Zero cardiovascular risk

[mccoy]

On 9/2/2023 at 3:21 AM, Ron Put said:

There is plenty of evidence for the effect of diet, from non-industry-funded studies:

Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials

I read the linked article and I find it a valuable one, first because it's a simple one, easy to understand, coherent with itself, and last because the results are conceptually sound. 

The results though are that vegan or vegetarian diets as a whole tend on average to decrease LDL-C by 10%, which is not much. Maybe it would be more interesting to see the results of lowfat vegan or vegetarian.

As a matter of fact though, we see that the studies by Ornish et al. are the ones underlining more decrease in LDL. We all know that Ornish promotes a VLF diet. We may isolate the effect of those studies in the APoB subgroup:

Even though the article cites an overall decrease of 13 mg/dL, if we separate the Ornish studies they yield an average decrease of about 25 mg/dL. Now, these are only two articles, not enough for a metanalysis, so the results must be taken with some grain of salt.

Nevertheless, it would tend to suggest that vegetarian VLF diets may decrease ApoB levels by an average of 25 mg/dL, which is not bad. In some good responders, the decrease may be 49 mg/dL, which would be a huge effect.

My take home lesson from the above metanalysis:

LF vegetarian and vegan diets appear to cause an average decrease of LDL-C in the region of 10%, not enough to reach very protective values below the 1st percentile.

VLF vegetarian and vegan diets may be more successful, but there is not ample evidence. The data from Ornish et al., not very recent, would suggest that some good responders may enjoy a 30-40 mg/dL decrease, which may be enough to go below the 1st percentiles, so achieving a really protective status. Some other worse responders would have a lesser decrease, perhaps not enough to reach very protective levels.

Edit: please not I had not much time to review the above article, it would be a good idea to search the two Ornish et al. articles cited and ensure they refer to VLF diets and see the details. Also, more studies on VLF diets should be examined.

Edited September 3, 2023 by mccoy

[mccoy]

On 9/2/2023 at 3:21 AM, Ron Put said:

Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality

I read that, interesting article. However, even before listening to Dayspring, I listened to other people, including nutritionists who explain that it is a well known fact that dietary cholesterol only in part contributes to blood cholesterol.

Now, the article describes an association between eggs consumption and detrimental effects, but it also underlines that the issue is highly debated. Assuming the methods are correct, assuming the epidemiological study based on questionnaire is not afflicted by large errors, then that cause of the deleterious effects could be due to TMAOs, to choline excess or to whatsoever other miriads of causes.

I realized that a single study is not very meaningful and that only people who are well into the literature and are free of biases and conflict can correctly interpret an article, knowing preceding consolidated literature and possibly knowing the real world associations.

So, I'll abstain from judgment, just say that one egg per day contributing to 10% increase in all causes death HR ma be a small association within the variability due to errors or confounders.

[Ron Put]

2 hours ago, mccoy said:

So, I'll abstain from judgment, just say that one egg per day contributing to 10% increase in all causes death HR ma be a small association within the variability due to errors or confounders.

Hi, mccoy. I don't disagree with you on the details. But based on what I read it appears that the average normal human will absorb about 30% of cholesterol from foods and diet contributes about 20% of their plasma cholesterol number. I believe that this is pretty well accepted, but the debate is about how efficiently the liver regulates intestinal cholesterol absorption.

Beyond an individual's saturation point, no significant further cholesterol is absorbed (which is why the dairy and meat industries use obese subjects with high cholesterol to show no effect of dietary cholesterol).

Dayspring and Attia acknowledge the 20% point, but then skirt over dietary absorption by presumably assuming 100% liver modulation efficiency, and by ignoring other factors, such as saturated fat or transfats.

Take a look at this, for example:

Does Dietary Cholesterol Matter?

Carefully controlled metabolic studies have shown that high-cholesterol intakes cause moderate increases in serum cholesterol levels. It is been difficult to verify this in population studies because of confounding factors. Nonetheless, meta-analysis of controlled studies documents a cholesterol-raising action of dietary cholesterol. Most of this effect occurs in low-density lipoproteins (LDLs), but the cholesterol content of other lipoproteins can be increased as well. Moreover, population studies strongly suggest that dietary cholesterol is atherogenic beyond any rise in LDL concentrations. It must be emphasized that dietary cholesterol is only one of several dietary factors influencing serum cholesterol levels. Others include saturated fatty acids, trans fatty acids, soluble fiber, and total caloric intake.

[mccoy]

Ron, I would really like to have some references that we may trust beyond any reasonable doubt. What we should do is build up a database of really unbiased experts and to that purpose I found very useful Simon Hill's THE PROOF podcast.

Christopher Gardner for example appears a very good reference and I would value his opinion on the topic. 

