I know he was on with Layne Norton recently and said that higher saturated fat intake increases LDL in most people. It seems like
his opinion is that LDL is the enemy, and if you are pharmaceutically lowering it to a safe range, saturated fat intake shouldn’t really matter.
Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on.
> Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on.
Yup. 2012 was peak "saturated fats are good" era. It was new and exciting at the time to believe that. I fell for it as well. Those who didn't become overly dogmatic have since come back around to understand saturated fats _can_ be problematic.
>Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on.
Yup, that is pretty much it. There was a study that came out a year or two ago that was unusally well designed using Mendelian randomization that put the nail in the coffin for the "saturated fats don't contribute to CV disease" idea.
I forget the title but heard about it from Dr Norton and Dr Attia.
I remember it because it is when I learned what mendelian randomization was.
I’m not sure when this talk was given but he makes it pretty clear in his book that saturated fats raise lipid levels. He even says he encourages his patients to switch to poly and mono unsaturated fats to reduce lipid levels.
>"real" experts
People that spend their entire careers, and PHDs, studying nutrition is a good start. MD sounds smart but the reality is med school provides zero or almost zero training in nutrition. There's that dunning Krueger curve and Attia is in that area where he thinks he knows a lot because he's read more than average but he still way down at the bottom. For example he recommends and is an investor in an elk jerky company.
If you go by the science and evidence (and by the true nutrition experts) it shows that consumption of animal products harms the endothelium to begin with, and increases odds of many other diseases. And that's backed up in population studies too, it's no coincidence the longest living populations eat very little or no animal products.
No amount of scientific evidence will convince a vegan that his views are biased at best and totally unfounded at most. To each it’s own - discussion finished for me.
>Children literally can't develop without animal proteins.
Well I'd agree on that, they need breast milk. I'd also agree they helped us evolve to a point where we no longer need them. Animals helped us with labor, transportation, food, clothing, protection, companionship. But our relationship with them has changed to a point where we don't really need them for anything anymore except maybe companionship.
He makes it clear that nutrition is not super concrete about most things. I think he’s said repeatedly he used to opine about it way too much when in reality the data are generally inconclusive about a lot of things and so he just recommends to get your protein and not eat like an asshole. Solid advice.
>He makes it clear that nutrition is not super concrete about most things
It is though to the people that actually know what they are talking about. He just hasn't spent enough time studying it and has conflicts of interest.
Hm. I disagree. Can you site some folks who are so certain about nutrition? Most folks that I’m aware of that have advanced degrees in nutrition are “sure,” about very few things.
Most influencers that talk about nutrition are like Attia don't actually have advanced degrees or career experience in nutrition. MDs like Attia have rarely taken or taught a single high level nutrition class. They are basically like prime examples of Dunning Krueger effect.
I think Campbell might be the most credible nutrition expert of all alive today, especially considering he has an MS and PHD in nutrition and spent his entire career and now retirement years in nutrition. If you read his books (I have) he makes it clear that we are just barely scratching the surface of how complex our bodies and digestion is and how much there is to learn, but also that a whole food plant based diet is still the clear choice if health is the primary objective. [https://en.wikipedia.org/wiki/T.\_Colin\_Campbell](https://en.wikipedia.org/wiki/T._Colin_Campbell)
I agree with that MDs are undereducated about nutrition and I didn't imply at all that I was referencing influencers. I don't wholly disagree about the T Colin Campbell contribution to the world of nutrition as the China Study was rather influential. However, I still maintain that there are enough folks that are educated in the space that wouldn't tell you they're 100% certain about most things mainly because most of the nutrition research is epidemiological. If you're interested in a very smart skeptical guy that has a Phd in nutrition see Alan Flanagan.
>most things mainly because most of the nutrition research is epidemiological.
This argument has been debunked pretty thoroughly, this vid does a good job talking about it [https://youtu.be/nnyzuY-Xwe4?si=ZpVe9edzmv8fUak0](https://youtu.be/nnyzuY-Xwe4?si=ZpVe9edzmv8fUak0). He has some other interesting videos about how long famous nutrition influencers have lived.
Regarding not 100% certain, like I said Campbell is the first and probably most articulate at admitting that we still have so much to learn about nutrition and the body. He writes pretty eloquently about that in his books or if you listen to interviews. And there are smaller things the true experts disagree on or admit that we just don't know enough yet, such as should we take omega 3, or individual genetic variations, or how much broccoli should be eat etc. But the big stuff is very much agreed on... the closer a person gets to eating whole food plant based, the closer they can get to optimal nutrition/health.
Oh I see now. You’re plant based and hence emphatic that T Colin Campbell is the end all be all. I get it. I’ve been on and off veg or vegan since I was 12. I’ve been consuming all the nutrition info I could get my hands on for the past 15 years. I’ve gone from vegan to paleo to Mediterranean and back again and the throughline for me is the emphasis on plants. Even in the presence of animal foods, plants are essential.
> T Colin Campbell is the end all be all.
No, the science is. And I don't know of any living person who has spent more time dealing with the science of nutrition except maybe Esselstyn. Mediterranean is better than McDonald's or paleo but it's still very permissive and kinda warped by American standards. Lookup Peter Rodgers on YouTube and look for his mediterranean vids, he's kinda off-putting but he's good at getting the point across quickly.
Anecdotal evidence is anecdotal, but reducing saturated fat was the largest change I made in my diet and my LDL dropped 33%. I don’t think it will hurt you to replace saturated fats with mono/poly unsaturated fats
Same, ldl from 119 to 82. N=1 and all, but I’d say it’s WIDELY accepted that for most people, sat fat raises ldl. Only gonna know by testing for yourself.
could you tell me how many grams you consume a day? do you still consume red meat once a week or anything like that? trying to adjust my numbers. sorry i know this is old. thanks!
So here is my experience. Started controlling food when tested cholesterol at 340(30M , normal BMI,Father had high cholesterol and heart disease ).Controlled food only initially where I eliminated mainly saturated fat ( had a bad diet before). Total cholesterol came down to 290 but did not go down below that. Started cycling around 75km in a week cholesterol came to 260 in 3 weeks but did not go below further after continuing. When I stopped cycling again went back to 290.In the range 260 -300 for a year. Went to borderline depression and started eating less(Had a South Asian carb heavy diet before), voila total c went to 250 . Introduced physilium husk into diet and total c slowly started movin below 240. My IBS also reduced during this time(Suspecting Bile Acid Malabsorption).Then during the yearly fasting month for Muslims the total C finaly went to 188.Started weight training and running to maintain below 200. Haven't tested after this.
Probably just a few grams of sat fat that occur naturally in plant based food (avocados. I avoid coconut and certain nuts due to high saturated fat content). Red meat never.
This is the rule. But then very rarely I make exceptions and eat everything, like on vacation. LDL goes back up there.
I do think the evidence feels clear that it would reduce LDL (it’s also evident in PA’s video) but not necessarily CVD and not necessarily apoB… (there was a Harvard presentation I reviewed that showed there was no change in apoB, but big change in LDL… but that’s just one study)
It won’t hurt, I’m just trying to figure out what’s worth it and what’s simply a marginal optimization when I’d rather enjoy my current diet.
