Carbs Kill? Fat Heals? What does PURE Really Say?

Are you still confused about all the contradictory advice on fat and carbs? We have been told for decades that low-fat is best when it comes to our health.  Turns out, that was pretty bad advice.

 

We now have even more evidence showing that fat certainly isn’t “bad,” and it is probably beneficial for our health. Carbohydrates, on the other hand, are trending toward the “bad” side and may need to be reduced.

 

Confused? I don’t blame you. Read on for more info.

 

First my usual disclaimer.

 

We do not eat fats and carbs. We eat food. A wonderful combination of macro- and micronutrients, including fat and carbs. Whole grain bread, farro, quinoa can all be labeled as carbs. So too, can bleached white bread, French fries, Cheetos, and cookies. They are all carbs, but I guarantee you they are not all the same for your health.

 

Grass-fed steak, wild salmon, and avocado can all be labeled as fat and protein. So too, can deep fried chicken, processed lunch meats and others.  Do you see where I am going with this?

 

The Study

 

With that disclaimer in place, let’s talk about the new study released in the Lancet and presented at the European Society of cardiology Conference earlier this week. You may have already seen the headlines, “Low-fat Diet May Kill You!” “The Low-Fat, Low-Carb Question Has a New Answer.” And others. As usual, the truth is never as exciting as the headlines, but it is still worth exploring.


This trial followed over 135,000 subjects from 18 countries for over 7 years. Researchers recorded nutritional intake through standard questionnaires (which are subject to errors as I’ve mentioned before), and investigators followed the subjects, noting who died, who had heart attacks, strokes or heart failure.

 

The short answer is that the group with the highest intake of carbohydrates (77% of daily calories) had an increase in their risk of dying when compared to the group with the lowest intake of carbs (46%). Interestingly, their risk of dying from heart disease was not increased, but their overall risk of dying was increased.  This was mostly driven by cancer, respiratory diseases and dementia.

 

Intake of fat, on the other hand, was associated with a lower risk of dying. This held true for saturated fat, monounsaturated fat and poly unsaturated fat.  There was no significant change in the risk of cardiovascular disease, but again, total mortality was significantly improved.

 

What can we make of all this?

 

It is important to remember that this was an observational trial. It doesn’t prove anything. It shows a very interesting association, but there is no way to control for all the variables that could influence the outcome (as an aside, the same caveat applies to all the prior observational trials condemning saturated fat).

 

The subjects filled out a food intake questionnaire at the beginning of the study, but they were not followed over the seven years to see if their food intake changed. That can certainly introduce inconsistencies in the data.

 

Also, the study lacked many nutritional specifics. What kind of carbs were the subjects eating? Something tells me in the high carbohydrate group, it probably wasn’t sweet potatoes, buckwheat, quinoa, and amaranth. The higher the overall intake of carbs, the more likely their diet included poor quality carbs. Food quality matters.

 

Nonetheless, increasing carb intake seemed to go along with increasing risk of death. That association was clear. Conclusion #1, therefore, is to reduce our carb intake. My editorial is to reduce your low-quality carb intake, although that was not specifically studied.

 

Increasing fat intake, on the other hand, was associated with a reduced risk of death.  The group eating 35% fat had a better survival than the group eating 10% or 18%. Importantly, increasing fat intake was not associated with a lower risk of cardiovascular disease. But it wasn’t associated with a higher risk of cardiovascular disease either. It was neutral to heart disease, and beneficial to overall mortality.

 

Picture your doctor telling you a pill won’t change your risk of heart disease, but will reduce your risk of dying. And it’s only side effects are enjoying it as you ingest it, it gives you energy and nutrients, and helps you feel full. Sounds like a pretty good pill to me! Sign me up. Only in this case, it wasn’t a pill. It was dietary fat.

 

Conclusion #2, therefore, is to not fear the fat. Adding fat can be a benefit, especially if (again, my editorial) it is high quality and helps you reduce your carb and overall caloric intake.