Peter Attia and Tom Dayspring seem pretty honest but often lose themselves in a myriad of subtleties and minutiae. Dayspring is sure a very qualified expert in the field, having written and refereed papers, being on the editorial board of important scientific magazines, and being the best-known teacher in lipidology in professional workshops. Nonetheless, I would value other opinions from neutral and unbiased people, I agree that skepticism is a healthy attitude in this field. 

[Saul]

I'd ignore "experts".  It's best to look at the data (obviosly ignoring biases; including vegan biases, and biases from meat packing companies.

  --  Saul

[mccoy]

16 hours ago, Saul said:

It's best to look at the data

But... which data? There are myriads of metanalyses, often one contradicting the other. We cannot navigate this dystopic, insane world on our own, we should trust some unbiased expert.

A valid alternative, would be to reason by bayesian updating, or subjective degrees of belief, something like the Dempster-Shafer theory.

https://en.wikipedia.org/wiki/Dempster–Shafer_theory#:~:text=In essence%2C the degree of,general assumptions about the data.

Edited September 10, 2023 by mccoy

[Ron Put]

2 hours ago, mccoy said:

But... which data?

IMO, this is exactly what the meat and dairy industries aimed for, and largely achieved.

In the confusion, the feel-good and effortless wins: The obese are not to be blamed or blame themselves for their diet choices, and the drug companies will sell "solutions" in a pill, all messaging aided by PR, media that lives on ads, and influencers funded and supported by industry.

Meat and dairy exalt the virtues of "high-quality protein" and blame "carbs" by equating them to soft drinks and cookies. The fish industry sells fish and byproducts by comparing it to steak. The olive oil industry sells EVOO and OO by comparing it to lard or butter. And the drug companies sell you drugs to mask the resulting maladies in the confused.

This is not new, but as access to abundance spreads ever more widely, the scale is new. The diets in Sardinia and Okinawa have little to do today with the diets in the first half of the 20th century. Okinawa now has a higher meat, and junk food consumption than the rest of Japan, and life expectancy has plummeted. The wealthier regions of the Mediterranean have significantly increased adjusted rates of cancer and CVD, corresponding to the significant increases in OO, dairy, fish and meat consumption.

If it matters, here is my personal take: Traditional diets in Blue Zones were very high in whole plant foods, and very low in meat, dairy, fish, or oil consumption. Genetics may have played some role, but the fact that spouses of centerinarians live longer than control points to the importance of lifestyle and diet factors. The only US Blue Zone is comprised of The Seventh Day Adventists and on average, they live considerably longer than control in each state. 34% of them are black and many are in the regions with the shortest life expectancies in the US, yet they still outlive the average American regardless of race. And when you compare omnivore SDAs to vegetarian SDAs, the vegetarians live longer, and the vegans generally live the longest:

"Table 4 reports the comparison of the multivariate-adjusted risk of death for 4 categories of vegetarians compared with nonvegetarians. Pesco-vegetarians had significantly reduced risk in both sexes combined for all-cause mortality (HR, 0.81; 95% CI, 0.69-0.94), IHD mortality (0.65; 0.43-0.97), and other mortality (0.71; 0.54-0.94); in men for all-cause mortality (0.73; 0.57-0.93), CVD mortality (0.66; 0.44-0.98), and other mortality (0.60; 0.39-0.93); and in women for IHD mortality (0.51; 0.26-0.99). Lacto-ovo–vegetarians had significantly reduced risk in both sexes combined for all-cause mortality (HR, 0.91; 95% CI, 0.82-1.00) and in men for CVD mortality (0.77; 0.59-0.99). Vegans had significantly reduced risk in both sexes combined for other mortality (HR, 0.74; 95% CI, 0.56-0.99) and in men for all-cause mortality (0.72; 0.56-0.92), IHD mortality (0.45; 0.21-0.94), and CVD mortality (0.58;0.38-0.89)."

And only half-jokingly, compare Campbell or Clapper to Dayspring, or Barnard to Attia... 🙂  Which group do you think looks healthier?

So, no, I don't see this as so confusing on a general scale, despite the noise.

[mccoy]

1 hour ago, Ron Put said:

...corresponding to the significant increases in OO,

One observation though, in all Italy, except mountainous regions, EVOO has always been consumed in relative abundance. In the mountains and in northern Italy, lard and butter were the fats of choice.

The same I think holds for all Mediterranean regions. In Greece, EVOO has historically been a staple for millennia.

[mccoy]

1 hour ago, Ron Put said:

And only half-jokingly, compare Campbell or Clapper to Dayspring, or Barnard to Attia... 🙂  Which group do you think looks healthier?

Attia definitely looks healthier than Barnard, to my eye. The vegan doctors are usually too thin and fragile- looking, usually, except Fuhrman who, albeit very lean, exercises regularly.