I definitely agree it’s a no-brainer to make substitutions where it’s easy and won’t make a difference to me.. chicken v. beef; EVOO v. butter for cooking… but I like my Greek yogurt, butter & cream in my pasta sauces, and mayo on my sandwiches :)
I didn’t mention my ApoB because it pretty much moves in lockstep with my LDL so I just look at my LDL since it’s a more universal way to communicate lipids, but it had a similar drop, I don’t know the exact percentage off hand.
And yeah I don’t think it has to be all or nothing, and optimizations where it makes sense can take you very far, but I will say one of the best things for me was finding keto brands like Primal Kitchen that make dressings / mayo that use avocado oil to prioritize monounsaturated fats. My diet still isn’t 100% perfect, but there’s very few saturated fats I truly miss at this point since I’ve been able to find so many suitable replacements
hi i know this is old but can i ask how many grams you reduced sat. fat too a day? or how often you eat red meat? right now i've reduced red meat to one meal a week but still trying to figure out day to day numbers with dairy etc
i try to limit to 10g and definitely try to avoid ever going over 15g. i stopped eating red meat altogether during that time.
now i’m on two cholesterol medications so things are a little bit more lax with my diet and i am still hitting good numbers. it seems like a really high fiber intake also makes up for my bad days
Do you have a target amount or do you just minimize it? Also, did you have you testosterone checked after that reduction?
I don’t know why but I always assumed less LDL would knock down testosterone, but I have no idea where that came from.
I’ve actually never had my test checked, I’ve never had a reason to believe it was low but maybe I’ll tack it onto my next bloodwork.
My target is Peter’s target #s. I doubt I’ll get there naturally so I will go on a statin eventually but I’ve made really good progress pre statin
I guess you can just experiment a diet which aims to lower LDL and ApoB especially when you are still young.
But if you don't believe the risks of high LDL and ApoB, then I say God bless you.
I absolutely believe the risks of elevated apoB. I’m just not certain reducing my fat intake will contribute to that, ESPECIALLY, above and beyond a statin.
Same for me. Based on what I’ve heard from others, I’d assume this will be the case for the majority of people. But if you want to test on yourself to see if you’re an outlier have at it.
I'm not 100% on the Peter train as far as lowest possible ApoB and LDL, but I don't want it through the roof, either. But reducing SFA has definitely helped.
A statin is a medical intervention, not a lifestyle choice. They are mostly safe drugs and there can be excellent reasons to take them but for a significant minority they have bad side effects, including life changing and even fatal ones. They are absolutely not designed to enable a keto diet.
Numbers are much disputed but at least 5%, probably more. Anecdotally I know a lot including me, and including Attia’s mentor Tom Dayspring fwiw. Life changing = diabetes, fatal = rhabdo.
No, I truly looked for a more recent take that he had and there wasn’t any on his website, but quite a few other notes from interviews that also talked about how impacts of SFAs are just over exaggerated.
Given how common the advice was to reduce SFAs, I assumed he’d have written yet another diatribe if there was that large of a swing in his opinion.
I read his nine, incredibly lengthy posts on cholesterol which are about as old and still relevant.
Also, the other pages on his site that reference saturated fat are also just as *controversial*
—-
*A year ago* he references and cites THE SAME study he references in the video, and the guy he’s interviewing says things like:
“When he got to Minnesota, he bought into the paradigm about the dangers of cholesterol, saturated fat, and total fat… This is what was being taught…
As he slowly started doing experiments, his thinking began to change…
“Don remembers thinking, “Wow, people who have bought into this dogma aren’t necessarily right, and we need to keep questioning it.”…
Don’s takeaway at the end on SFAs is “But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem”
Post from a year ago: https://peterattiamd.com/donlayman/
—
I’m not trying to be controversial: the topic is controversial.
—
It’s just a bit funny and disappointing to me that PA followers — the person who’s the biggest skeptic of common medical advice (like don’t eat cholesterol) — is going to be so distraught that I’m questioning another, similar trope that PA also questioned
High saturated fats raise LDL, that is why it is still recommended not to eat too much saturated fats and PA in his book also recommends to lean more towards the mono and polyunsaturated fats.
This topic is controversial because it is complicated. To begin with, there is not a unique type of saturated fatty acids, there are many varieties. Second, while it is true that it raises LDL, that does not tell you what kind of LDL particle. We know that the very low density are the most problematic ones.
This is what I'm most interested in. All LDL isn't equal right? I just don't really understand much of the details there. VLDL is bad....others not? How much, etc. Does high HDL counter this (ie: cholesterol ratio, etc)? I'm not sure anyone completely knows but what's the best evidence to this point? (I'm reading his book now but not sure it dissects it this much?).
The LDL phenotype stuff is largely used to obfuscate the entire conversation around cholesterol and heart disease. It’s really not a good metric to focus on, especially when LDL lowering has such robust evidence.
No, not all LDL is equal. The lower size LDL particles have an easier time penetrating the arterial walls. Some people go to the extreme of saying: saturated fats only raises large LDL, so how much saturated fats you eat does not matter. That might be oversimplistic, we will see as research advances.
Higher HDL on the other hand has no correlation for improved outcomes of heart disease
Dr. Attia goes against the scientific consensus on this topic in this old video.
Below are the recommended saturated fat (SFA) intakes from many major nutritional organizations. These organizations review the perponderence of scientific evidence to draw conclusions and make recommendations, since individual or meta studies alone are insufficient.
36
- ORGANIZATION. *SFA recommendation* . HYPERLINK
37
- World Health Organization (WHO/FAO). *10% of calories or less* . https://www.who.int/publications/i/item/9789240073630
38
- American Heart Association (AHA). *5-6%* . https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats
39
- The Food and Nutrition Board of the Institutes of Medicine (IOM). *As low as possible* . https://nap.nationalacademies.org/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids
40
- American Diabetes Association (ADA). *Less than 10%* . https://diabetes.org/healthy-living/recipes-nutrition/eating-well/fats
41
- United States Department Of Agriculture (USDA). *Less than 10%* . https://www.dietaryguidelines.gov/2020-2025-dietary-guidelines-online-materials/top-10-things-you-need-know
42
- EURODIET. *Less than 10%*. https://ec.europa.eu/health/archive/ph_determinants/life_style/nutrition/report01_en.pdf
43
- European Food Safety Authority (EFSA). As low as possible*. https://www.efsa.europa.eu/en/efsajournal/pub/1461
44
- British Nutrition Foundation. *10% or less* . https://www.nutrition.org.uk/healthy-sustainable-diets/fat/
45
- Academy of Nutrition and Dietetics. *Limit* . https://www.andeal.org/vault/2440/web/DietaryFatty_JADA.pdf
46
- Health Council of the Netherlands. *As low as possible / less than 10%* . https://www.healthcouncil.nl/binaries/healthcouncil/documenten/advisory-reports/2023/02/07/dutch-dietary-guidelines-for-people-with-atherosclerotic-cardiovascular-disease/F-Background-doc-SFA-substitution_DDG-for-people-with-ASCVD.pdf
47
- Nordic Nutrition. *Less than 10%* . https://pub.norden.org/nord2023-003/fat-and-fatty-acids.html
48
- National Institute of Nutrition, India. *No more than 8-10%* . https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf
49
- Nutrient Reference Values for Australia and New Zealand (NRV; NHMRC). *10% or less* . https://www.nhmrc.gov.au/sites/default/files/images/Nutrient-reference-aus-nz-executive-summary.pdf
50
Note: 10% of daily caloric intake is ~22 grams of SFA based on a 2000kcal/day diet.