 

There is Another

 

Based on most social media headlines, one may think that this was the only PURE study. It turns out, there was another one.

 

The other PURE study involved the same group of individuals, but it investigated overall fruit, vegetable and legume intake. The researchers found that three-to-four servings per day of fruit, vegetables and legumes was associated with the greatest decreased risk of death.

 

Interestingly, adding more was of no further benefit, but eating less was a lower benefit. This likely did not get the same media attention as the low fat study since the benefits of eating fruit, vegetables and legumes is much less controversial, and not surprising at all.

 

Should anything change from these studies?

 

Yes and no.

 

Real-foods like veggies, fruits, beans, legumes, nuts and seeds are a great place to start for most people. Hopefully we already knew that.

 

Fear of fat should get squashed. Fat is not inherently dangerous. Hopefully we already knew that as well.

 

Concern for too many carbs should be a hot button issue. Hopefully we already knew that also!

 

What may change for some people is further increasing the fat (up to 40+% of daily calories) and animal sources in your diet, and further limiting the carbohydrate sources (down to 40% of calories). Go ahead and add fish, meat, chicken, eggs, milk, olives, olive oil, avocados and avocado oil to your diet. Especially if your diet is based on veggies, fruits, beans, legumes, nuts and seeds. The evidence supports it.

 

Be careful of over-generalizing these results. Many details are missing, and observational trials cannot control for all the important variables. But since this is the best evidence we have, we still should take note.

 

Will this be enough to change national nutritional guidelines? That seems unlikely. Bureaucracy is much slower to move than individual recommendations. On an individual basis, not many people follow national guidelines anyway. But guidelines do impact governmental programs (i.e. school lunches, etc.), so my hope is that they will take note and start to change with the tide.

 

My advice?

 

Eat foods that make you happy. Eat foods that fit with your traditions. Just make sure you follow the concept of eating simply prepared, high-quality, real foods. Don’t over-do the carbs, and don’t underdo the fats. Start there and you are well on your way.

 

Interested in more information? Listen to my podcast, The Boundless Health Podcast here, read more of my blog here, learn about my book, Your Best Health Ever,  here, or The Boundless Health Membership Program here. My goal is to provide helpful information through multiple avenues to make sure you get what you need to live Your Best Health Ever!

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

Coconuts are Driving Me Nuts!

How does this headline sound to you?

“Newsbreak! We have no new information about Coconut Oil, but we have a news alert that we still think all saturated fat is bad for everyone.”

That is the real story behind the headline “Coconut oil isn’t healthy. It’s never been healthy” that has grabbed the attention of millions.

The American Heart Association released a statement that, to summarize, says:

  1. Coconut Oil is a saturated fat.
  2. Saturated fat can raise LDL.
  3. High LDL has been associated with increased risk of heart disease.
  4. Therefore, coconut oil will increase your risk for heart disease

Is there any direct proof that coconut oil is dangerous to our health?

No.

Is there any new evidence directly linking saturated fat to heart disease?

No.

Can we say that because “A” is true above that “D” has to be true?

No way.

But that sure is an attention-grabbing headline to try to connect the dots.

What Evidence?

Don’t get me wrong. It’s not like the AHA is making this up out of thin air. They are basing their opinion on decades of science. Decades of poor quality science. But since that was all the science we had for years, you can see why they came to the conclusion.

LDL cholesterol is an important part of the puzzle when it comes to your health. But it is exactly that. One piece of a very complicated puzzle.

What else does saturated fat do? It raises of HDL. For many, the total cholesterol-to-HDL ratio remains the same.  Does that increase the risk of heart disease? There is no good data to support that claim, but likely not.

Let’s look at it another way.

Is an LDL of 150 dangerous? That depends. Are you overweight, sedentary, have a diagnosis of metabolic syndrome, eating a high inflammatory diet, and have a strong family history of heart disease? Then an LDL of 150 likely is dangerous. And you likely also have a low HDL, high triglyceride level (TG), high blood sugar etc.

