think Atkins writes about it (Harvard nurses study, maybe). I think Denise Minger did the same thing with the China Study dataset.

  31. Ellen  July 18, 2012

    I created a 150 page website (www.healthy-eating-politics.com) as my “long and arid dissertation” to refute the lie that saturated fat and cholesterol cause heart disease, and to lay out how the money driven politics of the pharmaceutical industry, the agricultural complex, medical associations like the AHA and the ADA and the US government keep that lie alive.

    I hope and believe when enough people figure out through their own experience what constitutes truly healthy eating, we can start routing the mass brain washing. When people stop buying products produced from wheat, sugar, soybeans, corn and canola, we will be able to change the market place, and turn the tide on the staggering costs of our health care system.

    Given the damage that has been done by the diet heart hypothesis, it also infuriates me when someone lectures on how butter, meat and eggs are bad for the heart. Sometimes I’d laugh if it weren’t so ironic that this conversation usually happens at work over a table full of bagels, cookies and sandwiches.

    (reply)
    • Peter Attia  July 18, 2012

      Thanks, Ellen, this is great. I hope folks go to your site and check it out.

  32. David Nelsen  July 18, 2012

    Peter, since embarking on my low carb education I’ve often wondered how so many of the key figures in the mis-education of America (with regards to Nutrition & Health) could be wrong and the data they collect shows that they are wrong. You highlight several salient examples in your talk. I just finished a book titled “Mistakes were made, but not by me” http://www.mistakesweremadebutnotbyme.com/ and I think the reasons they cite are probably at the root of the problem. They highlight – Cognative Dissonance, self serving justifications and selection bias for the positions that they hold (or cling to). When confronted with data that disproves or questions their hypothesis – they might end up going through a thought process like:

    1. I am a good man/woman and I am an expert in my field.
    2. I have recommended a diet for America that should improve health.
    3. If the diet I recommended was wrong then I have in some way shortened the lives and health of countless people.

    At this point, they hold 2 dissonant ideas and basically reject item 3 and confirm they are a good person/distinguished scientist and would never knowingly harm anyone. They continue to go all in on their hypothesis.

    The thought pattern is similar for prosecuting attorney’s who have people convicted and sent to jail only to have the case reversed with DNA evidence. They can’t wrap their head around the fact that they were wrong and took 20 yrs of someones life – so they file new charges and retry the case to prove they weren’t wrong. The diets recommened by the esteemed scientists and the good old US government have taken 20yrs off quite a few people’s lives.

    To me it’s tragic that policy was made on insufficient data and that after we now have a fair amount of data there is no “Mon Dieu” moment with people slapping their collective foreheads. Kind of like what Alec Guinness’s character says at the end of “The bridge on the river Kwai” – What have I done?

    (reply)
    • Peter Attia  July 18, 2012

      David, this is a great insight into a human tragedy. I wish more physicians and policy makers were aware of this “defect” in our make-up. I think we are all susceptible to this.

    • CJWatson  July 21, 2012

      What if the LFHC diet doesn’t just take off 20 yrs, but leads to other disease, such as Alzheimers? What about those costs and suffering. I know the primary discussion is the studies to relating to CHD, but the low fat recommendations may have sent the public on the road to neurologic decline. Can you link the LF diet to other disorders of aging?

    • Peter Attia  July 21, 2012

      Great questions. There is actually an enormous body of literature linking a cluster of diseases to metabolic syndrome: CHD, Alzheimer’s disease, cancer, diabetes. In fact, it seems quite likely that removing sugars and simple carbs from diet is, in fact, an anti-aging “treatment.” Over time I will develop several blog series on each of these topics. Hope you can hang on until then.

  33. Jim Bowron  July 18, 2012

    re Richie Graham- my recollection of the Ludwig study was that all diets studied reduced c-reactive protein, but the low carb diet was marginally still higher than the low GI diet- it was not clear that the difference was statistically significant.

    (reply)
  34. Colleen  July 18, 2012

    Nice lecture. Here is another vote for getting the Q&A next time! As when reading GCBC, I get really angry listening to how low fat was pushed on little or no science. We ate low fat/no fat in college/grad school in the late 80’s/90’s because we wanted to be healthy. I look back now and see certain health issues most likely stemming from this unhealthy diet. Most recently alarmed at what we had been feeding my 3 yo daughter (not enough fat) prior to discovering Gary Taubes and then this website and others early this year. Thanks again.

    (reply)
  35. lorraine  July 18, 2012

    Ok, I’m here, I’ll have a little crack at it.

    Richie, regarding the Wall St Jrl story on illness and inflammation that you asked about, I too think that inflammation is a major driver in all disease, and I think there are many things that create the inflammation and many ways to reduce it, including diet. But you have to read very, very carefully when media writers start to link ideas together in ways that may sound logical, but are not really supported by the medical literature. And you especially have to be careful with the way they interpret studies to suit their point. Actually, this doesn’t just happen in news stories, but in the literature itself. I just finished a review article published in a medical journal in which the author was examining the evidence linking dairy to diseases of civilization. Having already read all the individual studies that he was using to make his hypothesis, I felt he was making huge unfounded leaps of logic in drawing his conclusions from that evidence. But it certainly sounded like the development of a very logical idea on the surface. So you have to watch out for how the evidence is used.

    I’m only going to address two points made in the Wall St. Jrl article to illustrate this. The first is the CRP data from the Ludwig study. What really happened in the study is that all three groups saw a drop in their CRP by about half (huge drop in terms of their clinical risk). The low fat group had the biggest drop, the low carb group had the least drop, but the difference between them was only something like .02 I’m forgetting the actual numbers, but I think they were .76 and .78 respectively. These numbers were *statistically* significant in their difference, but as they are both below 1, they are completely insignificant clinically. Anything below 1 on a CRP test is totally good to go. Now compare that reality to what was conveyed in the media. I’m pretty sure it was almost universal that the media stated that CRP went UP in the low carb group. Bull. And they couldn’t even leave the lie there, every story I read on it went on further to say that because of the “increase” in CRP in the low carb group, this diet may increase the risk for heart disease (of course completely ignoring all the other risk markers that went way down, better than the other diets).

    The other point I’ll address in the article you provided was the claim that “dietary fiber from whole grains may play a protective role against inflammation”. The author doesn’t give citations for any of her claims, which makes it hard to evaluate, but on this point she refers to a “recent study”. I just googled the above phrase and found a bunch of hits on a study published in February that looked at grain fiber and risk from all causes. I’ll point out that this study was the type of study that makes some of us bristle (observational epidemiology) in which they look at food diaries in large populations (famous for being inaccurate) to draw some comparative correlations (fairly weak evidence) and then somehow by the time it’s reported to the public in the media, it becomes an all out discovery about A causing B. For an analysis of the actual data in this study though, I’ll turn it over to Denise Minger, who analyzed this study in a guest blog post on Marks Daily Apple:

    http://www.marksdailyapple.com/will-eating-whole-grain-fiber-help-you-live-longer/#axzz20ypZ44p9

    Now you see why this media stuff makes us nuts.

    (reply)
    • David Nelsen  July 18, 2012

      Quick FYI – the low fat was around .76 for CRP and the LCHF was about .87. All still under 1 and clinically insignificant. I think any media types who want to write about health should have to pass some sort of test (similar to a drivers test) to show they know the difference between correlaton, causation and a controller experiment vs. a epidemiological survey. If they can’t pass the test, then they shouldn’t be allowed to write about it. Thanks for your observations. Then again I also think you should have to pass a test to be able to play on a golf course when it’s crowded.

  36. Kypros  July 18, 2012

    Richie,

    The low carb diet did not lead to an increase in CRP. That was the whole point of Peter’s previous article:

    “Each group experienced a significant decline in both PAI-1 and CRP, and there was no significant difference between the groups for either marker. However, the trend was (barely) significant favoring the low carbohydrate group for PAI-1 and favoring the low GI group for CRP.”

    (reply)
  37. Tony M  July 18, 2012

    To say that Nietzsche would be disgusted is redundant.

    (reply)
    • Peter Attia  July 18, 2012

      Nothing better than a little tautology here and there.

  38. Carol  July 18, 2012

    Dr. Michael Eades addresses the low carb/c-reactive question in this blog post:
    http://www.proteinpower.com/drmike/uncategorized/magnesium-and-inflammation/

    In brief, a low magnesium level is the first and most likely cause of inflamation that he would look at.

    Dr. Attia, thank you for this wonderful, thoughtful blog. My son just introduced me to it and I’ve spent several hours enjoying your sane, coherent and well reasoned writing.

    Thanks so much.

    (reply)
  39. Bobby  July 18, 2012

    Peter: I was glued to my computer during your presentation and liked the way you laid out the facts.
    In several of the studies you showed, the different groups would make initial progress on their prescribed diet only to lose some of the gains the longer the study went on. More than once, you attributed it to the fact that there was reduced adherence that diet. Could something else be going on?
    I have found at times when I experiment with a new diet the same thing happens, and I know my adherence is just as strict. I wonder if our bodies have some mechanism to maintain the status quo. I am not scientist and can’t begin the guess what is going, but I question whether adherence is the total answer.,

    (reply)
    • Peter Attia  July 18, 2012

      It’s a fair point, and both forces may be at play. However, when you look at intake (e.g., in the A TO Z trial), you see what is commonly observed between 2 and 12 months.

  40. Lex  July 18, 2012

    Thanks for your comment about having to knowingly answer questions wrongly on your nutrition CMEs. I had to show that to my 9-year-old twin boys, who pronounced you “cool”. One evening at dinner several months ago, they informed me of a TASA test question about limiting saturated fat to reduce heart disease. Funny thing is they knew how to answer it, wrongly, to get it right.

    (reply)
    • Peter Attia  July 18, 2012

      Any time 9-year-olds think you’re cool…you’ve got to be doing something right!

  41. george henderson  July 18, 2012

    I loved this and listened to the whole thing even though I’ve read the book more than once.

    This paper is a doozy
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712626/

    “In recent years, the idea that the diabetic liver may harbor a noxious brew of insulin resistance and excessive insulin sensitivity has gained a second wind.”

    Ever since I learned that livers infected with HCV (which can cause metabolic syndrome and DM2) have increased production of both glucose AND lipids, I’ve wondered, how is this possible? Doesn’t a doubling of energy substrates imply that the first law of thermodynamics, the conservation of energy, is being flouted to an extent even Dr Atkins would find outrageous?
    But with this paper, I’m getting closer to understanding the explanation.