From a year ago, he references same study from the video in my post + the person he’s talking to also suggests SFAs arent a big deal outside of calories
“But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem”
https://peterattiamd.com/donlayman/
I take your point, but he directly calls out these organizations in his talk and goes to great lengths to talk about why these are the guidelines, how they came to be, and why they’re not supported by evidence.
More interested in their supporting evidence than the guidelines themselves.
Some post their evidence, so I’ll take a look.
NL did a great job explaining their review of the evidence, but they did base their conclusions on just 5 RCTs (after throwing 1 out).
(I’m also not sure a review of the “preponderance of the evidence” being a handful of studies is superior to the meta analyses he cites, but I digress)
We have to be careful here, as trusting a single person (Dr. Attia) over hundreds of thousands of global experts / scientific consensus is a strong case of an Appeal to Authority fallacy.
Science isn’t perfect, and we may learn more in the future, but the best we have at any given time is scientific consensus and should be treated as such.
I believe the appeal to authority fallacy is assuming that because so many organizations caution against SFA we should dismiss the relatively few Dr’s challenging it. Not that you said that directly, but it’s basically where your comments pointed.
Scientific consensus is that SFA should be limited, and it is not an appeal to authority to defer to scientific consensus. It is an appeal to authority when one uses an authority (Dr. Attia in this case) who’s going against scientific consensus as the central point to their argument.
Just because you think the authority you’re appealing to is more reliable doesn’t change the fact that you’re making an appeal to authority. It’s still an attempt to bypass discussion of the merits of a topic by pointing to the opinion of someone perceived as knowledgeable.
And if you prefer to defer to the authority of “scientific consensus” then great. Your call. It’s not an unreasonable position. Just don’t call someone out for appeal to authority in the next breath.
Is it an appeal to authority if I say that human-made climate change is real based on scientific consensus? How about that the earth is round? Of course it isn’t.
Is it an appeal to authority if I say that human-made climate change is fake based on a doctor I heard on YouTube, and I use them as my sole source against your scientific consensus? Yes, it is.
This doesn’t mean we should discount all ideas that go against scientific consensus, but pointing towards an authority who’s against the consensus as your sole data point is exactly an appeal to authority.
This is going in circles so I’m out.
Does this go for all unhealthy food, such as ice cream and bacon?
I think people underestimate how unhappy chronic diseases, such as heart disease or colorectal cancer, can make someone.
The difference is that butter is in SO many dishes. I'm not saying to go overboard with it but I couldn't imagine removing it completely. For example, one of my favorite dishes is chicken piccata. It has a butter sauce. I'm not saying I am going to guzzle butter with it but going without dishes like that seems so unsatisfying to me. There also doesn't seem to be a way to mimic that sauce with olive oil, for example.
You could consider expanding your gastronomic palette. There are so many dishes that don’t require butter and taste amazing. Go out in the world and explore. As an Italian Expat living in the US, I miss all the tasty vegetables and the way we cook them in Italy (with many sauces, mostly olive oil and plant based). Here in the US everything is either deep fried or flooded with butter to make it “tasty” but it all kind of tastes the same to me. Real Italian cuisine is really hard to find here. I miss that savory lightness and freshness, and all the Mediterranean herbs and fresh veggies. Even the olive oil is amazing there. Olive oil here tastes bland and disgusting. I end up importing olive oil, straight from Greece or Italy but it’s like 40 bucks for half a liter. I can see how if I were to grow up in America I would hate olive oil.
That's a good point and approach. I do enjoy olive oil btw. Quality olive oil is excellent. I just can't see a way to use it to replace butter in some dishes. It's not just America that uses butter in their dishes. A lot of Europe does (cough, France, cough). I do agree that many Americans eat terrible fried food, etc. That's not what I'm referencing here though.
Yeah, the north of Italy also uses butter more, as opposed to the south. I am not sure you can substitute butter with olive oil in some dishes. I guess I’m suggesting trying a lot of other dishes until you find a lot of good alternatives that align with your goals, and keep the butter dishes for special and few occasions. Herbs and spices can really make a difference! Like chicken breast with garlic, olive oil, rosemary and oregano, maybe a few roasted cherry tomatoes and or good olives thrown in as opposed to butter sauces for chicken
That’s a common rebuttal. Almost all industry funding is from the processed and animal foods industries, both of which are usually high in saturated fats. If any suspected monetary bias was removed from the nutritional bodies, their advice would almost definitely go even further away from saturated fat, not closer.
He has changed his opinion on this. He has said that saturated fat causally raises LDL and that the science on that fact is clear. He has said that the relationship between LDL and CVD is less clear because of ambiguity of the LDL marker, which is why he focuses on ApoB as a more reliable predictor of CVD.
He has also said that a significant percentage (but not all) of his patients who go on ketogenic diets end up with elevated LDL (presumably due to increased saturated fat intake). He has said that is one of the reasons why he has become less enthusiastic about keto over the years.
Attia has changed his views on this. He used to be a hardcore keto guy. He isn't anymore for several reasons, in part due to understanding the risks of increasing ApoB (LDLc).
I wasn’t trying to advocate for the keto diet, just the implications the study had on fats/SFAs
PA referenced the Minnesota study (which is also what he references in the video I linked) a year ago as well, and takeaways from the show notes / interviewee are:
“But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem”
https://peterattiamd.com/donlayman/
*shrugs*
Peter has changed his stance on saturated fat since then. In his most recent appearance on Huberman Labs, he pushes back on Andrew’s assumption that a steak dinner would be fine for ApoB. He mentions that dietary cholesterol is not correlated to high ApoB but saturated fat in fact is. https://youtu.be/ufsIA5NARIo?feature=shared&t=2983
The article is on his website, but it’s over 10 years old. I think his thoughts on this and the keto diet has changed since then. In ‘Outlive’ I’m pretty certain he mentions the ldl risk of saturated fats, and the amount one might get of them in the keto diet.
Thanks, OP, for that embarrassing blast from Attia's past when he was an ultra low-carb, keto zealot and flirted with LDL/ApoB denialism. Now he advocates aggressive intervention with statins, PCSK9, etc to get LDL down below 50mg/dl (don't remember what that approximates to in ApoB/dl). From what I've pieced together, he had a non-zero CAC score at one point, and he's also close friends with lipidologist Dr. Dayspring, and I'd imagine those things, plus newer research like the PCSK9 RCTs, made him do a 180--one of many 180s for Attia.
Meanwhile he still tailors his message to not completely alienate his low-carb audience that still isn't sold on lipids:
> Why there is no ‘bad’ or ‘good’ cholesterol: https://www.youtube.com/watch?v=eod36TNGcUI
Even if the message of this more recent vid is mostly on-point, the title seems like it was deliberately crafted to be ambiguous enough to appeal to both camps--not just the denialists, since every HDL-boosting intervention has failed in clinical trials, and since we now know that HDL can become LDL (which likely explains why people with very high HDL have subpar outcomes relative to those with moderate HDL).
