We must face facts - meat is the problem

[DrGriz]

There were a number of studies covered in the video, link to source materials can be found here under "sources cited":

Dietary Guidelines: “Eat as Little Dietary Cholesterol as Possible” | NutritionFacts.org

Why do the official federal Dietary Guidelines for Americans recommend limiting the intake of dietary cholesterol (found mostly in eggs) as much as possible?

nutritionfacts.org

Yes. Still, I challenge you to find one person who can give you in granular detail what they ate for the last year (without lying), let alone over 20 years.

I am not endorsing egg consumption. I am saying that I am skeptical of observational studies which are by nature very subject to error in the setting of multifactorial situations.

 

[DrGriz]

This study measured cholesterol levels over the hours after eating eggs. So not subject to diet recall errors. Cholesterol goes up.

I don't care what my momentary cholesterol level is. I care if I am going to have a heart attack, stroke or die.

My brother-in-law and his sister, my wife, have similar high blood cholesterol levels. They eat similarly. He has a cardiac calcium score of over 1500. My wife? -0-. They are close in age, both old enough that the calcium score means something. (Whether or not they have premature cardiovascular disease, which they both are old enough to have). This is a problem. Someone won the gene lottery, and diet did not make that huge difference. Do I think that proves something?

No, but it should give one food for thought.

 

[David_Cary]

Agree that momentary cholesterol levels are an unknown factor. Interesting that egg consumption elevates it but doesn't prove anything.

The cholesterol mysteries are frustrating for sure. I think we can say the following things with some level of certainty.
Genetics is a huge factor both in levels and risk for disease.
Cholesterol consumption does not occur in a vacuum and overall poor quality diet seems to allow the dietary cholesterol to wreak havoc.
Added sugar is unequivocally bad.

Less than certain....
If eating eggs helps you maintain ideal weight and avoid sugar, on balance it is probably a good thing.
Processed carbs are as bad or almost as bad as added sugar.

I think there are few studies that really look at processed carb and sugar consumption in concert with things like saturated fat/cholesterol. It is why you can have the French with high sat fat consumption and little correlation to vascular disease compare to the high correlation in the US.

I know this for sure - eating beans/lentils is better for the environment than eating beef. And in most situations, it is better for health. My personal situation is that going to near vegan diet didn't help my cholesterol 1 point. In the past, I've been paleo bordering on keto for like 5 years - so the change from that standpoint was huge. In neither case though, did I consume much processed carbs or sugar.

You can debate certain health points for a long time. The enviromental stuff is more straightforward. Now - almonds and avacado get tricky. I mean, if we desertify the West faster with almond consumption, is that all bad? I mean I don't live threre. Maybe it wakes people up to reality faster.

 

[DrGriz]

I'll say it again. Observational studies should always be viewed with a jaundiced eye. There can be no controls, and they are not blinded.

Dietary observational studies are particularly worse because people don't eat the same diet over time, especially over decades, and reporting is awful.

Serum cholesterol. What does it mean? It is generally assumed to correlate to cardiac risk, and it does, but to what extent? Do we care about serum levels? Or cardiovascular events? We can look at some studies from medications that lower serum cholesterol. Particularly statins.

Number Needed to Treat (NNT)

This is the number of patients you have to treat over a period of time with a single intervention to avert a bad outcome, for instance. Studies can be double blinded and random, so good science.

For statins, which lower serum cholesterol, there are some studies out there looking at this in people without disease initially. Just high cholesterol.

To avert one cardiovascular event (stroke, heart attack, death combined), NNT in pooled studies was 20.
20 people treated to avoid one event. That means 19 did not benefit from years of taking medication. 95%.

To avert one cardiovascular death, NNT was as much as 1000!
999 people survived and did not need the statin to do so. 99.9%.

So, my point is, how important is cholesterol level in predicting cardiovascular events and how hard should we be working at it? We are not good yet in selecting asymptomatic people for intensive treatment. Way too many do not benefit. (The drugs have much better data in people who have known cardiovascular disease).

None of this means I am arguing against a vegetarian meatless diet. I am not. Just that maybe cholesterol levels are not the best way to address that topic.

 

[mspohr]

Millions of people take statins to lower cholesterol prescribed by their doctors.
There are numerous studies that support the conclusion that lower cholesterol leads to lower CV death.
Science.