    (reply)
  42. Pekka P.  July 19, 2012

    The link between inflammation and saturated fatty acids is interesting. There was an anti-low-carb article in Finnish newspaper describing the link: part of the immune system reacts to the saturated fatty acids as if they were parts of microbes and cause a constant state of inflammation in the adipose tissues. In the comments someone more knowledgeable revealed that those “saturated fats” causing inflammation have ten or less carbons. In Finnish usage “saturated fatty acids” include the short chain acids such as butyric acid, too, while English nomenclature seem to separate short chain fatty acids (SCFA) and the saturated fatty acids (SFA).

    The SCFAs are typically result of bacterial metabolism so it makes perfect sense that immune system gets activated by them. An important source of SCFAs is ruminant fat, lard and butter, which are supposed to be bad. The confusing part is that SCFAs are produced by the bacteria while they are decomposing the fiber in the gut. Fiber is supposed to be good for us, right?

    (reply)
    • Peter Attia  July 21, 2012

      Actually there is no evidence that fiber is good for us. The fiber story is similar to the fat story, but in reverse. I’ll detail this in another post.

    • David Nelsen  July 22, 2012

      I’ll be looking for the fiber presenation. For about 12 years or so I have to take Psyllium seed husks after dinner or the consequences are painful to say the least. I could eat a salad for breakfast lunch and dinner and there would still not be enough fiber in my system to move everything along. Keep up the great work. Hope to see the NuSi announcement soon. That and I’m waiting to see if Gary T. ever posts a comment on this blog. :)

    • Peter Attia  July 22, 2012

      The former is a guarantee. The latter? Don’t hold your breath…

  43. Craig  July 20, 2012

    I haven’t found an hour yet to devote to the video, but I have read GCBC. My reaction on completing the book
    was this: Taubes convinced me that the case against cholesterol and saturated fat isn’t as certain or convincing as the medical community seems to believe. But that doesn’t immediately lead to the conclusion that consuming large amounts of saturated fat, or having elevated cholesterol is therefore safe. Saying they have not conclusively proved it dangerous is not the same thing as proving conclusively that it is benign. Maybe the real answer is: we don’t know, make your choice and be prepared to live with the consequences.

    (reply)
    • Peter Attia  July 20, 2012

      Very fair point. Take-away message: we need to do more research.

    • Paul  September 17, 2012

      Actually Craig, I don’t think you have it quite right (and I know I maybe importing facts from other bloggers, such Chris Masterjohn etc, but I don’t think it contradicts anything in WWGF). Several things have no little no evidence of a association (let alone an actual causal relationship) and sometimes evidence to the contrary (i.e., an inverse correlation).
      Saturated fat intake and cholesterol levels.
      Dietary fat intake level and CHD.
      Dietary fat intake and overall mortality.
      (in other words at two(!) links in the causal chain between dietary fat and mortality don’t have evidence backing them)

      However, neither Taubes or anyone else is claiming that blood lipid profiles don’t matter. An increase of certain types of LDL species appears to be risk factor (however this very different from the what was believed before the 90’s). If am not mistaken, the association between *higher* HDL levels, triglycerides etc, is, or is becoming, fairly mainstream.

      But you are right that the data presented is not “proof”, it is more a case that (as Taubes documents) there has always been alternate hypotheses about weight, cardiac health, etc. The evidence presented is just more consistent with the alternate hypotheses rather than the conventional one, and perhaps more to the point, the evidence seems to be accumulating away from from the conventional viewpoint. But proof will only come with more data, better constructed studies, experiments, etc. In the absence of data, everyone has take responsibility for the risks of operating in a unavoidable information vacuum.

  44. Barbara  July 20, 2012

    Hi Peter. Very interesting talk – thanks again for putting it up for us. Can I be the lone dissenter and say that I thought the slides did not add much to your talk – or rather that you didn’t add much to the slides?

    One perspective you might think about is this: When you show a slide it doesn’t add much for you to simply read what the slide says, or to refer to it directly. When preparing slide presentations in business we were taught that we should ADD something to the slide, and that the slide should speak for itself without being read. I would eliminate the text slides which you simply read out, and replace them with more tables and data. Then while they are up you would ADD something – like an explanation of the data or another point that is not self explanatory.

    As I could not see YOU, only the slides, the action STOPPED while I listened to you read what I could read for myself. Hope you take this in the spirit in which I say it! I love your blog, and thank you so very much for all the information. You’re becoming a superstar!!! And well deserved.

    (reply)
    • Peter Attia  July 20, 2012

      I agree. The video would have been much better if it were a video of me giving the talk. I did think, however, this would have been better than just straight audio.

  45. Diana Attuso  July 20, 2012

    I’d like to submit my resume for NuSI. :-) I could make you fantastic presentations!

    (reply)
  46. Phuong  July 21, 2012

    Hi Peter,

    I can totally relate when it comes to having to hold back when you hear the age old sat fats are the root of all evil etc… I somehow had a mini debate with a friend’s friend on facebook of all places! She’s totally bought into the current dogma and seems to also be a fervant vegan (for moral reasons). What really got to me was that she was the one telling me that my views were dangerous and irresponsible! Rather than further getting into a war of words I made the comment that people should be free to see both sides of the coin and come up with their own conclusions. Funnily enough, her parting comment to me was that she had to no right to disabuse my ideas however if down the track I have health issues, I would be welcomed as a client (guess she’s a nutritionist or some sort of health professional). Keep up the good work! I hope one day what we know will be common and accepted knowledge.

    (reply)
    • Peter Attia  July 21, 2012

      Yes, I feel your pain. I know many folks who are vegan or vegetarian for moral reasons. I applaud these folks for their moral convictions. However, the only point I try to get folks to understand is that morality and science are not the same thing. Unfortunately, no area causes greater confusion on this issue that eating. Eating meat, for example, may be immoral for some. But this does not even suggest it is harmful.

  47. Joe  July 21, 2012

    Peter:

    While I read your blog regularly, I’ve never heard you speak before, and found the beginning of your lecture so interesting that I have stopped listening and will wait until later today when I can collar my girlfriend into listening to the entire thing with me.

    A quick comment in the interim, though. I notice that, unlike most speakers, you have virtually no verbal “junk filler” to take up airtime, e.g., “like”, “i mean”, “you know”, etc..

    However, you do use “um” and occasionally “uh”. Yes, you speak much, much cleaner than most people who speak extemporaneously (I mean without a script), but there’s a tiny amount of room for improvement. Since you are such a high-energy and disciplined guy, may I kindly suggest that you eliminate the rest of the junk filler, as well? You’re frankly already so close, and you have such an important message, that I kind of suspect you’d enjoy cleaning up the rest of it. It could only help your credibility and message, even though from most listeners’ point of views the improvement would be subliminal.

    If you were at the end of your career, I probably wouldn’t say anything to you about it. But considering how many speeches I believe you’ll be making over the decades to come, perhaps you will ponder the advantages of speaking completely cleanly. I assure you that your audiences will find your message even more intriguing if you simply pause silently, instead of saying “um”. Audiences _love_ hearing a thoughtful person silently think between the phrases, just as music audiences love hearing the musical rests in great music.

    Anyway, please consider this unasked-for advice as if offered in a kindly way (it is!), and if you have any interest in what I’m saying, simply go back and listen intently to your speech from the beginning for a minute or two. You’ll hear what I mean.

    This is a private comment to you. While you’re welcome to post it if for some reason you wish to, there’s no need whatsoever. Thanks, and I’ll look forward to hearing your entire speech. I always enjoy being educated by you.

    Best Wishes,

    Joe

    (reply)
    • Peter Attia  July 21, 2012

      Joe, THANK YOU so much for this feedback. While I’m naturally a strong introvert, I’m getting better at “faking” it and trying to bring energy to my speaking and public engagement. This is very helpful feedback and I’ll continue to do everything I can to improve upon this. As you can imagine, I’m an almost-pathologic perfectionist, so I won’t rest until I get it right. Please keep the feedback coming.

    • jw  July 22, 2012

      I thought that the talk was great. As someone who hates to talk in front of a conference room, let alone a conference, and has sat through thousands of talks, I would say that you are already in the 98th percentile.

      As with everything, mastery takes time, and you have to decide the priorities. I personally think that the passion that comes through offsets any (very) minor speaking issues. Like Gary Taubes, you will be in great demand soon as a speaker, so you will need to do these more often (and tape them…yes, this was a thinly veiled request for more videos…).

      I am also adding my vote to request a podcast of the Q&A, if it wouldn’t take too much time.

    • Peter Attia  July 22, 2012

      Thanks so much for the kind praise. I’d still like to hit 99.9… In retrospect, I wish we’d captured the Q&A better, as it was a great session, given the really astute audience. It was about 2 hours long, though! Hopefully next time.

    • Aviv  July 22, 2012

      Totally agree regarding the demand for you as a speaker!
      I will pay some good penny to hear you lecturing about the subject.
      When are you coming to New York? Tempted to meet you with a 20 pages questions… ;)

      As I said before, there’s a lot of mixed messages out there, even within the low carb/paleo community. Out of all, you (along low carb living and performance books) made things as clear as a summer day in the Israeli Negev desert !

      Thanks

  48. Christa  July 21, 2012

    Hey Peter,
    Great job on the presentation. Thank you for doing this!
    Christa

    (reply)
  49. Johna Till Johnson  July 21, 2012

    A propos of very little, but responding to Carol, who mentioned the impact of low-magnesium diets on inflammation:

    I discovered recently that unsweetened, pure (100%) cocoa is one of the most magnesium-rich food sources out there. It’s also relatively low-carb (1 gram per tablespoon).

    I’ve started adding a teaspoon of cocoa to my coffee-with-coconut oil in the morning. Along with eating almonds and soaking in magnesium salts, it’s a great way to increase magnesium levels.

    I have no idea if it’s working since I haven’t been logging things carefully, but I’m passing it along for those who agree with Carol and want to raise their magnesium levels.

    Oh, and plus… Cocoa, coconut oil, and coffee tastes GREAT! :-)

    (reply)
  50. Paula  July 21, 2012

    Hi Dr. Attia — FTR (for the record) I think you mis-speak at 35:32 when you say “elevated HDL was a marginal risk factor” – I think you meant to say elevated LDL. (Sorry, my OCD kicking in :-)

    (reply)
    • Peter Attia  July 22, 2012

      Thanks for catching that. Yes, elevated LDL-C was noted to be a marginal risk factor, while low HDL-C was found to carry a 4x higher risk of CHD.

  51. Robert  July 22, 2012

    An excellent and informative talk, Dr. Attia. I would love to hear the Q&A session even if it’s just your audio. I’m sure many others would agree with me.

    Thank you for your passionate and scientifically-sound efforts to persuade health authorities to objectively revise the accepted nutritional paradigm using the best science available – it’s desperately needed during this “diabesity” epidemic! I’m afraid that such open-mindedness can only be reliably engendered among pre-med, and maybe, very young med school students, however, who have not “bought-in” into the current model of obesity causation, treatment, and prevention.