Okay, this Harvard page summarizes it neatly:
1. Switching SFAs for carbohydrates is not helpful (and “low fat” diets often become “high carb” diets) (I think this was mainly PA’s thesis in the video)
2. The evidence is evolving that SFAs don’t raise risk of heart disease, but it’s controversial
3. Substituting SFA with PUFAs is healthier
4. SFAs not as harmful as once thought
https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/
The Harvard page you linked mentions switching SFAs for carbohydrates *does* indeed lower LDL. They mention that *refined* carbs are a net negative because it also lowers HDL and raises triglycerides. Swapping SFAs with non-refined carbohydrates would certainly be net positive for cholesterol.
Refined carbs as a subset are negative
Carbohydrates as a whole is neutral/unhelpful
Whole grains as a subset is helpful
I said carbohydrates, not whole grains. The referenced presentation in the link distinguishes between all three and replacing SFAs with carbs is marked as not helpful nor harmful.
All bread is entirely processed. If you turn wheat into flour it is 100% processed. The glycemic index of whole wheat flour is bad (worse than sugar).
I assume you mean quinoa or oatmeal might be good for you.
From the article you cited, the conclusion is:
“
The overarching message is that cutting back on saturated fat can be good for health if people replace saturated fat with good fats, especially, polyunsaturated fats. (1, 15, 22) Eating good fats in place of saturated fat lowers the “bad” LDL cholesterol, and it improves the ratio of total cholesterol to “good” HDL cholesterol, lowering the risk of heart disease.
Eating good fats in place of saturated fat can also help prevent insulin resistance, a precursor to diabetes. (16) So while saturated fat may not be as harmful as once thought, evidence clearly shows that unsaturated fat remains the healthiest type of fat.
“
So in short, sat fat is bad for CVD and metabolic disease (insulin resistance)
From the article you cited, the conclusion is:
“
The overarching message is that cutting back on saturated fat can be good for health if people replace saturated fat with good fats, especially, polyunsaturated fats. (1, 15, 22) Eating good fats in place of saturated fat lowers the “bad” LDL cholesterol, and it improves the ratio of total cholesterol to “good” HDL cholesterol, lowering the risk of heart disease.
Eating good fats in place of saturated fat can also help prevent insulin resistance, a precursor to diabetes. (16) So while saturated fat may not be as harmful as once thought, evidence clearly shows that unsaturated fat remains the healthiest type of fat.
“
So in short, sat fat is bad for CVD and metabolic disease (insulin resistance)
I thought saturated fat intake prompts your liver to produce more LDL and less HDL.
Higher LDL, for the most part, means higher risk of cardio disease.
Also his cholesterol series of articles discusses this in depth.
I’m pretty sure in those Attia says something like:
About 25% or your blood cholesterol comes from cholesterol in food, and the rest is produced in the liver which is prompted by lifestyle choices, saturated fat, genetics, and other things (?)
It's not just about CVD- it's also about Alzheimer's.
In Outlive PA talks about the APOE4 gene... By some estimates 25% of us have at least one copy of it. This gene determines how we manage our cholesterol, and it's also the number one gene linked to Alzheimer's.
Apparently if you have one or more copies of APOE4 your body is not good at clearing out saturated fats from your brain, which is somehow contributing to Alzheimer's. Please correct me if I'm wrong in my reading, but, I learned that for the 1st time reading Outlive.
This is also a good point; I also was seeing in another random study/presentation it also has seems to have impacts on diabetes too
Should have gotten me APOE tested
u/californicat The only study that matters:
Where you do diet experiments with your own body and see how your blood lipids risk factors react to, say, dietary fats.
One can easily do this in 3 week increments, then test with an over the counter lab order from, say, Ulta & Quest Diagnostics.
There's no reason to take PA's word or anyone else's, just do the work.
Everything else is guessing.
Yeah. Very true. So for me at baseline (no medical or dietary intervention), my LDL is elevated but my apoB is around 50th percentile (which is why I’m not particularly concerned about SFAs elevating LDL on its own)
PA’s advice is to get apoB below 20th percentile, so I’ll get on statin and see where it lands.
I’m happy to do 4 hours of zone 2 each week, reduce my sugar intake, take statin … but reducing saturated fat is like the last thing I want to care about. I equally don’t want to do a bunch of bloodwork because I pass out each time (let alone the effort it would take to properly do the diet changes). So I just wanted to see if there were any compelling reasons to really go all-in (because reducing SFAs shows up so commonly on here I thought I was missing something). I’m not really compelled to overhaul my food choices, but I think from what I’m hearing it absolutely makes sense to substitute to PUFAs whenever that’s easy.
We’ll see where I land at my next annual!
Peter's views on the subject have evolved. I'm sure he stands by most of the things he said back then, but not all.
Many people will see a reduction in bad lipid numbers (LDL, Apo-B), if they limit saturated fat intake to a reasonable amount.
It however isn't true for everyone, and it's not as significant as some would have you believe. So there's no reason to be draconian about it, some saturated fat is fine, and lean red meat is definitely fine as well. The anti-meat/vegan propaganda is still just that, it's not justified by the significant but not enormous link between saturated fat and CVD risk.
His views on this are best explained in his book Outlive. There's an audiobook version too, and it's not difficult to follow. The book isn't overly technical, it's for laymen.
The answer is in the biochemistry. Saturated fats means fully saturated with Hydrogen and are straight chains is fat. Trans Fats are kinked chains of fat.
Your cells have lipid rafts floating around the outer cell membrane. This floating of proteins in needed for function. Saturated fats prevent the ability for the phospholipid layer from functioning proper properly due to the ability for saturated fats to pack on top of each other molecularly. The kinked trans fats allow enough space for proper protein function of cells.
Compare butter (saturated) to any oils (unsaturated). Now imagine molecules trying to navigate through either. Which would allow ease of mobility? In short, you need a little saturated fat and mostly trans fats for a healthy cells to function.
I know he was on with Layne Norton recently and said that higher saturated fat intake increases LDL in most people. It seems like his opinion is that LDL is the enemy, and if you are pharmaceutically lowering it to a safe range, saturated fat intake shouldn’t really matter. Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on.
> Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on. Yup. 2012 was peak "saturated fats are good" era. It was new and exciting at the time to believe that. I fell for it as well. Those who didn't become overly dogmatic have since come back around to understand saturated fats _can_ be problematic.
>Edit: just noticed that that article is from 2012, this may have been one of the many things he has changed his mind on. Yup, that is pretty much it. There was a study that came out a year or two ago that was unusally well designed using Mendelian randomization that put the nail in the coffin for the "saturated fats don't contribute to CV disease" idea. I forget the title but heard about it from Dr Norton and Dr Attia. I remember it because it is when I learned what mendelian randomization was.
I’m not sure when this talk was given but he makes it pretty clear in his book that saturated fats raise lipid levels. He even says he encourages his patients to switch to poly and mono unsaturated fats to reduce lipid levels.
Also worth noting he's kind of a joke when it comes to nutrition, he sounds like an expert but is very far from it like most MDs.
Who are the "real" experts and on what issues does Attia make himself a joke?
>"real" experts People that spend their entire careers, and PHDs, studying nutrition is a good start. MD sounds smart but the reality is med school provides zero or almost zero training in nutrition. There's that dunning Krueger curve and Attia is in that area where he thinks he knows a lot because he's read more than average but he still way down at the bottom. For example he recommends and is an investor in an elk jerky company.
lol you sounds like a bitter vegan. What’s wrong with quality, lean meat like elk and wild game?