On the other hand, do you eat real food, mostly vegetables with appropriate portions of animal fats? Do you exercise, manage your stress, and have few if any other cardiovascular risk factors? Are your HDL, TG and glucose levels near ideal? Then that same LDL of 150 is likely not as dangerous for you.

It is misleading to suggest one size fits all.

(For more details on the saturated fat debate, and why the data is not as clear as most seem to think, see our prior article on the topic here.

Unfortunately, the American Heart Association discounts the evidence that shows no association between saturated fat intake and cardiovascular disease.  They continue to promote industrial, processed oils over natural fats. Again, rooted in decades of science. Poor quality science.

Both Sides Fail

In essence, the attention-grabbing news flash is simply restating the AHA’s longstanding position. There is nothing new.

To be fair, however, do we have good evidence saying coconut oil is healthy?

No, we do not.

Can we prove saturated fat reduces our heart disease risk?

No.

Can we believe Dr. Axe when he claims that coconut oil has 20 proven health benefits (including curing UTIs, protecting the liver and preventing osteoporosis)?

No way. That’s crazy talk.

If we are going to question the poor-quality evidence against saturated fat, we certainly have to question the horribly inadequate evidence supporting views like Dr. Axe’s.

So, what can we conclude?

We can conclude that nothing new was found for or against coconut oil.

Nothing new was found for or against vegetable oils.

Saturated fats (and by extension coconut oil) are not inherently bad, especially if they are a component of a real-foods, vegetable-based, Mediterranean style of eating.

Vegetable oils are highly processed, pro-inflammatory, fake foods that have evidence both for and against their use.

It’s all so confusing! I know. Trust me, I know.

What Can We Do?

What is someone to do in this sea of contradictory news?

Don’t believe the hype.

Focus on real, minimally processed foods.

When it comes to cooking fats:

  1. Olive oil is the best for low heat.
  2. Avocado oil is the best for medium heat.
  3. Higher heat gets tricky due to concern over smoke points.

    1. First, ask yourself, why are you cooking or frying in high heat to begin with? Can you get the same result with lower heat?
    2. If it’s something you have to do, you can choose from coconut oil, butter, ghee, and vegetable oil. Make you decision based on taste, or even better, mix it up.

Action Item: Do you want to know how cooking oils affect you, as an individual? Get your labs done (at a minimum check LDL, HDL, TG, TC, hsCRP, glucose. For more advanced testing try WellnessFX or other ways to get advanced lipid testing). Then switch to 100% coconut oil as your cooking oil for a month and recheck your labs. Review your labs with someone who has an open mind and looks at more than just your LDL number. LDL does not exist in isolation, but is part of the whole picture.  Now you know how it affects you. Individualized medicine beats general guidelines any day.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

Saturated Fat Kills! Or does it? Let the debate continue!

Dietary Saturated Fat Kills! Or does it? The Debate Rages On…..

 

A recent editorial publication in BMJ has once again stirred the raucous debate about dietary saturated fat. One subject with two completely opposing viewpoints, each one filled with ardent supporters who know in their hearts (pun intended) they are correct.

 

So……does dietary saturated fat directly cause heart disease, strokes and death? Or does it not?

 

Wait a second. This is science we’re talking about. Shouldn’t it be clear who is right? Shouldn’t the evidence prove one group right and the other wrong?

 

Nope.

 

Nutritional science is messy and rarely conclusive. That’s why we got into this mess in the first place.

 

Hooray for Debate

 

Before we get into the details, let’s all celebrate the debate itself. We should all be grateful that we can take part of an open and emotional debate among intelligent, successful and reputable individuals. Recent history has too many examples of some individuals trying to shut down debates in favor of declaring the “truth.” We all should know by now that isn’t going to fly.