    (reply)
    • Peter Attia  July 23, 2012

      I’m not entirely willing to give up hope on the post-med category. After all, I was one of them.

  52. Barbara  July 23, 2012

    Peter, this is an email to thank you for helping me transform my cycling this summer. I first heard you on Ben Greenfield’s podcast on low carb /ketogenic and endurance sports. I listened to the podcast a few times, read your site and am so grateful for all your info and experience. I just finished my 9th Tour De Cure (the ADA aside) and did it low carb, high fat, moderate protein. I used ucan products all 7 days, climbed 30,000 feet and covered 4 states and 550 miles. I ate avocado’s every day, cream cheese when i could get it and used pocket fuel on the bike with ucan….it is amazing at 56 I had my best tour ever….thanks to you and Ben…you guys changed my perspective …and for that I owe you a debt of gratitude…keep up the good work!!!

    Barbara

    (reply)
    • Peter Attia  July 23, 2012

      Great to hear. The irony of you doing this on an ADA ride, no less!

  53. Mira  July 23, 2012

    I too am a converted MD, and I have finished med school more than 25 years ago. I too used to warn patients from saturated fat, and recommend high carb diets. I now recommend low carb high fat diets and start to see some very good results. But – it isn’t easy. Many patients find it very hard not to eat bread, rice, pasta, potatoes. And others don’t believe me.

    (reply)
    • Peter Attia  July 23, 2012

      Keeping helping those you can help.

    • Lex  July 23, 2012

      Mira,
      I have to ask, because your first name and age fit the description of an M.D. named Mira I have met (what are the odds?), does your last name begin with “V”? Curiosity is getting to me.

  54. Alessa  July 24, 2012

    Thank you very much for a wonderful site. I find your detailed discussions of scholarly articles and the changes you have experienced from being in ketosis to be the best I’ve seen on the web. It is the only site I have seen thus far that, as a fellow MD, I would recommend for someone searching for the quality of information – and explanations – they need to better understand these complex issues on their own.

    One aspect I have not seen addressed (and I may have simply overlooked it) is mineral loss in ketosis, especially sodium and calcium. I assume that with the increased losses, you supplement minerals. Is that correct? How did you estimate the required daily amount of sodium? Thanks.

    Thank you.

    (reply)
    • Peter Attia  July 24, 2012

      Thanks very much. Glad you find this to be a helpful resource. Lots on here about mineral and electrolyte replacement, but most throughout comments, especially under topics pertaining to ketosis. I supplement lots of sodium and magnesium. The Ca++ and K+ take care of themselves when these 2 are corrected, especially sodium.

    • Jim Bowron  July 26, 2012

      Our local newspaper referenced an article apparently published in the American Journal of Physiology-Renal Physiology that concluded that ‘excess salt’ resulted in increased excretion of calcium (100 mg extra salt=1 mg extra Ca excreted), leading to potential kidney stones and osteoporosis. Study was done on mice, so a bit of an extrapolation to humans. Always hard to sort out all the conflicting information, especially with my non-medical background.

    • Peter Attia  July 28, 2012

      Mice studies are worth very little.

  55. Alessa  July 24, 2012

    Thanks for the reply. (On a lighter note, I have to add here that I am not a compulsive thanker; the third “thanks” in my original post was an editing error.) I haven’t looked through all the comments yet, but I will.

    It has been more than a decade since my med school years, but I would be shocked if the quality of nutritional education has improved much. Given the inseparability of diet and health, this seems to me to be a major failing of our medical education system. And that does not address, of course, the prevailing inaccuracies of much of what is currently taught. I know several other physicians who are, like me, attempting to fill in our knowledge gaps about these issues. It is heartening to see your site engaging in such an effort and doing it well. (Ok, maybe I am a bit of a compulsive thanker, but this is like rain in a drought.)

    (reply)
  56. Maryann  July 24, 2012

    This arrived in my order from the Vitamin Shoppe: “Food Based Packaging- The lightweight packing in your box is enviornentally friendly. Although it may look like styrofoam, it is actually made from potatoes, rice, and other natural foods and will dissolve on contact with water.” Finally a good use for the low fat, high carb diet.

    (reply)
    • Peter Attia  July 24, 2012

      Ha ha ha! I have a pen made from potatoes.

  57. chris  July 24, 2012

    hi peter,

    thanks for making this talk available, really enjoyed it & have spread it far & wide.

    obviously with 90-120 min of Q & A your audience was very interested. what was the general vibe of the audience? do you feel you “won them over”? were they enthused, negative, angry….

    cheers chris

    (reply)
    • Peter Attia  July 25, 2012

      The audience certainly seemed interested and informed. Not sure I captured their mood upon departure other than somewhat surprised or in a state of disbelief.

  58. Dwayne L.  July 27, 2012

    When tracking grams of carbs via a site like http://www.calobonga.com/, do you take the total carbs listed and subtract the total fiber (soluble and insoluble) assuming they are both non-metabolized, or can the gut flora also utilize some of this portion too through complex fermentation reactions? I’ve also seen articles inferring that some soluble fiber makes it across the gut barrier and into the circulation. Is that really true and if so how is that metabolized or excreted?

    (reply)
    • Peter Attia  July 28, 2012

      I don’t personally, because I like to keep it simple. I know that if I’m keeping total carbs less than 50 gm/day, and none of my carbs are “bad” ones, my net is probably half that or less.

  59. NSVM  July 28, 2012

    Hello Dr,

    Thank you for all of your sincere efforts. Is there any way to contact you privately?

    Thank you.

    (reply)
    • Peter Attia  July 28, 2012

      Yes, do so through the contact me page.

  60. Dave  July 29, 2012

    Hi Peter,

    I do not feel like completely eliminating carbs would be something that would suit me, or that I could sustain in the long run. Instead, I plan to cut out all refined sugars and simple carbohydrates, and eat purely complex carbohyrdrates that are low in sugar (porridge, wholemeal etc.).

    However, If i am still eating carbs, what effect does this have on how much fat I should be eating. From what I understand, the carbs are what triggers insulin to be produced which is what puts the fat into your fat cells (thus making you gain weight). So if you are eating no carbs, then the fat will not be stored in your cells.

    If you are still eating carbs, should you start worrying again about how much fat you are taking in, as this will now be put into your cells? How much fat should one be aiming to eat daily if they are maintaining complex carbs in their diet?

    (reply)
    • Peter Attia  July 29, 2012

      Dave, I’m glad you’re thinking of things through the lens of long-term sustainability. If you just eliminate sugar and simple carbs, you’re going to get a huge bang for your buck. You will also require far less fat than someone in ketosis who needs to go out of their way to ingest fat. There really aren’t great data to answer the question I think you’re asking. It certainly seems that eating saturated fat + sugar is a bad combo. I have not seen any evidence, however, that eating saturated fat in the presence of “good” carbs is bad. If you think about, most of subjects the studies I presented here were not in ketosis, suggesting ketosis is a “magical” state where one is immune to the effects of saturated fat.

  61. Oxboy  August 1, 2012

    Doc, I was trying to find a good place to post my questions/comments so I think this is as good as any:

    I went through your site and didn’t find much on the topic of inflammation. A lot of experts and doctors who “get it” speak about reducing it, which “feels” like the way to go, but I think there is a lack of practical advice about some very basic items for us Average Joes regarding the topic:

    What in your opinion is a solid comprehensive definition of inflammation?
    What are the most common forms of inflammation among us struggling Avg Joes?
    How do you know if you’re systemically inflamed? What are the signs? Can you specifically test for it?
    What can be done to specifically target and/or reduce inflammation?

    Like I said, I’m on board with the concept, but we need you guys to break it down so we know better what it means, how we know we have it and how it specifically relates to diet. I’m sure it’s a complicated, not fully understood topic so far but any more insight you can share?

    (reply)
    • Peter Attia  August 4, 2012

      Too many questions for a simple answer. Worth of own post. Will get there, but not for a while. Check out Robb Wolf in the interim.

  62. Kristen  August 3, 2012

    I came across your RadioLab randomly and was very interested, because for about two years I had already been on a high-fat, low-carb, no-sugar diet. After becoming enthralled in the topic and reading your blog often, I ironically was diagnosed with hypobetalipoproteinemia (my LDL is 17). I looked back at previous cholesterol tests and the one I took when I was a vegetarian/mostly vegan had my LDL at 47. How does that make sense? p.s. I am kind of freaking out because the doctors in KC espouse “the lower the better,” without taking into consideration how low LDL is linked to pre-term birth, suicide rates, and neurological disease. It is seriously annoying.

    (reply)
    • Peter Attia  August 3, 2012

      Kristen, it’s hard to really draw great conclusions from a lot of these data because they are very observational, as you know. Also, don’t forget that lower LDL-C and LDL-P are not the same thing.

  63. Jim Georgopoulos  August 7, 2012

    I just got around to viewing your presentation, Peter. Great summary of where we are and how we got here. I’m visiting family in Greece and just yesterday I fell into the trap of getting into the argument “saturated fat=bad”.
    Anyway…I think you know you have a long way to go. These myths and half-truths are now part of the mainstream.
    Objective researchers, such as you and Gary, are doing everyone a great service. Some of us appreciate that service right now and some will in the future.
    Great presentation!
    Keep it up.

    (reply)
    • Peter Attia  August 7, 2012

      Hopefully this presentation can help you in your discussions with friends and family around this topic.

  64. T.Low  August 8, 2012

    Dr Attia,

    Thanks for putting together an amazing blog and a stellar presentation. I came across your blog 2 months ago and I’ve spent every evenning reading it late into the night (mostly reading things three and four times over, as I can be a bit thick about science). Incredible. I don’t want to open a politcal can of worms, but the issue does make me think of the Keynesian Avalanche. http://www.youtube.com/watch?v=6ubTQfr_tyY

    I too have been fit and ahtletic all my life and still managed to see my weight climb to a whopping 240 lbs by last New Years (2012). At 47 yrs old and 5’11, the final straw was not being able to fit into my $1,000 GoreTex Drysuit. A ketosis based diet has been responsible for me losing 55 pounds this spring and finding your blog gives me great hope for the future. It’s great to have my Mojo back.

    Question regarding the infamous old clogged artery arguement: Would it be accurate if I were to simply say (at one of our post mountain bike ride BBQ’s) that there is more than enough L-Argenine in my bacon cheeseburger and grilled broccoli to produce Nitric Oxide to improve my blood vessel dilation and maintain healthy arteries?

    Keep up the great work. Thank you so much for your time and efforts.