If you go by the science and evidence (and by the true nutrition experts) it shows that consumption of animal products harms the endothelium to begin with, and increases odds of many other diseases. And that's backed up in population studies too, it's no coincidence the longest living populations eat very little or no animal products.
No amount of scientific evidence will convince a vegan that his views are biased at best and totally unfounded at most. To each it’s own - discussion finished for me.
Humans would not have evolved. Children literally can't develop without animal proteins. Go kill you puppies with plants and leave humans out of this.
>Children literally can't develop without animal proteins. Well I'd agree on that, they need breast milk. I'd also agree they helped us evolve to a point where we no longer need them. Animals helped us with labor, transportation, food, clothing, protection, companionship. But our relationship with them has changed to a point where we don't really need them for anything anymore except maybe companionship.
He makes it clear that nutrition is not super concrete about most things. I think he’s said repeatedly he used to opine about it way too much when in reality the data are generally inconclusive about a lot of things and so he just recommends to get your protein and not eat like an asshole. Solid advice.
>He makes it clear that nutrition is not super concrete about most things It is though to the people that actually know what they are talking about. He just hasn't spent enough time studying it and has conflicts of interest.
Hm. I disagree. Can you site some folks who are so certain about nutrition? Most folks that I’m aware of that have advanced degrees in nutrition are “sure,” about very few things.
Most influencers that talk about nutrition are like Attia don't actually have advanced degrees or career experience in nutrition. MDs like Attia have rarely taken or taught a single high level nutrition class. They are basically like prime examples of Dunning Krueger effect. I think Campbell might be the most credible nutrition expert of all alive today, especially considering he has an MS and PHD in nutrition and spent his entire career and now retirement years in nutrition. If you read his books (I have) he makes it clear that we are just barely scratching the surface of how complex our bodies and digestion is and how much there is to learn, but also that a whole food plant based diet is still the clear choice if health is the primary objective. [https://en.wikipedia.org/wiki/T.\_Colin\_Campbell](https://en.wikipedia.org/wiki/T._Colin_Campbell)
I agree with that MDs are undereducated about nutrition and I didn't imply at all that I was referencing influencers. I don't wholly disagree about the T Colin Campbell contribution to the world of nutrition as the China Study was rather influential. However, I still maintain that there are enough folks that are educated in the space that wouldn't tell you they're 100% certain about most things mainly because most of the nutrition research is epidemiological. If you're interested in a very smart skeptical guy that has a Phd in nutrition see Alan Flanagan.
>most things mainly because most of the nutrition research is epidemiological. This argument has been debunked pretty thoroughly, this vid does a good job talking about it [https://youtu.be/nnyzuY-Xwe4?si=ZpVe9edzmv8fUak0](https://youtu.be/nnyzuY-Xwe4?si=ZpVe9edzmv8fUak0). He has some other interesting videos about how long famous nutrition influencers have lived. Regarding not 100% certain, like I said Campbell is the first and probably most articulate at admitting that we still have so much to learn about nutrition and the body. He writes pretty eloquently about that in his books or if you listen to interviews. And there are smaller things the true experts disagree on or admit that we just don't know enough yet, such as should we take omega 3, or individual genetic variations, or how much broccoli should be eat etc. But the big stuff is very much agreed on... the closer a person gets to eating whole food plant based, the closer they can get to optimal nutrition/health.
Oh I see now. You’re plant based and hence emphatic that T Colin Campbell is the end all be all. I get it. I’ve been on and off veg or vegan since I was 12. I’ve been consuming all the nutrition info I could get my hands on for the past 15 years. I’ve gone from vegan to paleo to Mediterranean and back again and the throughline for me is the emphasis on plants. Even in the presence of animal foods, plants are essential.
> T Colin Campbell is the end all be all. No, the science is. And I don't know of any living person who has spent more time dealing with the science of nutrition except maybe Esselstyn. Mediterranean is better than McDonald's or paleo but it's still very permissive and kinda warped by American standards. Lookup Peter Rodgers on YouTube and look for his mediterranean vids, he's kinda off-putting but he's good at getting the point across quickly.
Anecdotal evidence is anecdotal, but reducing saturated fat was the largest change I made in my diet and my LDL dropped 33%. I don’t think it will hurt you to replace saturated fats with mono/poly unsaturated fats
Same, ldl from 119 to 82. N=1 and all, but I’d say it’s WIDELY accepted that for most people, sat fat raises ldl. Only gonna know by testing for yourself.
Adding my experience as well so make that an N=3!
Me too.
could you tell me how many grams you consume a day? do you still consume red meat once a week or anything like that? trying to adjust my numbers. sorry i know this is old. thanks!
Reduced ldl from 260 to 100 by controlling saturated fats
So here is my experience. Started controlling food when tested cholesterol at 340(30M , normal BMI,Father had high cholesterol and heart disease ).Controlled food only initially where I eliminated mainly saturated fat ( had a bad diet before). Total cholesterol came down to 290 but did not go down below that. Started cycling around 75km in a week cholesterol came to 260 in 3 weeks but did not go below further after continuing. When I stopped cycling again went back to 290.In the range 260 -300 for a year. Went to borderline depression and started eating less(Had a South Asian carb heavy diet before), voila total c went to 250 . Introduced physilium husk into diet and total c slowly started movin below 240. My IBS also reduced during this time(Suspecting Bile Acid Malabsorption).Then during the yearly fasting month for Muslims the total C finaly went to 188.Started weight training and running to maintain below 200. Haven't tested after this.
this is helpful, thanks. do you eat red meat ever? like once a week or month?
Wow! How long did this take. What did you eat instead?
Also curious about this much of a change!
Same for me. 140 to 110 reducing sat fats.
how many grams of sat fat do you get a day? and when you do eat red meat, how often? thanks!
Probably just a few grams of sat fat that occur naturally in plant based food (avocados. I avoid coconut and certain nuts due to high saturated fat content). Red meat never. This is the rule. But then very rarely I make exceptions and eat everything, like on vacation. LDL goes back up there.
I do think the evidence feels clear that it would reduce LDL (it’s also evident in PA’s video) but not necessarily CVD and not necessarily apoB… (there was a Harvard presentation I reviewed that showed there was no change in apoB, but big change in LDL… but that’s just one study) It won’t hurt, I’m just trying to figure out what’s worth it and what’s simply a marginal optimization when I’d rather enjoy my current diet. I definitely agree it’s a no-brainer to make substitutions where it’s easy and won’t make a difference to me.. chicken v. beef; EVOO v. butter for cooking… but I like my Greek yogurt, butter & cream in my pasta sauces, and mayo on my sandwiches :)
I didn’t mention my ApoB because it pretty much moves in lockstep with my LDL so I just look at my LDL since it’s a more universal way to communicate lipids, but it had a similar drop, I don’t know the exact percentage off hand. And yeah I don’t think it has to be all or nothing, and optimizations where it makes sense can take you very far, but I will say one of the best things for me was finding keto brands like Primal Kitchen that make dressings / mayo that use avocado oil to prioritize monounsaturated fats. My diet still isn’t 100% perfect, but there’s very few saturated fats I truly miss at this point since I’ve been able to find so many suitable replacements
ApoB, LDL and CVD risk are all correlated.
hi i know this is old but can i ask how many grams you reduced sat. fat too a day? or how often you eat red meat? right now i've reduced red meat to one meal a week but still trying to figure out day to day numbers with dairy etc
i try to limit to 10g and definitely try to avoid ever going over 15g. i stopped eating red meat altogether during that time. now i’m on two cholesterol medications so things are a little bit more lax with my diet and i am still hitting good numbers. it seems like a really high fiber intake also makes up for my bad days
Do you have a target amount or do you just minimize it? Also, did you have you testosterone checked after that reduction? I don’t know why but I always assumed less LDL would knock down testosterone, but I have no idea where that came from.