 

[Konicom04]

Yes, yet another reason to stop eating meat.
- It's bad for your health

I am thoroughly convinced that force eating medium rare steak recently finally fixed my 6 year long battle with Colitis

 

[DrGriz]

The numbers needed to treat are also science. Meaning most people don't benefit, because our selection criteria are imperfect.

Statin Use in Primary Prevention of Atherosclerotic Cardiovascular Disease According to 5 Major Guidelines

This study compares the sensitivity, specificity, and estimated number needed to treat to prevent 1 atherosclerotic cardiovascular disease event in 10 years according to statin criteria from 5 major guidelines.

jamanetwork.com

 

[JRP3]

Quinoa for environment and health.

 

[mspohr]

The numbers needed to treat are also science. Meaning most people don't benefit, because our selection criteria are imperfect.

Statin Use in Primary Prevention of Atherosclerotic Cardiovascular Disease According to 5 Major Guidelines

This study compares the sensitivity, specificity, and estimated number needed to treat to prevent 1 atherosclerotic cardiovascular disease event in 10 years according to statin criteria from 5 major guidelines.

jamanetwork.com

Interesting study.

Conclusions and Relevance With similar NNT10 to prevent 1 event, the CCS, ACC/AHA, and NICE guidelines correctly assign statin therapy to many more of the individuals who later develop ASCVD compared with the USPSTF and ESC/EAS guidelines. Our results therefore suggest that the CCS, ACC/AHA, or NICE guidelines may be preferred for primary prevention.

 

[DrGriz]

Interesting study.

Conclusions and Relevance With similar NNT10 to prevent 1 event, the CCS, ACC/AHA, and NICE guidelines correctly assign statin therapy to many more of the individuals who later develop ASCVD compared with the USPSTF and ESC/EAS guidelines. Our results therefore suggest that the CCS, ACC/AHA, or NICE guidelines may be preferred for primary prevention.

Yes, as a physician who has treated most of his patients with statins over decades, and who has helped establish medical guidelines for stating a health system, I think I know all that. It literally has been my bread, butter, and cheese.

What I am hoping to help you with is to understand that the NNT, depending on the study, means you have to treat 10 or 20 people to benefit one. The guidelines say it's worth it for population health. But the reality is there are only 1 (or 2) avoided events for that many treated. 90-95% don't benefit. The problem is, we can't predict who is at risk with enough granularity to just treat those people who benefit, and spare the others.

And so it is with eggs.

 

[mspohr]

Yes, as a physician who has treated most of his patients with statins over decades, and who has helped establish medical guidelines for stating a health system, I think I know all that. It literally has been my bread, butter, and cheese.

What I am hoping to help you with is to understand that the NNT, depending on the study, means you have to treat 10 or 20 people to benefit one. The guidelines say it's worth it for population health. But the reality is there are only 1 (or 2) avoided events for that many treated. 90-95% don't benefit. The problem is, we can't predict who is at risk with enough granularity to just treat those people who benefit, and spare the others.

And so it is with eggs.

This article seems to point the way to be more selective in statin use. Hopefully this will be refined even more.
It's clear that the drug companies have pushed for broad use of their products so there are a lot of people on these drugs who may not benefit.
Still, a 5% or 10% NNT is not a bad result for a drug with few side effects.

 

[DrGriz]

This article seems to point the way to be more selective in statin use. Hopefully this will be refined even more.
It's clear that the drug companies have pushed for broad use of their products so there are a lot of people on these drugs who may not benefit.
Still, a 5% or 10% NNT is not a bad result for a drug with few side effects.

Yes, it's getting better, but your "5%" means 5% of people treated benefited. Therefore 95% didn't. That's a pretty poor bet. From an individual's perspective.

I agree it's worth it to prevent heart attacks or strokes, if you are looking at it from an overall population perspective. Especially from purely a cost advantage.

 

[K.I.T.T.23]

Yes, it's getting better, but your "5%" means 5% of people treated benefited. Therefore 95% didn't. That's a pretty poor bet. From an individual's perspective.

I agree it's worth it to prevent heart attacks or strokes, if you are looking at it from an overall population perspective. Especially from purely a cost advantage.