    T.Low Tom

    (reply)
    • Peter Attia  August 8, 2012

      I’d ask the question this way: can someone point to the evidence that the saturated fat you eat (or cholesterol, for that matter) is ending up in your arteries?

    • T.Low  August 9, 2012

      Oops on the video link. Wanted to link to the Hayek/Keynes Avalanche video . Yeow.
      http://www.youtube.com/watch?v=d0nERTFo-Sk

  65. Mark Hoheisel  August 9, 2012

    It may be giving the mainstream dogma too much dignity, but I think there’s a useful analogy to the classic breakdown of the Ptolemaic earth centered model vs. the Copernican. [yea it's only been around since the 60's but it's accepted so thoroughly it might as well have been around for centuries]

    The stream of newly discovered problem or protective food categories…like Fiber, Red Meat, Alcohol, Salt…are really all “epicycles”. Ptolemaic earth centered models were pretty sophisticated at predicting the movements of planets..but they had to be tweaked with new “epicycles” and exceptions quite often when they failed to predict something…so epicycles and exceptions kept accumulating for every new anomaly. Eventually the complexity became an issue in itself and set the stage for a paradigm shift to the sun centered model that could account for the facts more simply.

    When some “paradox” arrises like the fact that the french consume lots of saturated fat but have lower heart disease rates…there is a search to solve the “mystery” of how this can possibly be. It must be that drinking wine protects them! It can’t be that refined flour and sugar cause traditional societies to start getting a whole range of diseases because we know that fat is the culprit…so it must be the fiber that was taken out that really matters. Patients still get high blood pressure on a “heart healthy” low fat high carb diet…so we have to campaign to reduce the consumption of salt…cuz that’s gotta be it!

    The shocking importance of this little niche issue is illustrated by the fact that each time the mainstream invents some new little epicycle to cover some newly discovered contradiction…it sets off billions of dollars of consumption shifts and massive “education” campaigns.

    It may help to break through the clutter with some people to point out how the alternative hypothesis…kinda like the Copernican model, makes all these “paradoxes” and exceptions go away.

    (reply)
    • Peter Attia  August 10, 2012

      This is a great insight, Mark. Thanks for laying it out there. Important to keep this problem in perspective. I think sometimes we discount the “human” element of this dissonance because we have more technology, or better science, or more X or Y today than in the days of Copernicus.

  66. Dennis  August 14, 2012

    Hi from up here in Canada. This mornings Canadian news featured a report from the university of western Ontario wherein they compared egg yolks to cigarettes. Yes, cigerettes. I like eggs, and I eat them every morning; and I’m going to keep on eating them every morning.

    As a low carber, these kinds of “reports” drive me nuts. I know in my heart that if I could read the actual report, I’m sure I could find the flaws in it. However, as I can’t actually find a copy of the study, I can only go by the university’s press release.. They seem to be saying that the older you get, the more plaque one is going to get irrespective, but the cholestoral in egg yolks will make the natural accumulation faster.

    After all of my reading here and elsewhere, how in gods name did these scientists come up with this report? What are they looking at that leads them to these conclusions!! How does a working stiff with not much of a science background deal with these kinds of media reports?

    Anyway, my eggs are waiting and I’m off to breakfast. I like’m scrabbled in coconut oil.

    Here’s the link to what made headline news in Canada.

    http://communications.uwo.ca/western_news/stories/2012/August/research_finds_egg_yolks_almost_as_bad_as_smoking.html

    (reply)
    • Peter Attia  August 14, 2012

      Dennis, the cholesterol you eat does not end up in your arteries. Observational studies do not establish causality. 2 fatal flaws in one study = should have never been published.

  67. John Dawson  August 14, 2012

    You and Dr. Dayspring and others have said that a low carb diet improves lipids for many, but not all people. I think you estimated it at 60-70% who respond positively. We have had on this blog quite a few though, that report negative effects on their lipids. I have been wondering whether the response might be predicted by whether or not a person is insulin resistant? With the insulin resistant persons getting the positive response. So that perhaps the insulin resistance test could be used as a screen to see if the low carb diet is appropriate?

    (reply)
    • Peter Attia  August 15, 2012

      These exact questions are being asked in studies going on right now. While it make a few more years to find out the answers, the hypothesis that those whose atherogenic particles are part of an IR picture may be most responsive to dietary intervention is a logical one.

  68. Joshua Wardrop  August 14, 2012

    Of course you don’t make these allegations, but there seems to be a political and financial benefit to coming to the “convenient” conclusion when reporting these government (or government grant-funded) research results.

    Secondly, the media is clearly in bed when they’re pushing the topic as hard as they can, with no more evidence than “that branch of government implied it is so”, especially when the evidence contradicts those findings.

    (reply)
  69. K.Gopal Rao  August 16, 2012

    Spot on in all respects but one. I’m a living example of the fallacy that at the most 10% of dietary cholesterol is absorbed, and therefore the contribution to chol lebels is marginal. As an egg-afficianado, I went into an egg-whites only mode for several years when my chol (read LDL) zoomed, and such dietary controls plus statins and a rigorous exercise programme brought LDL down to acceptable levels. Voila! I thought I had the leeway now to try out eggs including yolks again, and lo and behold within a year my LDL was way up there again. Some googling led to views that about 1/3rd of the human population IS susceptible to hi chol absorption from food. Now, whether 1/3rd or less, I am certainly an example of the fact that SOME people at least DO absorb dietary chol. Any views?

    Now I have a question. Having accepted that chol per se is not the cause of atherosclerosis, and that it’s inflammation levels in the body which cause plaque formation, would it not still be sensible to try and limit chol levels since, without hi-chol even inflammation will not result in plaque. Seems to be much like a gun control situation with children in the house, when any accident is not directly attributable to the gun, only to the child, but then we know where that leads us. Likewise, the normal human body will, from time to time, suffer hi inflammation due to various causes, either external or personal. Does it not make sense to keep chol below levels wich will result in atherosclerosis in the event of hi-inflammation from time to time? Anything wrong with my logic?

    (reply)
    • Peter Attia  August 16, 2012

      No doubt. Remember, about 15% of the population actually have a “defective” ATP binding cassette G5, G8 and absorb too much FREE cholesterol. That majority of dietary cholesterol is esterified and literally unabsorbed. The important question, though, is not what happened to your LDL (I assume you’re reporting LDL-C), but what happened to your LDL-P (or apoB). Ultimately, of course, this speaks to a recurring theme on the blog…custom eating solutions are necessary for optimal health.

  70. Jacquie  August 17, 2012

    So glad to find your blog! Even though it’s been slow going trying to convince people that low-carb is an effective and healthy lifestyle, I’ve seen the idea starting to normalize a bit more among my friends/family. All of a sudden, a bunch of people I know are on the paleo diet (which is not inherently low carb, but when you cut out processed foods and all wheat/grains, of course you will naturally reduce your carb intake), and even though many people are resistant of the idea of giving up carbs, not as many people seem to question its efficacy or call it a “fad.” Amazing how the general public seems to be getting the picture while much of the medical community is still convinced that you just need to “reduce your calorie intake and exercise” to loose weight. Truly, it’s staggering. Keep fighting the good fight! :-)

    (reply)
    • Peter Attia  August 19, 2012

      Thank you so much, Jacquie.

  71. Martin  August 20, 2012

    Hi Peter,

    Reading the recent obituary of diabetes and insulin pioneer Dr. George Cahill in the NY Times I came across this very succinct explanation of what you are trying to tell people about diet and insulin metabolism. The question we have to ask is, if this has been known for so long, how has the knowledge been perverted and obscured? The answer, I guess, is the idea that fat is bad and causes heart disease.

    Could the summary of this research done 50 years ago be any more plain in pointing the way to losing fat?

    ” Among his research subjects were divinity students who were paid $300 to fast for a week and hibernating bears. Some of his most important research, in the 1960s, involved tracking the blood chemistry of people who were trying out an experimental treatment for severe obesity: total starvation, for up to six weeks, in the hospital.

    A crucial finding was that in the first few days without food, the liver starts breaking down protein to make glucose to feed the brain. But using protein as fuel can be perilous, because it is the stuff of vital organs and muscle.

    But people do survive weeks of starvation. Dr. Cahill’s study helped explain why. After about a week, the body makes another shift, and instead of cannibalizing its own proteins it starts breaking down fat into substances called ketones, which can feed the brain in place of glucose. A natural drop in insulin is what drives the shift to ketones, Dr. Cahill determined. ”

    http://www.nytimes.com/2012/08/17/health/george-f-cahill-jr-diabetes-expert-dies-at-85.html?src=recg

    Now we know that obese patients can skip the starvation and instead initiate ketosis by limiting carbohydrates and lowering insulin levels.

    Thanks again for all your good work.

    (reply)
    • Peter Attia  August 23, 2012

      Yes, Dr. Cahill really seemed to understand this problem. I’ve been re-reading some of his papers later. I’m really disappointed I never got to meet him. Similarly, I’m disappoint I never got meet Ancel Keys. While I didn’t agree with about 80% of what Keys put forth, for better or worse, these men were the pioneers of our nutritional paradigm. If I could have met anyone, though, it would have been John Yudkin.

  72. Dennis  August 20, 2012

    Hi again.

    Well it appears that up here in Northern Ontario there is no way to get an NMR profile. My doctor tells me however that I can get an Apo-b protein test included with my blood work.

    The reason I’d like a particle count is that my LDL C in my last blood work dramatically increased after going high fat. Mind you, my triglicerides to HDL C ratio went from 1.45 to .65 so I’m pretty happy with that. Still, I’d feel better getting some hard numbers on the particles.

    So in the absence of an NMR test, is the above test still worth doing, or should I drive to Michgan (assuming I can find an NMR test there :) .

    Thanks for all the work your doing here. I don’t know how many lives your changing, but you’re having a big influence for the better in our family.

    (reply)
    • Peter Attia  August 21, 2012

      Yes, it seems OHIP won’t send out for NMR, but if you get a proper apoB test, it’s almost as good. An remember, the person of figured out the role of apoB is at McGill!

  73. Dennis  August 21, 2012

    Heck, I’d have been happy to pay for it, however, the labs just don’t do them ( come to think of it that’s probably because OHIP doesn’t pay for it and there’s not enough private interest.)

    Allan Sniderman is the fellow from McGill. : I vaguely remembered that from Good Calories, Bad Calories. In fact it was that section of the book that lead me to first discuss the test with my Doctor back in march. He’s another very cool doctor. When I told him I’d been going low carb since January, he basically said ” it’s your life, live it the way it works best for you..I don’t judge.” I did not expect that response. I actually bought him a copy of Good C, Bad C. I guess I’ll find out if he read it next visit.