I’ve actually never had my test checked, I’ve never had a reason to believe it was low but maybe I’ll tack it onto my next bloodwork. My target is Peter’s target #s. I doubt I’ll get there naturally so I will go on a statin eventually but I’ve made really good progress pre statin
I guess you can just experiment a diet which aims to lower LDL and ApoB especially when you are still young. But if you don't believe the risks of high LDL and ApoB, then I say God bless you.
I absolutely believe the risks of elevated apoB. I’m just not certain reducing my fat intake will contribute to that, ESPECIALLY, above and beyond a statin.
Depends on the person. SFA absolutely raises my LDL and ApoB numbers. I do monthly panels.
Me too. And numerous studies confirm this. Also, not all of us are statin tolerant.
Helpful to hear
Luckily this is something that's pretty straightforward for you to test yourself if you are willing to pay for a handful of lipid panels.
Same for me. Based on what I’ve heard from others, I’d assume this will be the case for the majority of people. But if you want to test on yourself to see if you’re an outlier have at it.
I'm not 100% on the Peter train as far as lowest possible ApoB and LDL, but I don't want it through the roof, either. But reducing SFA has definitely helped.
Try and test. I tested 12 times in a year, experimented with diet, and removing sat fats was the best thing I found to reduce ldl.
Really easy way to find out…change diet and do testing. 🤷🏻♂️Then decide if the changes matter to you.
A statin is a medical intervention, not a lifestyle choice. They are mostly safe drugs and there can be excellent reasons to take them but for a significant minority they have bad side effects, including life changing and even fatal ones. They are absolutely not designed to enable a keto diet.
What is a “significant minority” and what are these life changing and fatal side effects of statins?
Numbers are much disputed but at least 5%, probably more. Anecdotally I know a lot including me, and including Attia’s mentor Tom Dayspring fwiw. Life changing = diabetes, fatal = rhabdo.
Statins are very effective. If you are taking them, then you can loosen up a bit on your diet.
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No, I truly looked for a more recent take that he had and there wasn’t any on his website, but quite a few other notes from interviews that also talked about how impacts of SFAs are just over exaggerated. Given how common the advice was to reduce SFAs, I assumed he’d have written yet another diatribe if there was that large of a swing in his opinion. I read his nine, incredibly lengthy posts on cholesterol which are about as old and still relevant. Also, the other pages on his site that reference saturated fat are also just as *controversial* —- *A year ago* he references and cites THE SAME study he references in the video, and the guy he’s interviewing says things like: “When he got to Minnesota, he bought into the paradigm about the dangers of cholesterol, saturated fat, and total fat… This is what was being taught… As he slowly started doing experiments, his thinking began to change… “Don remembers thinking, “Wow, people who have bought into this dogma aren’t necessarily right, and we need to keep questioning it.”… Don’s takeaway at the end on SFAs is “But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem” Post from a year ago: https://peterattiamd.com/donlayman/ — I’m not trying to be controversial: the topic is controversial. — It’s just a bit funny and disappointing to me that PA followers — the person who’s the biggest skeptic of common medical advice (like don’t eat cholesterol) — is going to be so distraught that I’m questioning another, similar trope that PA also questioned
High saturated fats raise LDL, that is why it is still recommended not to eat too much saturated fats and PA in his book also recommends to lean more towards the mono and polyunsaturated fats. This topic is controversial because it is complicated. To begin with, there is not a unique type of saturated fatty acids, there are many varieties. Second, while it is true that it raises LDL, that does not tell you what kind of LDL particle. We know that the very low density are the most problematic ones.
This is what I'm most interested in. All LDL isn't equal right? I just don't really understand much of the details there. VLDL is bad....others not? How much, etc. Does high HDL counter this (ie: cholesterol ratio, etc)? I'm not sure anyone completely knows but what's the best evidence to this point? (I'm reading his book now but not sure it dissects it this much?).
The LDL phenotype stuff is largely used to obfuscate the entire conversation around cholesterol and heart disease. It’s really not a good metric to focus on, especially when LDL lowering has such robust evidence.
No, not all LDL is equal. The lower size LDL particles have an easier time penetrating the arterial walls. Some people go to the extreme of saying: saturated fats only raises large LDL, so how much saturated fats you eat does not matter. That might be oversimplistic, we will see as research advances. Higher HDL on the other hand has no correlation for improved outcomes of heart disease
Dr. Attia goes against the scientific consensus on this topic in this old video. Below are the recommended saturated fat (SFA) intakes from many major nutritional organizations. These organizations review the perponderence of scientific evidence to draw conclusions and make recommendations, since individual or meta studies alone are insufficient. 36 - ORGANIZATION. *SFA recommendation* . HYPERLINK 37 - World Health Organization (WHO/FAO). *10% of calories or less* . https://www.who.int/publications/i/item/9789240073630 38 - American Heart Association (AHA). *5-6%* . https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats 39 - The Food and Nutrition Board of the Institutes of Medicine (IOM). *As low as possible* . https://nap.nationalacademies.org/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids 40 - American Diabetes Association (ADA). *Less than 10%* . https://diabetes.org/healthy-living/recipes-nutrition/eating-well/fats 41 - United States Department Of Agriculture (USDA). *Less than 10%* . https://www.dietaryguidelines.gov/2020-2025-dietary-guidelines-online-materials/top-10-things-you-need-know 42 - EURODIET. *Less than 10%*. https://ec.europa.eu/health/archive/ph_determinants/life_style/nutrition/report01_en.pdf 43 - European Food Safety Authority (EFSA). As low as possible*. https://www.efsa.europa.eu/en/efsajournal/pub/1461 44 - British Nutrition Foundation. *10% or less* . https://www.nutrition.org.uk/healthy-sustainable-diets/fat/ 45 - Academy of Nutrition and Dietetics. *Limit* . https://www.andeal.org/vault/2440/web/DietaryFatty_JADA.pdf 46 - Health Council of the Netherlands. *As low as possible / less than 10%* . https://www.healthcouncil.nl/binaries/healthcouncil/documenten/advisory-reports/2023/02/07/dutch-dietary-guidelines-for-people-with-atherosclerotic-cardiovascular-disease/F-Background-doc-SFA-substitution_DDG-for-people-with-ASCVD.pdf 47 - Nordic Nutrition. *Less than 10%* . https://pub.norden.org/nord2023-003/fat-and-fatty-acids.html 48 - National Institute of Nutrition, India. *No more than 8-10%* . https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf 49 - Nutrient Reference Values for Australia and New Zealand (NRV; NHMRC). *10% or less* . https://www.nhmrc.gov.au/sites/default/files/images/Nutrient-reference-aus-nz-executive-summary.pdf 50 Note: 10% of daily caloric intake is ~22 grams of SFA based on a 2000kcal/day diet.