 

Instead, we should celebrate every chance to debate the science and its impact on our lives. After all, we can still have free speech even if we can’t have free healthcare.

 

Bad Data

 

Here is the problem with nutritional science. It is really bad science.

 

Remember your science fair project as a kid? You were supposed to design an experiment that tested a hypothesis, controlled for one variable, and proved if that hypothesis was valid or not.

 

Nutritional science doesn’t work that way. Instead, most nutritional studies are observational studies. We observe how people live their lives, collect as much data as we can, and follow them to see who has heart attacks, who has diabetes, who lives and dies, etc. We can then see what habits each person had and try to draw statistical associations.

 

The problem is that this cannot prove anything. It can only suggest an association. When compared to your middle school science fair experiment, you can see the stark differences.

 

The observational study does not control any variables (they try to control for certain variables, but that is an impossible task especially since we can’t know all the variables for which we need to control), does not test a single hypothesis, and does not prove anything.

 

Why Does This Matter?

 

Here’s the problem. There are lots of studies that show an association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

But here is the kicker. There are also lots of studies that show there is no association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

Huh? How can that be?

 

There are many reasons why but here are the two big ones. 1- People are all different, and 2- Food is all different

 

People are Strange, I mean Unique

 

In the BMJ article, the authors propose that inflammation, not saturated fat, is the main cause of heart disease. There is definite sound evidence to support inflammation as a contributing causative factor in heart disease.

 

However, we need to acknowledge that inflammation is different in everyone. We are all unique. Our internal environments, from our degree of inflammation to our gut microbiome, are all different.

 

Therefore, how we respond to our external environment (i.e. the food we eat) is going to vary from person to person.

 

LDL cholesterol is a prime example. LDL is not inherently “evil.” Why would our bodies evolve to produce a substance whose job it is to kill us?

 

LDL is a necessary component in our cells, our brains and for making our hormones. We cannot live without it. Our internal environment, however, can alter LDL and turn it into an oxidized and inflamed structure that is more likely to cause heart disease. That may not be an inherent property of LDL, but rather, something our body’s environment does to LDL.

 

The same can be said of eating saturated fat. It is certainly plausible that introducing large quantities of saturated fat into an oxidized and inflamed environment can cause harm. But what if the individual exercises regularly, eats a veggie-first/real foods diet, practices mindfulness regularly, gets regular restorative sleep, and therefore has very low levels of inflammation and oxidation?  Chances are, the same amount of saturated fat in this individual is unlikely to cause damage (that’s my hypothesis, I haven’t don’t my science fair project on this yet).

 

Observational studies cannot tell the difference between these two types of people with different degrees of inflammation and oxidation. Instead, the trials try to reach a general conclusion that then is applied to everyone.

 

Does that sound like good science to you? I’d give it a C- in the middle school science fair (and that is being generous with extra points for their passion). Should we be making decisions about our health based on C- science?

 

We Don’t Eat Saturated Fat, We Eat Food!

 

Picture a big greasy burger on a huge bun, soaked in ketchup, with a side of fries and a coke. Observational studies call that a saturated fat eater.

 

Now picture a spinach and kale salad with beets, strawberries, walnuts, carrots and tomatoes topped with 4 ounces of grass fed steak. No fries. No coke. Observational studies also call this person a saturated fat eater.

 

I’ll say it once again. We don’t eat saturated fat. We eat food! It is crazy to think we can isolate one specific macronutrient and know all that it does. For starters, there multiple different types of saturated fat of highly variable quality with variable effects on our bodies.

 

Second, what we don’t eat (i.e. avoiding saturated fat) is just as important as what we do eat (instead, eating refined, processed, simple carbohydrates and sugar vs. veggies, fruit, nuts etc.). 

 

In the example above, the first person had a huge bun, fries and a coke. There wasn’t a veggie to be seen. Tough to pick just one villain in that so-called meal.