    One last question: the Apo-b test doesn’t tell me anything about the LDL particle subsets, only the total LDL particle count; true or false?

    Thanks again.

    (reply)
    • Peter Attia  August 22, 2012

      Correct, but that’s really all that matters, at least at the first-order.

  74. Alexandra M  August 25, 2012

    I totally missed this post for some reason, and just left a comment on the what-your-daughter-eats post that would have been better here. It looks like my question about getting a certification in nutrition will be answered in the video.

    I liked Bastiat’s quote, but I like Mark Twain’s, too – or sometimes ascribed to James Watt:

    “A lie can travel around the world while the truth is getting its boots on.”

    (reply)
    • Peter Attia  August 25, 2012

      That’s a great quote.

  75. Alexandra M  August 26, 2012

    I really enjoyed the video – or should I say “video?” I was really hoping to see YOU giving the presentation, because I imagine you being as animated and energized as you sound. I’m very surprised to read that this was your first time giving this talk. Give it a few more times and it will be killer!

    I found that I didn’t need the slides, because after obsessing about this topic for 10 years I was familiar with almost every study (and graph) you cited. I still found the talk very engaging, but it definitely needs YOU in it to go viral. IMHO.

    (reply)
  76. Mark  September 9, 2012

    Dr Attia,

    Hi. A friend pointed me to your video, and it prompted me to do a little lit search. Are you aware of these two metanalyses?

    Jakobsen, M. U., O’Reilly, E. J., Heitmann, B. L., Pereira, M. A., Balter, K., Fraser, G. E., Goldbourt, U., et al. (2009). Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. American Journal of Clinical Nutrition, 89(5), 1425–1432.

    Hooper, L., Summerbell, C. D., Thompson, R., Sills, D., Roberts, F. G., Moore, H., & Davey Smith, G. (2011). Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev, 7.

    If you’re familiar with these, what do you make of their conclusions? I’d be interested to hear your take.

    Thanks

    Mark

    (reply)
    • Peter Attia  September 10, 2012

      As with all meta analyses, “good” or “bad,” they are only as good as the studies going into them. The biggest shortcoming of studies, even prospective ones looking at SFA intake, is they are difficult to control for *other* things that often track with SFA (vs. MUFA or PUFA). Chief among these, of course, is sugar and other highly refined carbs (not necessary in the same food, as in the case of ice cream, but also in parallel). So overall, I’d say these studies aren’t particularly convincing to me that SFA is “bad.” You’ll note that the AJCN article made this point, indirectly. When you sub in carbs for SFA (even at just 5%), you increase the risk of CHD, though doing the same with MUFA was not. The Cochrane study did not find a difference in overall mortality, either.

  77. June  September 9, 2012

    Mark and Dr. Attia,
    I was not able to complete the email section required to reply to a comment above because the I could not type in the box, so I settled for putting my reply here.

    I can assure you from my education that there is dissent among the nutrition program ranks. The default answers on everything were based on the government recommendations, and while I was a student, we were only allowed to produce materials, student education etc. based on the food pyramid specifically. But, I had my core nutrition courses taught by a professor who was pro fat, along the Weston Price lines. I already agreed with this line of thinking. I knew that the problem was not fatty meat. You can imagine my surprise when on the first day, after she grilled us to see if we really knew our biology/chemistry she asked us why we thought fat was bad when it came up, as I suspect she knew it would. I had kept my tongue during my education about low fat dogma, and suddenly I had a spot of hope. I only wish I could have heard the interaction between her and the other professors, and heads of departments.

    This dissent was not limited to one professor, but the program is so competitive, if you wanted to get a spot in the program towards professional credentialing, then it everyone knew to keep their thoughts to themselves on tests and projects. I can empathize with Dr. Attia, about the pain of marking what I knew was the wrong answer to score well on an exam. I searched during my education for evidence that saturated fat was the nutritional problem it is conveyed as, and I could not find evidence. The problem is, the idea of fat is bad is so ingrained that most people assume it is unquestionable, while at the same time we are taught that we must question our assumptions and back them up with evidence.

    So please know that the nutrition/dietetics community is struggling with the same issues as the medical community, with the added burden of most physicians outranking us promote low fat.

    (reply)
  78. Gemma  September 11, 2012

    Hi Peter

    Thank you so much for your insightful website. I have had hours of enjoyment learning about the low carb lifestyle. I also purchased Gary’s book and watched a number of conferences on the topic. I’ve always felt there is so much more to the ‘energy in’ ‘energy out’ theory on weight gain and maintenance. I constantly question why some people seem naturally lean, whilst others continue to struggle with their weight, with each mouthful. It does not seem fair !

    I’ve always struggled with my own weight being nearly 11 stone at my heaviest and around 9 at my lightest. I’ve been at the lighter end for some time now but I really want a lifestyle which is not starvation and a continual struggle with cravings. I want to feel like I can comfortably be a slim person rather than battling every day! You look very healthy and lean, which is what I aim for!

    Following all this inspiration from yourself, Gary and Zoe Harcombe, Ive recently started a low carb diet. I’m eating less than about 30g a day. Plenty of meat, high fat dairy, butter, coconut oil, water and green vegetables. However I don’t feel good! I’m weak, sluggish, spaced out, feeling down and totally unmotivated to do anything. It’s really not a nice feeling ! I read that ketosis does have this effect on the body and was wondering how long it lasts or if I could do anything to reduce the symptoms?

    I’ve also come across an abundant amount of information which suggests ketosis can cause muscle loss, lead to acid in the blood which is dangerous to the kidney and bones. I’m not sure how credible this information actually is, and after reading Gary’s book, I understand how badly science can and has been interpreted. I was wondering whether you had any further insight on this or if you have any credible sources you would recommend?

    Gem

    (reply)
    • Bob West  September 14, 2012

      Gemma, I am not Peter and I am certainly not an expert, but have you looked into increasing sodium (via bullion, for example), which Peter mentions in his account of similar problems with going into ketosis? This helped me. Also, Volek and Phinney in their books (recommended on this site) have some tips on mineral supplementation while in ketosis.

      I’ve found that ketosis gives me more energy, not less, but I have had to tweak it a bit, following these recommendations.

      Hope this helps you!

      Bob.

  79. Mario  September 12, 2012

    Thank you for adding some intelligence to the topic of nutrition. I have been on the front lines for over seven years in my capacity as a health consultant working in a natural dispensary. It is extremely difficult swimming against the tide some days and there are not enough anti emetics available from the onslaught of “scientific opinion”. I don’t proclaim to know everything but my position is unique in that I see many hundreds of people and over time patterns can emerge as to what works and what doesn’t. All I’m interested in is getting at the “truth” but with so many variables I don’t think there is enough computing power on the planet to handle the job. Especially when common sense observation is neglected. Just for context, I had a massive heart attack at 36 with “normal” cholesterol levels, my doctor concluded that my test results were wrong! Fortunately a more competent doctor was able to identify iron as the culprit. I will be looking forward to more posts.

    (reply)
    • Peter Attia  September 12, 2012

      Mario, hopefully you’re on the path to truly understanding your risk factors and taking appropriate action.

    • Mario  September 12, 2012

      Yes I think I have, I could probably write a small book, it’s been over sixteen years since my attack and I have not been in better condition. I basically take the approach of treating the mitochondria since it seems to keep coming down to them. I don’t know of many disease states that don’t have some degree of defect in cellular respiration at their core. For one thing I avoid PUFA’s as much as possible especially in their denatured processed states. I’m saying this as I look out my window at the corn and soy fields the local farmers plant for animal feed. I shudder as I drive by these seemingly endless fields of corn, wheat and soy every day. Hopefully if we keep educating; the tide will eventually shift.

  80. Paul  September 13, 2012

    How do you plan to deal with the idea that different individuals/genetic groups may have significantly different nutritional requirements and/or reactions? For example, an Inuit and a South Sea Islander probably wouldn’t each do well on the other’s standard diet.

    (reply)
    • Peter Attia  September 13, 2012

      Of course. This is a given.

  81. Carthalia  September 25, 2012

    Hi Peter,
    I am posting this comment here because I believe this is related to fat consumption and after perusing a bit thought it the mos appropriate forum. I have recently discovered your blog and feel very fortunate to have done so. I’ve read through a great deal of your content, though I do have much more to read and look forward to it! I have converted my way of eating (to LCHF) and, rather than have a large proportion of protein in comparison to fat (as I’ve done in the past) I’ve adopted your suggestions and have been consuming a lot more fat in my diet (namely bacon fat, coconut oil, full-fat cream, avocado, cheeses, MCT oil etc). I am on about day 6 or 7 and noticed that this evening I’ve felt overheated, almost like I’m burning up a bit – comparable actually to how one might feel after hiking in the sun all day and getting a little too much sun exposure. I am assuming this is due to thermogenesis. Have you covered this on your blog? I did a search and found little in regards to it (unless I missed it, and in that case, my apologies). Have you had personal experience with this or have heard about other situations like this?

    I’d be most appreciative if you can shed some light on why I feel so hot! I’m considering myself fortunate in that I’m thinking it’s thermogenesis. Hope this is the case.

    Thanks for all the time and thought you’ve put into your blog. I think that it’s going to be quite a while before people start to wake up and realize what’s going on. This wouldn’t happen if it weren’t for individuals like you who, not only woke up but, took the time and concern to share their knowledge.

    (reply)
  82. Keefe  September 26, 2012

    I have a hypothesis that may seem kind of far fetched, but hear me out, even if it is a bit long winded:

    All I have is my personal anecdote, here goes: Since shifting to a Primal lifestyle, I’ve noticed I have incredible resistance to sunburns. Not just a slight increase in resistance. I went from being able to burn severely in less than an hour in UV index rating 7, to being able to be fully exposed for over 8 hours in that same UV index rating, with no ill effects. I live in Edmonton, Alberta, so we never get above UV index 7, the sun isn’t that powerful this far north.

    Hypothesis:
    Can an as yet unidentified cholesterol metabolic issues (non-optimal hdl/ldl ratio, insufficiancies, etc) leave no safe avenue for UV radiation to react with, so instead of reacting with cholesterol as intended, forming vitamin D, that UV energy is transferred to normally non-reactive cellular apparatus, (ie: DNA,) causing conditions that can lead to cancerous/precancerous epidermal events? If this is the case, is a “optimal” (as determined by the first part of the hypothesis) cholesterol panel an effective means of skin cancer prevention when compared to SPF 30 sunscreen lotions, applied as directed?

    Basically, a test of one of the laws of physics, that energy can neither be created or destroyed, only transferred, and determining if that transfer, in the absence of a properly functioning cholesterol metabolism, can result in skin cancer.