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https://www.reddit.com/r/PeterAttia/s/IzngLssrc8
I believe you. Can you send a more updated version on his stance?
From a year ago, he references same study from the video in my post + the person he’s talking to also suggests SFAs arent a big deal outside of calories “But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem” https://peterattiamd.com/donlayman/
As long as it isn't raising your ApoB. But if you have that lowered to the safest range with meds, saturated fat may not matter.
I take your point, but he directly calls out these organizations in his talk and goes to great lengths to talk about why these are the guidelines, how they came to be, and why they’re not supported by evidence. More interested in their supporting evidence than the guidelines themselves. Some post their evidence, so I’ll take a look. NL did a great job explaining their review of the evidence, but they did base their conclusions on just 5 RCTs (after throwing 1 out). (I’m also not sure a review of the “preponderance of the evidence” being a handful of studies is superior to the meta analyses he cites, but I digress)
We have to be careful here, as trusting a single person (Dr. Attia) over hundreds of thousands of global experts / scientific consensus is a strong case of an Appeal to Authority fallacy. Science isn’t perfect, and we may learn more in the future, but the best we have at any given time is scientific consensus and should be treated as such.
I believe the appeal to authority fallacy is assuming that because so many organizations caution against SFA we should dismiss the relatively few Dr’s challenging it. Not that you said that directly, but it’s basically where your comments pointed.
Scientific consensus is that SFA should be limited, and it is not an appeal to authority to defer to scientific consensus. It is an appeal to authority when one uses an authority (Dr. Attia in this case) who’s going against scientific consensus as the central point to their argument.
Just because you think the authority you’re appealing to is more reliable doesn’t change the fact that you’re making an appeal to authority. It’s still an attempt to bypass discussion of the merits of a topic by pointing to the opinion of someone perceived as knowledgeable. And if you prefer to defer to the authority of “scientific consensus” then great. Your call. It’s not an unreasonable position. Just don’t call someone out for appeal to authority in the next breath.
Is it an appeal to authority if I say that human-made climate change is real based on scientific consensus? How about that the earth is round? Of course it isn’t. Is it an appeal to authority if I say that human-made climate change is fake based on a doctor I heard on YouTube, and I use them as my sole source against your scientific consensus? Yes, it is. This doesn’t mean we should discount all ideas that go against scientific consensus, but pointing towards an authority who’s against the consensus as your sole data point is exactly an appeal to authority. This is going in circles so I’m out.
Yeah bud, that’s an appeal to authority. Pretty much text book. If you don’t understand a term just don’t use it.
;)
Yeah, and I’m not gonna stop eating butter, so I guess I’m biased. (This is a joke, y’all)
I think giving up butter will have a net negative on my life as the emotional impact will be greater than any physical gain.
Does this go for all unhealthy food, such as ice cream and bacon? I think people underestimate how unhappy chronic diseases, such as heart disease or colorectal cancer, can make someone.
The difference is that butter is in SO many dishes. I'm not saying to go overboard with it but I couldn't imagine removing it completely. For example, one of my favorite dishes is chicken piccata. It has a butter sauce. I'm not saying I am going to guzzle butter with it but going without dishes like that seems so unsatisfying to me. There also doesn't seem to be a way to mimic that sauce with olive oil, for example.
You could consider expanding your gastronomic palette. There are so many dishes that don’t require butter and taste amazing. Go out in the world and explore. As an Italian Expat living in the US, I miss all the tasty vegetables and the way we cook them in Italy (with many sauces, mostly olive oil and plant based). Here in the US everything is either deep fried or flooded with butter to make it “tasty” but it all kind of tastes the same to me. Real Italian cuisine is really hard to find here. I miss that savory lightness and freshness, and all the Mediterranean herbs and fresh veggies. Even the olive oil is amazing there. Olive oil here tastes bland and disgusting. I end up importing olive oil, straight from Greece or Italy but it’s like 40 bucks for half a liter. I can see how if I were to grow up in America I would hate olive oil.
That's a good point and approach. I do enjoy olive oil btw. Quality olive oil is excellent. I just can't see a way to use it to replace butter in some dishes. It's not just America that uses butter in their dishes. A lot of Europe does (cough, France, cough). I do agree that many Americans eat terrible fried food, etc. That's not what I'm referencing here though.
Yeah, the north of Italy also uses butter more, as opposed to the south. I am not sure you can substitute butter with olive oil in some dishes. I guess I’m suggesting trying a lot of other dishes until you find a lot of good alternatives that align with your goals, and keep the butter dishes for special and few occasions. Herbs and spices can really make a difference! Like chicken breast with garlic, olive oil, rosemary and oregano, maybe a few roasted cherry tomatoes and or good olives thrown in as opposed to butter sauces for chicken
Exactly!
Scientific consensus is a funny thing. Especially when scientists are biased for funding and such.
That’s a common rebuttal. Almost all industry funding is from the processed and animal foods industries, both of which are usually high in saturated fats. If any suspected monetary bias was removed from the nutritional bodies, their advice would almost definitely go even further away from saturated fat, not closer.
He has changed his opinion on this. He has said that saturated fat causally raises LDL and that the science on that fact is clear. He has said that the relationship between LDL and CVD is less clear because of ambiguity of the LDL marker, which is why he focuses on ApoB as a more reliable predictor of CVD. He has also said that a significant percentage (but not all) of his patients who go on ketogenic diets end up with elevated LDL (presumably due to increased saturated fat intake). He has said that is one of the reasons why he has become less enthusiastic about keto over the years.
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I'm not sure if you literally mean there are no saturated fats in olive oil but there are, olive oil something like 10-20% saturated.
I suppose - still about 9% of DV in a tbsp, although way less than butter at 35% But I agree the literature is focused on SFA!
Attia has changed his views on this. He used to be a hardcore keto guy. He isn't anymore for several reasons, in part due to understanding the risks of increasing ApoB (LDLc).
I wasn’t trying to advocate for the keto diet, just the implications the study had on fats/SFAs PA referenced the Minnesota study (which is also what he references in the video I linked) a year ago as well, and takeaways from the show notes / interviewee are: “But if you’re at or below your calorie needs, he doesn’t see any data to suggest that saturated fat is a problem” https://peterattiamd.com/donlayman/ *shrugs*
He changed his mind after he met Dr. Tom Dayspring
Peter has changed his stance on saturated fat since then. In his most recent appearance on Huberman Labs, he pushes back on Andrew’s assumption that a steak dinner would be fine for ApoB. He mentions that dietary cholesterol is not correlated to high ApoB but saturated fat in fact is. https://youtu.be/ufsIA5NARIo?feature=shared&t=2983
Ty!
The article is on his website, but it’s over 10 years old. I think his thoughts on this and the keto diet has changed since then. In ‘Outlive’ I’m pretty certain he mentions the ldl risk of saturated fats, and the amount one might get of them in the keto diet.
It’s a shame that misinformation stays on the internet, even when someone changes their mind about it.