[Ron Put]

2 hours ago, mccoy said:

Attia definitely looks healthier than Barnard, to my eye. The vegan doctors are usually too thin and fragile- looking

Barnard is 70, and to the best of my knowledge, he is not suffering from any chronic illness and is not on any medications.

Attia is 49, looks like a middle-aged boxer, and is on a cocktail of drugs to try and offset the consequences of his diet. If I were to bet who is less likely to be around in 20 years, my money is on Attia. 🙂

As to the pre-1950s Sardinian diet, I think I had posted a chart somewhere here and the Blue-Zoners definitely consumed less meat, dairy, and OO than the flat-landers, and far less than the rest of Italy. Can't find it quickly, but found this:

"

The traditional Sardinian diet contained:

• Cereals, Legumes, and Potatoes: Consisting mainly of self-produced food, the Sardinian traditional diet was based on cereals (wheat, barley and, more rarely, corn), legumes and potatoes.
• Sourdough Bread and Vegetable Soup: It was complemented by sourdough-leavened bread and vegetable soup made from fresh vegetables (onions, fennel, carrots, celery) and pulses (beans, fava beans, peas).
• Native Herbs: These were integrated into the daily diet.
• Nuts: Chestnuts and walnuts were consumed in the villages and made up a lot of the calorie content of the diet, particularly in the winter months.
• Small Amounts of Fruit: Fresh fruit was consumed in modest amounts.  Seasonal fruits (figs, grapes) were often dried so they could be eaten throughout the year.
• Very Little Meat: From the mid-19th to mid-20th century, meat consumption rarely exceeded 2-4 servings per month and was mostly sheep, pork or poultry.
• Some Dairy Products (Cheese): Dairy products mainly came in the form of mature goat or sheep cheese.
• No Fish: The consumption of fish in the traditional diet was surprisingly low, particularly in the inland areas of Sardinia. Fish consumption was limited to the villages along the rivers, not the mountainous region where the Blue Zone is located.
• Little Wine: Before the 1950s, wine consumption in Sardinia was quite below the Italian average.
• Low in Calories: The traditional diet was ‘remarkably frugal;’ daily food intake was moderate, and they did not overeat.

However, the modern day Sardinian diet is:

• Much Higher in Calories: The ‘frugal’ Sardinian diet has been abandoned for a diet much richer in calories. The traditional low-calorie vegetable soup which was once the mainstay has been replaced with higher-calorie foods like meat and white bread and pasta.
• More Olive Oil: Olive oil consumption has increased 56 percent.
• More Meat and Fish: Beef consumption has increased 55 percent while fish consumption has risen 50 percent. This is significant because a diet higher in animal protein and fat is associated with an increased risk of chronic disease and overall mortality risk.
• Less Potatoes and Pulses: Potato consumption has fallen 45 percent, and pulses are eaten 42 percent less.

On the bright side, consumption of fresh fruits and vegetables has risen over 60 percent and lard consumption has dropped 80 percent.

Anyway, I think the Seventh-Day Adventists study I posted above is pretty telling: It's large, and it takes genetics and race out of the equation, while providing homogeneity for life choices such as church attendance and "vice" avoidance. The increase in lifespan from omnivores through vegetarians, to vegans, is "dose-dependent" and significant.

[Ron Put]

Speaking of confusing messages, I just started listening to this, and it's on point:
 

 

[mccoy]

Re. Sardinian diet. As described in the above post, to my knowledge it was pretty similar to the diet of peasants in rural Italy, back in the time.  This is from the recollections of elders that I remember when young, and form my direct observations in rural areas of peninsular Italy. In short, a Mediterranean diet where meat was eaten only on sundays, vegetables, cereals and legumes made up 90% of it and pigs were killed in December, sausages and hams made to tackle the hardships of the wintry season (not to starve, basically). 

What was probably different in Sardinia, Ogliastra, is that it was and still is a shepherds area. Shepherds, who made up a great part of the male population, when out in the mountains had to eat milk and cheese, often they do not return home at night.

[mccoy]

This is slighlty off-topic, so I'll post a more torough discussion on it in the blue zones thread.

Sardinian shepherds (as well as the sheperds of other regions) likely were on a diet high in saturated fat. Milk and above all sheep ricotta, the poorest of the dairy products, are high in fats. Sheep ricottta has about 30% fat, most of which is faturated. Were there many centenarians in shepherds? We don't know, this basic data is missing in the blue zones literature.

Edited September 11, 2023 by mccoy

[IgorF]

https://www.nature.com/articles/d41586-023-03543-z

Maybe not the real tool in 15years but the approach is interesting, especially if it will be a two-way tool

[mccoy]

Very interesting article, the CRISPR gene editing method in action to lower cholesterol, it inhibits for 6 months PCSK-9.

It doesn't compare it to pharmaceutical PCSK-9 inhibitors though, which at first would seem safer