    I’m not a scientist, nor do I have a scientific background, so I am in no place to do anything but think critically and ask (hopefully intelligent) questions. Nor do I know if this is science that has already been carried out. Again, no science background, can’t read a journal to save my life.

    Is this a valid hypothesis (are there others with the same anecdotal experiences, with cholesterol panel histories to back it up) or is my experience just a statistical aberration? If this is a valid hypothesis, is this something that NuSI would be interested in delving into?

    (reply)
    • Peter Attia  September 27, 2012

      Very interesting. I have not thought of this idea before, but would be interested to hear the anecdotes of others.

    • J  September 27, 2012

      Hi Keefe,
      Your hypothesis is very interesting!
      I have very fair Irish skin and have always burned easily. Once in midsummer I got a deep red, painful sunburn on my shoulders after less than 15 minutes of exposure (that was how long it took me to realize I’d forgotten to put sunscreen on my shoulders). At that time I had vitamin D deficiency (finally it got back to normal after 4 years of supplementing). Very recently (about the last 8 months) I’ve been eating primally and I did notice that this summer I never got a sunburn. I usually slather on sunscreen thickly, but in the summers before this I’ve always gotten the occasional burn from not reapplying often enough, and this summer none. In fact for most of August I got lax about applying it and sometimes went out without any but didn’t burn. So, I think you may be on to something. And your hypothesis is really interesting. I would have guessed, if it had to do anything with diet, that it was because of better antioxidant status from eating very well, but your hypothesis would explain it much better.

    • Susan  September 27, 2012

      Interesting hypothesis. Since I’ve been supplementing vitamin D, bringing mine up from a low of 14 to a more acceptable 55, I’ve noticed a lot less tendency to sunburn. As a fair-skinned woman, I used to avoid the sun as much as possible to prevent the inevitable sunburn and skin damage; but I now take regular walks at lunchtime with my arms bared to the sun. I no longer burn and peel like I used to after even a brief sun exposure.

      I have also wondered about the relationship between sunlight, cholesterol, and vitamin D. But my question was along different lines. To wit: if our bodies use sunlight to convert cholesterol into vitamin D, does a lack of sunlight encourage the production of more cholesterol in an attempt to increase our level of vitamin D?

    • Cindy C  May 22, 2013

      Hi,

      In my reading cholesterol and vitamin D are very similar in structure, and it is said we make Vitamin D(actually a hormone) from the cholesterol in our skin. Perhaps being in the sun lowers our cholesterol. At any rate, I have fair skin and after greatly increasing my foods with cholesterol, I do not burn as quickly. I am going out in the sun now much longer without sunscreen, and consider the sun very healing.

      http://www.news-medical.net/news/2008/01/07/34041.aspx

      http://www.cholesterol-and-health.com/Vitamin-D.html

  83. Von Packard  September 27, 2012

    Peter – I LOVE your blog, so a big thank you. After finding my cholesterol was over 300, I asked a friend for some tips on lowering cholesterol, she referred me here, and I’m about three weeks into my ketogenic diet and I’m sooo happy! (203 lbs to 179 lbs!!!) I have a TON of questions, but I’ll limit it to two main things. I’ve tried to do my due diligence and searched through the blog for these answers with no result, so forgive me if they’ve already been answered :-)

    1) I’ve been doing the BeachBody Insanity workout w/ great results. I have 2 more weeks, but will continue to do it for another month after. They promote their recovery formula, which I’ve used, and it’s great as far as muscle fatigue but it’s 40g carbs! I’ve eliminated that and replaced it with a drink of 0 carb and about 8g of BCAAs, and this hasn’t been as effective in helping the recovery. A different blog I ran across: http://www.4hourlife.com/2011/06/01/targeted-ketogenesis-exercise-and-the-4-hour-body-slow-carb-diet/
    is run by a PA who advocates a ketogenic diet and Tim Ferris’ 4 hr. system. He discussed how the glucose after the workout is important with a high intensity workout, and a large amount of carbs associated with the workout is okay and won’t knock you out of ketosis. My question is basically if you would agree with that, your thoughts on a recovery drink, it’s components, how important is glucose for this phase? Any thought would be appreciated!

    2) This is piggybacking on this blog post (the last one was more of the 9 part cholesterol). My girlfriend & her mom are both RNs and very fit & healthy, and they are FREAKING out about my diet! I can’t eat anything when we go to her mom’s house because she’s so intent on the traditional no/low fat, no red meat, no egg yolks, lots of “complex” carbs, etc. uggghhh She literally thinks I’ve signed my death certificate!!! I’ve tried to gently steer them to your blog and other studies I’ve found or ask them how they know what they know, but they just won’t take the time to educate themselves and just say “I’m a nurse and I talk to doctors all day, blah blah blah”. Any advice on how to show them what I’ve learned? BTW – they just think it’s Atkin’s diet all over and don’t see a difference regardless of what I say. “It’s just another fad diet . . .”

    Oh – and congrats on NuSI!!!!

    (reply)
    • Peter Attia  September 28, 2012

      To your first question, BCAA and glutamine are probably good supplement during and after resistance workouts, respectively. To your second question, ask them what evidence THEY site to support their point…This post gives you plenty to talk about.

  84. Hemming  October 22, 2012

    Dr. Attia,

    I’ve read this post on skimmed the four about cholesterol but I can’t seem to find a definitive answer to my question.
    From what I’ve read other places, after consuming fat the level of triglycerides in the blood rises which should make the liver insulin resistant. Especially saturated fat should make the liver insulin resistant.

    How does this fit into the thinking of consuming a large portion of your daily calories as fat? I mean is there a long term risk of becoming insulin resistant due to eating animal fat, butter, cheese etc.?

    Thank you.

    (reply)
    • Peter Attia  October 22, 2012

      The data suggest the opposite, actually, for most people. Dietary fat does not increase steady-state TG levels. What happens on a minute-by-minute basis may vary, but most well-conducted clinical trials actually show that removal of carbs, especially sugars and simple ones, is the most efficacious way to reduce TG. Mine fell by 5x (about 150 to 30) with the removal of carbs and addition of fat. Remember: you are not what you eat; you are what your body chooses to do with what you eat.

  85. Samuel Burkeen  December 8, 2012

    Your slide presentation confirmed my experience. I am 65 years old, and here is a data point that seems to track very well with the study results presented and your interpretation. Two years ago my cholesterol breakdown was HDL/Tg/LDL – 74/144/135. My doctor was pressuring me to take statins and monitor my liver function. He recommended the low fat, no fat, whole grain fruit – veggy, low cholesterol diet. I did this for one year. I gained five pounds to put me at the upper end of my BMI range, but not obese. The result was HDL/Tg/LDL- 71/138/138. My exercise was constant, walk 3 miles per day, lift weights every other day, ride a bike 50-70 miles every ten days.

    I ignored my doctor and the boilerplate nutritional advice offered by my HMO and decided to do the polar opposite. I went from a no-fat, very high carbohydrate diet to a low carbohydrate diet; I counted carbs and restricted myself to less than 125g per day, which I have come to realize is really not too extreme. I made a point to eat plenty of fat and protein in the form of meat as well as fish. I started taking coconut oil as a small supplement. I slowly lost 14 pounds over six months – I did not count calories, only carbs. My weight stabilized at a BMI slightly less than the mean value recommended for my height and sex. The cholesterol went to HDL/Tg/LDL – 96/79/127.

    Is this a healthier cholesterol profile? I don’t know, but my doctor, although being alarmed at my approach, said he would have to go with the numbers. I cannot ever remember an HDL number that high. My fasting blood sugar was 95, unchanged in all of this. I do not have high blood pressure.

    If it was not for the web and access to a variety of different opinions I would be on statins right now and at least 14 pounds heavier.

    (reply)
    • Peter Attia  December 8, 2012

      Thanks for your comments, Samuel. If I could just understand one thing, it would be this: for what % of the population is the experience you just described the expected one? Is it 50%? 75%? More? Less?

  86. Richie Graham  December 17, 2012

    Looks like you and Gary Taubes have it all wrong, Peter. The reason for the French “paradox” is that they eat Roquefort cheese. God help us.

    http://www.telegraph.co.uk/health/healthnews/9749949/The-secret-to-why-the-French-live-longer-Roquefort-cheese.html

    (reply)
  87. Bruce Berry  January 10, 2013

    I’m trying to assimilate as much as I can of your excellent cholesterol series – but still stuck on – HDL particles are much smaller than small LDL, so why are they not seen penetrating arterial walls even more readily than LDL ? It seems to me a weak idea that penetration occurs just because LDL particles are small, I mean they are naturally occurring at some concentration, even if normal may not be well established. I have to wonder if there is not an initiating injury or insult that is opening the door for these, or they are in fact supposed to enter, but the injury repair process is dysfunctional, so they continue building, etc. What if an arterial epithelial cell can’t make cholesterol quickly enough for timely repair, so it “calls for” additional cholestererol resources from the blood. But then something goes wrong…
    Second, after 1 yr on LCHF, I seem to have OK blood work (TG 0.64, HDL-C 2.4 mmol/L) , except for LDL-C of 6.9 mmol/L (267 mg/dL). I will get the LDL-P number done for sure, but I’ve no reason to believe I fall into a discordance pattern such that LDL-C number is an overestimate by factor of two or more…. any thoughts ?

    (reply)
  88. Bruce Berry  January 10, 2013

    oops – I guess that should be “endothelial”

    (reply)
    • Peter Attia  January 12, 2013

      They do penetrate. The difference is that they do not get oxidized when they are there and do no elicit an immune response, likely because they don’t carry apoB n their surface.

  89. Grace  January 24, 2013

    Good Eve! I have been low carb for over 2 years with a few slip ups. I went from 148 to 118 in a 4 month period on a 40C/40P/20F ratio. I have maintained this for just over 2 years. I have been reading quite a bit about the LCHF method and really feel it is the way to go..However, like many I just can’t get over the fact that the fat isn’t causing any damage…I know this is from many years of hearing “cut fat, lower fat”. I just started this weekend and have lowered my carbs from between 90-150 to about 50ish and have increased my fat by double 120ish. I am still working on the protein fat ratio (again I think it is actually a mental block not allowing this :0). I am going this week for a staring point for my labs. My last one in July was great. So I am curious how this one will be as well as one 6 months from now.

    So my questions for you are…
    my info:I am femail, 5ft, 44 and currently 120. I am active (I climb a local mtn 4-5/wk, climb a loacl set of stairs 1-3/wk, and a 4mph walk 1-2/wk. I normally do something every day with an occasional break. I eat very healthy (with the exception of nuts, can’t get enough nuts). I have been caught up in the eat your grains hype…was so hard to give up my daily unsweetened oatmeal with blueberries.
    -How do I get past the fat conspiracy?
    -Do the calories have anything to do with entering ketosisi or is it only about the carbs?
    I am tying to loose that last 6-8 lbs but am totally stuck (which started my research on the LCHF, paleo, etc methods).