Question for you Dr. Griz. I never see anyone about cardiac issues regarding cholesterols because mine are low; so much so that my doc was recommending fish oil pills to try and raise the good (HDL) cholesterol (spoiler: they had no effect). I don't remember the numbers off hand. I think I have records; if you are curious, I can get that info and send it privately.
I eat mostly Eggs, meat (red and white) with a heavy amount of vegetables. I eat grains to bulk up or when I am attempting to perform better.
Previously, when I was not as health consciousness I had a high processed food diet, caffeine, sugars... all the bad stuff, my weight varied by up to 50lbs a year (yes, I know; really bad).
Through all that time though, my cholesterol numbers remain similar, no significant deviation.
I do think I have a genetic predisposition to these numbers, my father is the same, so are my uncles (all boys on that side of the family) grandfather died from a stroke, but all my uncles and father are in their early 70's, two of them (2 of 5) had to have bypass surgery. They are all overweight... which was part of my motivation to maintain a healthy weight and activity.
All of the research I have seen is on the normal issue of high numbers... Which is not helpful.

My question is: have you seen anyone with low numbers, and are there potential issues I should be on the look out for? Is there any research you could direct me to that would be beneficial to someone who has a genetic predisposition to low numbers?

Thanks in adavance.

 

[mspohr]

Yes, it's getting better, but your "5%" means 5% of people treated benefited. Therefore 95% didn't. That's a pretty poor bet. From an individual's perspective.

I agree it's worth it to prevent heart attacks or strokes, if you are looking at it from an overall population perspective. Especially from purely a cost advantage.

As a public health person, that's worth it.

 

[DrGriz]

Question for you Dr. Griz. I never see anyone about cardiac issues regarding cholesterols because mine are low; so much so that my doc was recommending fish oil pills to try and raise the good (HDL) cholesterol (spoiler: they had no effect). I don't remember the numbers off hand. I think I have records; if you are curious, I can get that info and send it privately.
I eat mostly Eggs, meat (red and white) with a heavy amount of vegetables. I eat grains to bulk up or when I am attempting to perform better.
Previously, when I was not as health consciousness I had a high processed food diet, caffeine, sugars... all the bad stuff, my weight varied by up to 50lbs a year (yes, I know; really bad).
Through all that time though, my cholesterol numbers remain similar, no significant deviation.
I do think I have a genetic predisposition to these numbers, my father is the same, so are my uncles (all boys on that side of the family) grandfather died from a stroke, but all my uncles and father are in their early 70's, two of them (2 of 5) had to have bypass surgery. They are all overweight... which was part of my motivation to maintain a healthy weight and activity.
All of the research I have seen is on the normal issue of high numbers... Which is not helpful.

My question is: have you seen anyone with low numbers, and are there potential issues I should be on the look out for? Is there any research you could direct me to that would be beneficial to someone who has a genetic predisposition to low numbers?

Thanks in adavance.

Not presuming to treat anyone over the internet , but you bring up an interesting point. Yes, I have seen plenty of people with low numbers. Low HDL is a risk factor for vascular disease for sure although it may not be causative. By that I mean that it is a marker of other factors that cause CV disease and low HDL. There's no reliable medication to treat low HDL (they've tried. Caused liver failure). And raising HDL by itself doesn't seem to change risk. Quitting smoking, weight loss to a closer to normal weight and aerobic exercise seem to raise HDL, but that probably moderates risk independently of the HDL levels. I believe all of those are a good idea.

I think there is a large component of inflammation regarding the generation of vascular disease and animal protein can exacerbate that in people who are susceptible. With that family history I'd go easy on that. Nothing wrong with a vegetarian diet at all. Or Mediterranean if you prefer to go that way. And weight loss. Good for you for working on that.

As far as low LDL, it is often due to illness, but there are pathological genetic variants that can be investigated. One would decide to treat depending on the specifics. Pick better parents next time!

I can email you an article with references and probably more than you want to know, if you want to PM me an email address But that's the bottom line.

 

[JRP3]

Surprise, special interests at work as usual:

 

[K.I.T.T.23]

Not presuming to treat anyone over the internet , but you bring up an interesting point. Yes, I have seen plenty of people with low numbers. Low HDL is a risk factor for vascular disease for sure although it may not be causative. By that I mean that it is a marker of other factors that cause CV disease and low HDL. There's no reliable medication to treat low HDL (they've tried. Caused liver failure). And raising HDL by itself doesn't seem to change risk. Quitting smoking, weight loss to a closer to normal weight and aerobic exercise seem to raise HDL, but that probably moderates risk independently of the HDL levels. I believe all of those are a good idea.