 

Don’t Throw It All Away

 

Don’t get me wrong. I am not about to suggest that we throw out all nutritional research. We still need it to guide future research and help us generate hypothesis.

 

I will suggest, however, that we need to be very careful about interpreting the research. Anyone who claims observational trials definitively prove anything must be seriously questioned.

 

And when they claim a “vast collection” of evidence, or an “overwhelmingly consistent conclusion” from the evidence, keep in mind that a vast collection of dog poop is still just a bunch a dog poop.

 

I respect and value ardent supporters on both side of the saturated fat aisle. But I also know that neither has the strength of evidence that their conviction conveys.

 

What Do We Do???

 

Be wary of anyone who claims they have the “answer” and the “conclusive” evidence. Try not to get caught up in all the debate if you don’t want. You can keep it simple and keep it healthy.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes.

 

If you enjoy the debate, by all means participate. It’s good for science. But here is the one and only thing I can say with absolute certainty.

 

I can’t prove anything that I recommended in this article.

 

There has never been a randomized study to prove my personal nutritional consensus. No one has done their middle school science fair project to prove my hypothesis.

 

Sometimes, we need to take a leap and say, “this makes sense.” We need to integrate all the evidence, combine it with clinical experience, and come up with our best solution.

 

That is why experts can be so passionate and so resolute in their position, and yet the positions can be so variable.

 

And that is why we need to find reliable voices we can trust. 

 

My voice? Keep it simple.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Action Item:

Identify a belief you hold to be true about nutrition. Something that is ingrained in your core that must be true. Saturated fat is a perfect example, but there are plenty others. Salt? Carbs? Juicing? Whatever you feel is undoubtedly healthy or unhealthy. Next, search online for the exact opposite position. Keep an open mind and explore what the opposing side says. This will hopefully help you understand the complexities and uncertain nature of nutritional science.

 

Then, get back to the basics and (say it with me now….) eat real food. Mostly vegetables and some fruits with healthy fats. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

 

 

 

 

 

 

Take 2 Eggs and Call Me in the Morning

“Take Two Eggs and Call me in The Morning”

(For my easy to make veggie and eggs breakfast, see the video link here)

If I gave you this advice, how would you react? Would you think I was trying to harm you?

 

Or would you realize this is sound advice as part of a healthy nutritional strategy?

 

While the latter is true, most people likely fall into the first category. We can thank governmental and professional societal recommendations for that. For years eggs have been lumped into the “fat is bad” trend that ruled American nutritional standards.

 

Here is the truth. Eggs, including the yolks, can be an important component of a nutrient dense, vegetable based, real-foods style of eating that is beneficial to our overall health.

 

Mis-Guided Guidelines

 

As recently as 2000, the American Heart Association and American College of Cardiology guidelines recommended limiting dietary cholesterol intake to less than 300mg per day. Interestingly they followed that recommendation with the following quote: “There is no precise basis for selecting a target for dietary cholesterol intake.” Essentially they admit that they just made up the 300mg limit. That doesn’t appear to be the strongest of guidelines.

 

To be fair, they felt there was a legitimate concern.  Eating cholesterol could increase blood cholesterol levels, or so they thought. In addition, they pointed out that foods high in cholesterol are also high in saturated fat, and therefore should be avoided. In a way, dietary cholesterol was vilified because of the company it keeps. Of course, now we know the restrictions on saturated fat were also misguided (see the specific post here).

 

Fortunately, the ACC/AHA has come around and their most recent guidelines state “There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL-C.”

 

That has not kept cereal makers, bread and bagel companies, and others from continuing to promote eggs as dangerous to our health and something we need to avoid.

 

The interesting and often misleading intersection of health, food, and marketing rises again.

 

Setting the Record Straight

 

It turns out, there are numerous studies that all draw the same conclusion: For the general population, egg consumption is NOT associated with an increased risk of cardiovascular disease, and does not adversely affect our cholesterol levels. In fact, there is some evidence to suggest it is beneficial to our overall health.