    I think that is all the info you need but I really want to enter ketosis and get rid of this last few lbs. I also want to continue the lchf lifestyle once the weight is gone. It really works for me and so far I feel great, except I find myself pinching my fat making sure nothing new is sneaking up on me :0)

    One other Q, I can not find the DEXA scan at SDSU anywher. Can you update that link?

    Thank you so much!! I love your blog, the info you offer, your journey and your inspiration and support.

    (reply)
    • Peter Attia  January 24, 2013

      Wait until I finish the ketosis series before you decide you want to do it. Ketosis does not guarantee fat loss. The SDSU site is called COHP. If you google some combination of SDSU DEXA and COHP you’ll find it.

    • Grace  January 24, 2013

      Thank you!! But do you still reccomend the LCHF way of eating (for non ketosis) or is that only for ketosis? Sorry I have read all of your posts but I kind of got lost at one point. :0) Thanks again for your help!

    • Peter Attia  January 24, 2013

      I must be doing a horrible job of writing this blog :)

  90. Grace  January 25, 2013

    NO! You are awesome…I think I am on info overload. Think I am trying too hard!.. Have a good eve!!

    (reply)
  91. mhikl  February 11, 2013

    Brilliant! At first I wasn’t sure I’d learning anything new (I do an inordinate amount of studying) but that I can ignore LDL is a big one (though mine is low) and that regular cholesterol numbs tell you nothing, a bigy too. My HDL is 4.4 mmol/L – don’t know US measure – triglycerides 0.9 mmil/L. I do a Ketogenic raw Paleo moderate protein, low carb diet, which I suspect, is the diet Ansel ate when not being observed. :) He lived to 100- where is the justice?
    Science is scary as I suspect even scientists don’t understand the scientific method when their jobs and reputation among their peers are at stake.
    My younger brother has just had a heart attack and has diabetes and follows his doctors orders to the T, always. It is distressing when the answer falls on deaf ears.

    (reply)
  92. Joe Chambers  April 14, 2013

    Peter,

    I’m extremely interested to hear your take on the latest studies about carnatine in red meat and pork being a key factor in endothelial vascular damage via metabolism by our gut bacteria.

    I find it interesting in that it supports the idea that saturated fats and cholesterol are ok as you and others have been saying, but still suggests that red meat, though not beef fat, is something to be avoided.

    (reply)
    • Peter Attia  April 15, 2013

      See my FB and Twitter links to the analyses by Chris K and Chris M.

  93. Dawn Randolph  May 6, 2013

    I did not know about your site or adventure until this month, May 2013. My question is about following this food intake approach without a gallbladder and with psoriatic arthritis. I know plenty of people in my situation. In April 2010 I went cold turkey off all wheat and grain, primarily I had done lots of research about my joint pain, joint swelling and weight gain and was very sure I had psoriatic arthritis (confirmed by a rheumatologist a month later). So I took myself off all grain based food as well as all foods containing gluten. Meats, a little veggies, lots of cheese and dairy. By mid fall 2010 I had lost 20lbs, joint pain gone and no meds. My rheumatologist was astonished. She still is to this day. I thought I had found my food balance which very much mirrored your approach.

    I kept the weight off until 2012. Then it started creeping back up and I gained 25 lbs and was sick after most meals. By June I was in the emergency room having my gall bladder removed. Ok, the thing was now I had to lower the fat in my diet after the operation because my surgeon said I would not be able to process fat as well. I couldn’t eat wheat or gluten for sure. What was I going to eat? I lost 30 lbs and kept it off for 8 months after the surgery. Started eating rice, non gluten grains, chicken and lots of fish and more foods with sugar. The weight has all returned. Mind you I am 5’8 and usually weigh about 162, but now at 180 and 47 year old female.

    Any advice to follow this meal plan without a gall bladder and with autoimmune issues?

    (reply)
    • Peter Attia  May 6, 2013

      Take a look at the book by Volek and Phinney, “The Art and Science of Low Carbohydrate Living.” They peripherally address this issue. Not having a gallbladder does not prevent you from making bile (necessary to digest fat), it only suggests you may want to consume them in a more spread out fashion over the day.

    • Dawn A Randolph  May 7, 2013

      Peter, thanks for your quick reply. I am an avid reader and researcher and appreciate the book referral. – Dawn

    • Cindy C  May 19, 2013

      Hi,

      I have read that eating at the same time can be good for releasing bile. I have read taurine can help. I know of a person who has no gallbladder, but can handle coconut oil just fine. It is not digested the same as other fats. Here are some recommendations, although I cannot say I have tried all these, except taurine.

      http://paleohacks.com/questions/186867/how-to-increase-the-digestion-of-the-fat-you-eat#axzz2TmJ6rdJZ

  94. What's Nick Eating?  May 7, 2013

    Your talk was very thorough and engaging. You have certainly given me much to think about. I have recently adopted a vegan diet but rather than mindlessly advocate for one lifestyle over another, I’ve begun a research project to try to understand all sides of the argument. I’ve come across very compelling research to adopt a whole foods, plant based diet (e.g. THe China Study and others) but I am very much looking forward to the studies you mentioned as well as watching Christopher Gardner’s YouTube video.

    (reply)
  95. Nicky Hansard  May 8, 2013

    Hey Peter I was just wondering if you have seen the study performed on mice that were genetically modified to change which cells were affected by insulin? It is is well known that a calorie restricted diet will prolong the life of most organisms but the mice who were genetically tampered with (insulin receptors in fat cells were knocked out) lived 18% longer, they weren’t calorie restricted and they also showed less signs of ageing.

    (reply)
    • Peter Attia  May 8, 2013

      Yes, I’ve seen it. Interesting, but need to be careful extrapolating from mice.

  96. Francis  May 10, 2013

    Over the last two years, I’ve been an enthusiastic adherent to a low-carb, high-fat (quasi-paleo, quasi-ketogenic) diet and have been very impressed with the results. Early 40s male and feel better than I have in over 20 years. I’ve lost over 25 lbs, feel great, diminished hunger cravings, increased endurance etc. Based on your extremely informative blog posts on cholesterol, I insisted that my general practioner order a NMR lipid profile rather than the standard cholesterol test during my most recent phsyical. Results were, to put it mildly, somewhat disconcerting: LDL-P at 2236; Triglycerides at 61; HDL-P at 26.2 and small LDL-P at 112 (LDL size at 22.1) (overall cholesterol at 267, LDL cholesterol at 200 and HDL cholesterol at 55). I take some comfort from my triglyceride, HDL cholesterol number and small LDL-particle number, but – taking your admonishment to heart that LDL-P is the most important number – I am concerned about my results. I know there is some disagreement / controversy on whether small LDL-P is really the number to focus on (i.e., large, fluffy LDL particles pose little risk of peneterating the arterial wall). I know from perusing the Web that this is not an isolated reaction to a low-carb, high-fat diet. Any thoughts or recommendations? Or ideas as to what might be driving the high LDL-P number? Might be worth a future blog post! Thanks for everything you do – your blog post is awesome!

    (reply)
    • Peter Attia  May 10, 2013

      Yes worth a dedicated post, probably part X of The Straight Dope…

  97. Cindy C  May 19, 2013

    Hi Peter,

    I read this article today, in that lowering cholesterol interferes with weight loss, and the burning of carbohydrates(basically damaging the mitochondria).

    http://www.fool.com/investing/general/2013/05/18/pick-your-poison-overweight-or-high-cholesterol.aspx

    As a side point, I looked up John Thyfault, and he was one of the authors of a study shown here. Were you able to read that study, and did he end up saying people have diabetes from sitting in a chair?

    http://onlinelibrary.wiley.com/doi/10.1111/dom.12105/abstract

    http://ns.missouri.edu/faculty_thyfault.html

    Thanks for all you do.

    (reply)
    • Peter Attia  May 19, 2013

      I don’t agree with this as the cause of diabetes. It may be an effect, though.

  98. Stephen Q  May 20, 2013

    Hi Peter – thanks for your postings and talks – especially thank you for avoiding as much hype as you do. I am still wading through the information you provide, having started LCHF about 7 months ago. I too look forward to part X of the ‘Straight Dope…’ and the next posting on ketosis. And if you talk about why the cholesterol numbers go up for so many people (mine too) that would be good to read.

    Here is a thought:

    in the current environment of ‘Crowd-sourcing’ perhaps NuSI would be interested in collecting, collating and analysing the information from people who could give information on diet and their lipid profile.

    (reply)
    • Peter Attia  May 20, 2013

      Interesting point, which I’ve thought about off and on. No immediate plans, but it’s no my radar.

  99. Debbie  July 30, 2013

    The LCHF diet is driving my cardiologist bananas. He has basically said go away till you have your heart attack. I am a Wolfe Parkinson White ablatee, and n of 1. I found that when (post ablation and pre ablation) I exercised and my heart rate went up, arrhythmia occurred, preventricle and preatrial contractions. I would then have shortness of breath and several other cardiac symptoms. On the low carb diet I do not have arrhythmias. I use an r-r heart monitor to figure out if I am having arrhythmias. I feel incredible – now I can go on 12 mile hikes above 11,000 ft and feel great (I live in CO). The experiment is repeatable – go home at Christmas time eat carbs, arrhythmias return when I exercise. Have biscuits and gravy for breakfast – can’t exercise or hike.

    I have genetic “high” LDL’s, “high” total cholesterol, “high” HDL’s via standard lipid measurements. As a geophysicist, I knew what an NMR was and I know that cholesterol is a volume test. Since the research is implying that small LDL’s are problematic and big ones are not, I had the measurement of cholesterol by NMR done. I found that I have high LDL’s but very low small LDL’s. Plus my high LDL’s are not as high as the LDL C would imply – the total volume of LDL is high cause the particles are big not small. My doc wants me on a statin and low fat diet. I want to stay on LCHF eating – we have parted ways.

    Since I have several friends with cardiovascular disease and we all exercise at higher levels (not marathoners – ski patrollers) who have “good” cholesterol levels and have had heart attacks or multiple artery bypass; I do not feel that LDL C or HDL C alone are good measures. I think you need to have a correlative test of cholesterol by NMR to determine your risk. Is this your experience?

    The lab that does cholesterol by NMR also calculates an insulin resistance versus insulin sensitivity measure from the lipid results. There is no direct measure of glucose or insulin in the test. Is it your impression that insulin sensitivity/resistance could be reflected in the lipid profile?