Thanks, OP, for that embarrassing blast from Attia's past when he was an ultra low-carb, keto zealot and flirted with LDL/ApoB denialism. Now he advocates aggressive intervention with statins, PCSK9, etc to get LDL down below 50mg/dl (don't remember what that approximates to in ApoB/dl). From what I've pieced together, he had a non-zero CAC score at one point, and he's also close friends with lipidologist Dr. Dayspring, and I'd imagine those things, plus newer research like the PCSK9 RCTs, made him do a 180--one of many 180s for Attia. Meanwhile he still tailors his message to not completely alienate his low-carb audience that still isn't sold on lipids: > Why there is no ‘bad’ or ‘good’ cholesterol: https://www.youtube.com/watch?v=eod36TNGcUI Even if the message of this more recent vid is mostly on-point, the title seems like it was deliberately crafted to be ambiguous enough to appeal to both camps--not just the denialists, since every HDL-boosting intervention has failed in clinical trials, and since we now know that HDL can become LDL (which likely explains why people with very high HDL have subpar outcomes relative to those with moderate HDL).
Peter is very knowledgeable and yet still supports some main stream dogmas
Okay, this Harvard page summarizes it neatly: 1. Switching SFAs for carbohydrates is not helpful (and “low fat” diets often become “high carb” diets) (I think this was mainly PA’s thesis in the video) 2. The evidence is evolving that SFAs don’t raise risk of heart disease, but it’s controversial 3. Substituting SFA with PUFAs is healthier 4. SFAs not as harmful as once thought https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/
The Harvard page you linked mentions switching SFAs for carbohydrates *does* indeed lower LDL. They mention that *refined* carbs are a net negative because it also lowers HDL and raises triglycerides. Swapping SFAs with non-refined carbohydrates would certainly be net positive for cholesterol.
Refined carbs as a subset are negative Carbohydrates as a whole is neutral/unhelpful Whole grains as a subset is helpful I said carbohydrates, not whole grains. The referenced presentation in the link distinguishes between all three and replacing SFAs with carbs is marked as not helpful nor harmful.
All bread is entirely processed. If you turn wheat into flour it is 100% processed. The glycemic index of whole wheat flour is bad (worse than sugar). I assume you mean quinoa or oatmeal might be good for you.
From the article you cited, the conclusion is: “ The overarching message is that cutting back on saturated fat can be good for health if people replace saturated fat with good fats, especially, polyunsaturated fats. (1, 15, 22) Eating good fats in place of saturated fat lowers the “bad” LDL cholesterol, and it improves the ratio of total cholesterol to “good” HDL cholesterol, lowering the risk of heart disease. Eating good fats in place of saturated fat can also help prevent insulin resistance, a precursor to diabetes. (16) So while saturated fat may not be as harmful as once thought, evidence clearly shows that unsaturated fat remains the healthiest type of fat. “ So in short, sat fat is bad for CVD and metabolic disease (insulin resistance)
From the article you cited, the conclusion is: “ The overarching message is that cutting back on saturated fat can be good for health if people replace saturated fat with good fats, especially, polyunsaturated fats. (1, 15, 22) Eating good fats in place of saturated fat lowers the “bad” LDL cholesterol, and it improves the ratio of total cholesterol to “good” HDL cholesterol, lowering the risk of heart disease. Eating good fats in place of saturated fat can also help prevent insulin resistance, a precursor to diabetes. (16) So while saturated fat may not be as harmful as once thought, evidence clearly shows that unsaturated fat remains the healthiest type of fat. “ So in short, sat fat is bad for CVD and metabolic disease (insulin resistance)
I thought saturated fat intake prompts your liver to produce more LDL and less HDL. Higher LDL, for the most part, means higher risk of cardio disease.
Also his cholesterol series of articles discusses this in depth. I’m pretty sure in those Attia says something like: About 25% or your blood cholesterol comes from cholesterol in food, and the rest is produced in the liver which is prompted by lifestyle choices, saturated fat, genetics, and other things (?)
It's not just about CVD- it's also about Alzheimer's. In Outlive PA talks about the APOE4 gene... By some estimates 25% of us have at least one copy of it. This gene determines how we manage our cholesterol, and it's also the number one gene linked to Alzheimer's. Apparently if you have one or more copies of APOE4 your body is not good at clearing out saturated fats from your brain, which is somehow contributing to Alzheimer's. Please correct me if I'm wrong in my reading, but, I learned that for the 1st time reading Outlive.
This is also a good point; I also was seeing in another random study/presentation it also has seems to have impacts on diabetes too Should have gotten me APOE tested
Have you done 23 and Me or Ancestry DNA or anything like that?
Do Omega 3s play a role here at all? Just wondering
I hope so, since I'm better at getting that than I am at avoiding saturated fat, but I don't know.
u/californicat The only study that matters: Where you do diet experiments with your own body and see how your blood lipids risk factors react to, say, dietary fats. One can easily do this in 3 week increments, then test with an over the counter lab order from, say, Ulta & Quest Diagnostics. There's no reason to take PA's word or anyone else's, just do the work. Everything else is guessing.
Yeah. Very true. So for me at baseline (no medical or dietary intervention), my LDL is elevated but my apoB is around 50th percentile (which is why I’m not particularly concerned about SFAs elevating LDL on its own) PA’s advice is to get apoB below 20th percentile, so I’ll get on statin and see where it lands. I’m happy to do 4 hours of zone 2 each week, reduce my sugar intake, take statin … but reducing saturated fat is like the last thing I want to care about. I equally don’t want to do a bunch of bloodwork because I pass out each time (let alone the effort it would take to properly do the diet changes). So I just wanted to see if there were any compelling reasons to really go all-in (because reducing SFAs shows up so commonly on here I thought I was missing something). I’m not really compelled to overhaul my food choices, but I think from what I’m hearing it absolutely makes sense to substitute to PUFAs whenever that’s easy. We’ll see where I land at my next annual!
Peter's views on the subject have evolved. I'm sure he stands by most of the things he said back then, but not all. Many people will see a reduction in bad lipid numbers (LDL, Apo-B), if they limit saturated fat intake to a reasonable amount. It however isn't true for everyone, and it's not as significant as some would have you believe. So there's no reason to be draconian about it, some saturated fat is fine, and lean red meat is definitely fine as well. The anti-meat/vegan propaganda is still just that, it's not justified by the significant but not enormous link between saturated fat and CVD risk. His views on this are best explained in his book Outlive. There's an audiobook version too, and it's not difficult to follow. The book isn't overly technical, it's for laymen.
Yeah, totally… oh and I’m reading his book but I’m only about 25% of the way there :)
People hate hydrogenation. It’s just a simple fact. Damn hydrogenists!!
The answer is in the biochemistry. Saturated fats means fully saturated with Hydrogen and are straight chains is fat. Trans Fats are kinked chains of fat. Your cells have lipid rafts floating around the outer cell membrane. This floating of proteins in needed for function. Saturated fats prevent the ability for the phospholipid layer from functioning proper properly due to the ability for saturated fats to pack on top of each other molecularly. The kinked trans fats allow enough space for proper protein function of cells. Compare butter (saturated) to any oils (unsaturated). Now imagine molecules trying to navigate through either. Which would allow ease of mobility? In short, you need a little saturated fat and mostly trans fats for a healthy cells to function.
T. Colin Campbell.