 

A look back at the Physician’s Health Study of over 21,000 people found that eating up to 6 eggs per week had no association with an increased risk of heart attack or death.  Eating more than 7 eggs per week in diabetics may have had an association, but beyond that, there appeared to be no harmful link.

 

Analysis of both the Health Professionals study and the Nurses’ Health Study concluded that eating one egg per day had no significant impact of risk of heart disease or death.

 

A large meta-analysis of 17 trials and over 4 million person-years showed higher consumption of eggs was not associated with an increased risk of heart disease or stroke.

 

In aggregate, there is no evidence in the general population that egg consumption increases the risk of heart disease or death. While those with diabetes may be an exception, that requires further investigation.

 

Is There a Benefit?

 

Just because something isn’t bad for us doesn’t mean we should flock to it and make it part of our regular eating habits. But is there evidence that eggs may be good for us?

 

It turns out there is.

 

For starters, eggs are packed with vitamins and minerals that our bodies need. One large egg has

  • 78kcal
  • 6gm protein
  • 5gm fat (1.6 gm saturated fat, 2 gm monounsaturated fat)
  • Fat soluble vitamins: Vit A, D, E, and K2 (K2 is very difficult to get from other common nutritional sources)
  • Vitamins B-6 and B12
  • Calcium
  • Amino acid leucine
  • Choline
  • Selenium
  • Omega 3 fatty acids
  • And more…

 

If you just eat the whites, remember that the yolk has all the fat-soluble vitamins and 90% of the B vitamins, calcium, fatty acids and other nutrients (aside from the protein).

 

Packed with that many vitamins and minerals, it makes sense that eggs would be good for us.

 

One additional benefit is that they help fill us up. Compared to a bagel breakfast with the same total calories, an egg breakfast increased the feeling of being full and reduced how many calories subjects ate the rest of the day.

 

And remember the concern that eggs worsen our blood cholesterol levels? It turns out that couldn’t be further from the truth.

 

Eggs may minimally increase total cholesterol, but more importantly, they increase HDL and thus maintain the total cholesterol to HDL ratio, a more powerful predictor of heart disease risk than total cholesterol alone.

 

Whole egg consumption, compared to an egg white substitute, improves the atherogenic lipid profile (that means it makes the cholesterol less dangerous).  

 

Eggs increase HDL, and can change the LDL from dense, more dangerous particles to large, less dense less dangerous particles.

 

None of this means that eggs have been proven to lower our risk of cardiovascular disease, but absence of proof does not equal proof of absence. In other words, since eggs haven't been proven to be harmful, and there are plausible reasons why they could be beneficial, we should welcome them as part of a vegetable-based, nutrient dense eating pattern.

Eggs Got a Bad Rap

 

So, in the end, it turns out that eggs got a bad rap.

 

They were innocent bystanders caught up in the marketing storm that followed poorly understood guidelines regarding dietary cholesterol intake.

 

Eggs can be an integral component of a nutrient dense, real-food way of eating.

 

They provide essential vitamins and minerals, they are filling and enjoyable, and they can improve our overall blood lipid profiles. While there is still some hesitation about individuals with diabetes consuming more than one egg per day, the rest of us can freely “Take two eggs and call me in the morning.”

 

Remember, however, the company they keep is still important. Instead of having two eggs with hash browns, pancakes and low-quality processed sausage at your local dirty spoon, try preparations like my simple eggs and veggie dish. It takes less than 5-minutes to make start to finish, it is delicious, and it is the perfect way to start your day. Here is the video link:

 

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

Make it! You only need, eggs, avocado oil, a box of spinach, a sprig of kale, left-over veggies, celtic sea salt, and grass-fed cheese. It takes less than 5-minutes to make. And if you don’t have time to eat it, take it with you in a glass container. It even tastes great cold!

 

Bret Scher, MD FACC

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