    I have 9 months of excel spread sheets with nearly everything I ate in grams, with the breakdown of fat, protein, carb, fiber, cholesterol and Na grams, and liquids. My doctor was impressed with the accuracy but not the 80% fat diet. 3 cholesterol tests – one after 10 g or less saturated fat per day, one after 20 g or less saturated fat per day, one after over 20 g saturated fat per day and the NMR cholesterol after the >20g sat fat.
    In general Triglycerides go down with higher saturated fat, HDL’s go up with higher saturated fat, around 20 – 30g being my required amount (feet are warm at night when I eat more than 10g saturated fat).

    Are you interested in an n of 1, doing LCHF because of electrical issues? There is also an electrolyte component to stabilizing the arrhythmias but it is minimal. I can be very low on Mg, K or Na, if I am ketotic then I do not have arrhythmias – just feel poorly.

    (reply)
  100. Kevin  August 11, 2013

    Hi Peter,
    Thank you for this very insightful presentation. I completely agree with the thinking (and have adopted your dietary suggestions for my whole family for the past 1 year) but wanted to get your advice regarding the need of cholesterol-lowering, blood-thinning, and blood pressure lowering drugs after angioplasty surgery. Conventional doctors strongly urge the need of these drugs otherwise the arteries could be easily clogged near the stents. Do you agree with the need of these drugs given the circumstances?

    (reply)
    • Peter Attia  August 12, 2013

      Any and all of these treatments have some merit, but most likely they are far more ubiquitous than necessary.

  101. Russ Scott  August 13, 2013

    Here’s something for you to ponder… at 27 years old, weighed (if I remember correctly) about 200 pounds, at 6’2″. I could run a mile in less than 6 minutes. Could run TEN miles in (roughly) an hour… ate well (at least I thought I was). Ate proteins (chicken, fish) took supplements (protein, amino acids, efa’s), some vegetables. Yet, I had a heart attack. My cardiologist said, “we did a blood test. your good cholesterol (hdl) was a little low, but not enough for it to be a concern. your BAD cholesterol (ldl) was WAY too low.” that’s ALL I had received for information as to why. of course, he asked all the standard questions, “do you do…” drugs, drink, smoke, marijuana (which i thought fell into the category of drugs), cocaine… all answered with a resounding “no, I don’t.”

    (reply)
    • Peter Attia  August 13, 2013

      Impossible to know without real data.

  102. Mihir  August 28, 2013

    Hi Peter,

    I’ve been reading your site for a few weeks now and thought I’d post after getting my most recent lab numbers back. I’ve been doing LCHF for about 3 months now and feeling great otherwise. As expected, my LDL (calculated) went up a bit and triglycerides (245 to 114) plummeted. However, my HDL actually went down (from 45 to 33). It was a bit disappointing to see the drop in HDL.

    I have lost quite a bit of weight (of which I’m sure some is lean muscle). I’m interested in knowing if this initial drop in HDL is normal?

    Thanks.

    (reply)
    • Peter Attia  August 28, 2013

      No, quite atypical, actually. Definitely worth re-checking in time.

    • Mihir  August 28, 2013

      Can you think of any reason this would happen? Too much protein? Not enough fat? I’ll admit my exercise level is far from optimal, but I don’t think that would have an effect on HDL levels. I’ve been scouring the internet, but I can’t find anyone that sees a drop in HDL after starting LCHF.

      I am a Type 2 diabetic and currently taking Metformin (2000mg/day). Don’t know if that would make a difference. I do supplement with fish oil (750 DHA 1250 EPA) and various other supplements. I’m just at a loss here. Any thoughts would be greatly appreciated.

      Thanks.

  103. Dennis  November 15, 2013

    Doctor Attia, hope I’m not of topic, but I was wondering if you were familure with the book “Grain Brain” written by David Perlmutter. He seems to agree with many of you thoughts on cholesterol as well as some of the other topics on your site. He also seems to go a little further than reducing carbs and suggests a gluten free diet. If you are familure with his work, what are your thoughts. thanks

    Dennis

    (reply)
    • Peter Attia  November 15, 2013

      I generally think his work is sounds.

  104. Crystal  November 18, 2013

    Funny I came upon this after reading about the myths and such. I don’t understand why our government is continuing on these rampages without educating themselves. OK I was also confused, trans fats? They are taking them out of foods, what would this mean for us? I eat my butter on my white bread, with my eggs, my milk and my home grown bacon. Not sure if it’s good or bad but at this point who the hell knows. Trying to follow trends turns your brain into scrambled eggs. So screw it, they act like they are trying to make us healthier instead they are causing us to give up…

    (reply)
  105. Shaun Wiegert  February 27, 2014

    I just wanted to say thanks for all of the great information. I have been engrossed by your webpage for 3 days now whenever I have a free moment. Gotta love technology these days that allow us to fill our brains with knowledge at any moments notice. Anyhow I read about a lot of this type of information a few years ago by a gentleman named Lyle Mcdonald. He has a page http://www.bodyrecomposition.com/ that shares a lot of the same feelings as you do. The first time I read his blogs, It was hard to believe what I was reading. Now having read your Blogs I have a lot of faith in what I have been reading.

    I am just now getting back into shape after a few years of being out of construction. You have helped me tremendously with deciding on diet plans for this year. I had almost forgotten about the fat is not bad and the carbs are the enemy. I have always believed somehow that sugar is one of the worst drugs in the world that many americans are simply addicted to. Thank you again for all of the GREAT information you provide! I wish more people could and would read these pages.

    (reply)
  106. Mark  March 4, 2014

    From the “Saturated Fats Q&A” on the American Heart Association, I see this: “Eating foods that contain saturated fats raises the level of cholesterol in your blood. High levels of blood cholesterol increase your risk of heart disease and stroke. Be aware, too, that many foods high in saturated fats are also high in cholesterol – which raises your blood cholesterol even higher.” That’s on the AHA website. Today. Right now! I just stumbled upon it. I’ve read some of your pages on cholesterol, Dr. Attia, and I’m interested to hear where your commentary might begin with regard to this content from the AHA.

    (reply)
    • Peter Attia  March 4, 2014

      You should watch the video embedded in this blog post.

  107. Margaret Ruesch  March 24, 2014

    Hello Dr Attia,

    I am 64 year old female diabetic for 20 years, overweight, with controled A1 but by taking lots of insulin and metformin. Also on BP meds and stantins. I started hflc about 10 days ago cutting out sugar AND wheat and also stopped taking statins and triglyceride lowering drugs and BP meds. I reduced the insulin to only long acting stuff mostly, and much less of the quick acting insulin. I check my blood many times during the day, 3 times minimum sometimes more. I was able to reduce the very low readings and found NO readings higher than 200 blood glucose. I check often because I have not had insurance until recently and was my way of self regulating.

    I then had blood tests done because it is the time of year to see my doctor. I get a frantic call from them asking me if I was still taking my drugs because my triglycerides were so high. Well no. I have been enjoying bacon and cream for the last 2 weeks and results are CHOLESTEROL 115 – 200 mg/dL 423 TRIGLYCERIDE 10 – 149 mg/dL 1596. I have always had high triglycerides and never could find answers for this until I read your information. Also, my GRF is 63 up from 50. (BTW why were they not super concerned when it was 50 ???? 18 months ago – my new doctor wants me to get kidney counciling and heart counciling).

    So, I believe in your theories – have had an education bar none in the working of insulin resistance and cholesterol from your work. I will have to face these doctors soon and have to try and get them to work with me. Can you tell me how long it will take, or give me an idea, for my triglycerides to go down while continuing on hflc diet?

    Thank you for your inspiring work.

    (reply)
  108. Lorenzo  May 30, 2014

    Hi Peter, love your work. I was also diagnosed with Metabolic Syndrome/IR and is been a year that I lowered my carbs especially simple ones. Recently, I completely stop eating any form of sugar and limiting my carbs to a keto level. I feel great right now but I Just want to ask you about weight lifting and limiting my protein intake. How is this going to affect my muscle development and what could i do about it. Thanks for all your effort you have done since you started.

    (reply)
    • Peter Attia  May 30, 2014

      Only reason to limit protein (typically to 120 or so g/day) is to be in ketosis. Not necessary for other benefits of CHO reduction.

  109. Al S.  June 23, 2014

    Peter,
    Just saw this article in The Scientist re triglicerides and a genetic mutation (based on an article in Forbes):

    http://www.the-scientist.com//?articles.view/articleNo/40312/title/Mutation-Tied-to-Reduced-Heart-Disease/

    A quote from the article:

    “In medical school we were told to ignore triglycerides and focus on [high-density lipoprotein],” Ethan Weiss, an associate professor at the University of California, San Francisco, School of Medicine, told Forbes. “It turns out that we probably had it backwards, and that we should be paying attention to triglycerides and ignoring HDL.”

    (reply)
    • Peter Attia  June 23, 2014

      He’s sort of right and sort of wrong, but mostly missing the point. Low HDL-C and high TG are bad, but largely because they are markers for inefficient transport of CE in apoB lipoproteins.

  110. Jack  July 31, 2014

    Hi Peter,

    I was randomly browsing and I came up on a site called “direct labs”. I see that they have a “10 Most Important Tests” and I wanted to see if you had an opinion of whether these tests are BS or important/ My main goal is to get the Lipid NMR test done and also seeing if there are any other tests I can do, just to see where I stand on a health scale. I am 28 years old.

    Thank you

    https://www.directlabs.com/OrderTests/tabid/55/language/en-US/Default.aspx

    (reply)
    • Peter Attia  August 1, 2014

      Most important tests for what?

    • Jack  August 1, 2014

      I wanted to know with your knowledge, which tests/blood work should someone should have to make sure the body is working “properly” and if there is any room for improvement.

  111. Brooks  August 27, 2014

    A saying of my H.S. football coach:

    Foolish is the man who has absolutes! Wise is the man who understands his absolutes are his faith.

    I was a medical student and later a surgery resident at the U of MN during the ’60’s and early ’70’s. I remember having to memorize the Krebs cycle and minimal attention fat metabolism but remember betahydroxybuteric acid and acetoacetic acid. We learned calories/ gm. and that a diabetic diet should be about 40-30-30%. That was about it for training in nutrition aside from vitamin deficiency diseases. Dr. Ancel Keys was a full professor and at his peak with his lab tucked away in the bowels of the Gopher football stadium. We didn’t get one lecture from him and if I saw him, didn’t recognize him.
    Question Peter:
    What is your opinion of the Budwig protocol—Flax and cottage cheese?

    Brooks FACS

    (reply)
    • Peter Attia  August 28, 2014

      It needs to be tested in clinical trials.

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