I think there is a large component of inflammation regarding the generation of vascular disease and animal protein can exacerbate that in people who are susceptible. With that family history I'd go easy on that. Nothing wrong with a vegetarian diet at all. Or Mediterranean if you prefer to go that way. And weight loss. Good for you for working on that.

As far as low LDL, it is often due to illness, but there are pathological genetic variants that can be investigated. One would decide to treat depending on the specifics. Pick better parents next time!

I can email you an article with references and probably more than you want to know, if you want to PM me an email address But that's the bottom line.

Thank you! Definitely not looking for diagnosis online, just to be pointed in the right direction. I have never smoked, drink on rare occasion, and exercise has been central to my life even when I was overweight. I would attribute the weight to stress/unhealthy coping mechanism, but even then I ran/biked/climbed quite a bit. Like I mentioned earlier, watching the issues with my grandfather and uncles; I wanted to avoid an early grave or heart surgery.

O, and "pick better parents next time"... priceless, I am going to save that one to use on my kids lol.

My job in the military was researching things I knew nothing about and processing that information, so I am up for a challenge. (PM sent) I look forward to the reading. This is a subject that bothers me as my issues here are not normal and the literature seems to be few and far between; I couldn't find any.

 

[David_Cary]

Just as an aside (and a personal factor of mine), there are other endpoints than death of course. Dementia appears to have a reasonably strong vascular effect - more so than was discussed when I was in school. So the benefits of statins can fall into things other than death.
I honestly don't know if there is enough duration in the studies along with following all people to death that would tease out this effect - since when people die of dementia they mostly probably stop their statin or get removed from a study because of compliance/follow up issues. What I can tease out is that statins during middle age lower dementia risk. I know there have to be all-cause mortality numbers. I just don't know how clean the numbers are when in comes to dementia where death would occur many years after onset.

This article is certainly imperfect (observational and all) but interesting nonetheless. The one-liner is that both low carb and high carb diets had higher all-cause mortality than medium carb diets. When carbs where replaced by animal fat and protien, there was a mortality increase. When it was more plant based, it was not. 4 US communities despite published in England. And for those that don't know, The Lancet is about as good as it gets (and are great about on-line access with no paywall).

Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were...

www.thelancet.com

 

[DrGriz]

Thank you! Definitely not looking for diagnosis online, just to be pointed in the right direction. I have never smoked, drink on rare occasion, and exercise has been central to my life even when I was overweight. I would attribute the weight to stress/unhealthy coping mechanism, but even then I ran/biked/climbed quite a bit. Like I mentioned earlier, watching the issues with my grandfather and uncles; I wanted to avoid an early grave or heart surgery.

O, and "pick better parents next time"... priceless, I am going to save that one to use on my kids lol.

My job in the military was researching things I knew nothing about and processing that information, so I am up for a challenge. (PM sent) I look forward to the reading. This is a subject that bothers me as my issues here are not normal and the literature seems to be few and far between; I couldn't find any.

Sent!

 

[mspohr]

Just as an aside (and a personal factor of mine), there are other endpoints than death of course. Dementia appears to have a reasonably strong vascular effect - more so than was discussed when I was in school. So the benefits of statins can fall into things other than death.
I honestly don't know if there is enough duration in the studies along with following all people to death that would tease out this effect - since when people die of dementia they mostly probably stop their statin or get removed from a study because of compliance/follow up issues. What I can tease out is that statins during middle age lower dementia risk. I know there have to be all-cause mortality numbers. I just don't know how clean the numbers are when in comes to dementia where death would occur many years after onset.

This article is certainly imperfect (observational and all) but interesting nonetheless. The one-liner is that both low carb and high carb diets had higher all-cause mortality than medium carb diets. When carbs where replaced by animal fat and protien, there was a mortality increase. When it was more plant based, it was not. 4 US communities despite published in England. And for those that don't know, The Lancet is about as good as it gets (and are great about on-line access with no paywall).

Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were...

www.thelancet.com

Interesting article.
Confirms that meat and animal fat are unhealthy.
Curious about high carbohydrate diet which they don't discuss much except this:
Our conclusions about animal fat and protein might have less generalisability to Asian cultures, which often feature very high carbohydrate consumption but with a primary meat source that is often from fish.
Fish is healthy.
Could be that high carbohydrate diets leading to increased mortality could have a lot of sugar.