Thank You, American Heart Association (Sincerely)

Once again, I’m apparently having a very different reaction than everyone else.

Last week the American Heart Association (AHA) put out a Presidential Advisory statement online warning against the use of saturated fats and in favor of polyunsaturated fats.

Lead author Frank Sacks, MD was quoted by Medscape:

We want to set the record straight on why well-conducted scientific research overwhelmingly supports limiting saturated fat in the diet.

 

Later in the article, he goes on to say:

This advisory is based on careful scientific review — it has been organized in a very systematic way, involving experts from a wide range of fields who have looked very carefully at the literature. Then the recommendations have been thoroughly vetted and questioned through multiple levels of peer review and scientific advisory committees across the entire AHA.

Okay, without question, I considered this excellent news for several reasons. Let me explain with an analogy….

Trial of The Century

Imagine saturated fat was a defendant on trial for murder. The trial stretched into years, then decades, and now approaches a century. The prosecution side is well funded with lots of resources and has been flooding the trial with mountains of papers and studies. The defense keeps finding issues with the evidence presented and starts to bring around many studies of its own, appearing to look better and better up to this point. The jury seems to be slowly moving more and more in the direction of the defense.

Like me, you might be a juror that is coming in late and feel overwhelmed by how much homework you’ve been given and how much material you have to sift through to have any idea of what to think.

But then, out of nowhere, the prosecution says, “Alright, alright — nevermind all these things. There are really just four studies that matter. Four studies that meet the standards necessary to judge this entire case on.”

You, me, and the rest of the jury look up in both surprise and relief. Everything just got easier for all of us!

Why This is Great

The AHA (whether it meant to or not) has now told us several things by this release:

  1. People are starting to believe saturated fat is okay or even healthy to the point where the AHA feels the need to act. This isn’t a study itself or a new guideline — this is a full-throated message to the masses.
  2. The AHA is insisting we narrow this down to just four studies. Four!!!
    1. Obviously, this means The Big Four presented must stand up to scrutiny in their methodology and data. And to be sure, I don’t know myself all the ins and outs of these studies to have a strong opinion — but I definitely will eventually. After all, I only have this tiny list now instead of the thousands in front of me before.
    2. Likewise, this implies every other study besides The Big Four is clearly unfit to meet the criteria set forth by the AHA. This too must be examined closely.
  3. The selection criteria itself is now something we can look at. When you announce you have used an objective, categorical set of standards — you have to be prepared to defend it.

The Debate is Consolidated

There have been many, many voices of opposition that have sprung up in the last week, but I’m going to point to two in particular.

On the public prominence front, Gary Taubes delivers an impressive critique that outlines approach, bias, and the overall politics regarding the science and studies chosen.

Of sources on the biochemical front, no one comes close to Chris Masterjohn’s very methodical breakdown of each of the Big Four. He exposes both the problems with these studies and the inconsistencies with the AHA’s selection criteria.

If I could get you to read/listen to just two – make it these two.

Will They Address Criticism Directly?

This is an extremely relevant question.

We can determine a lot by the next actions of the AHA with regard to defending their release — or ignoring arguments altogether. Is this about science or politics?

If this is about the science:

  • They will rightly defend their selection criteria and address comments about this process itself.
  • They will likewise rebut issues with the studies directly and why they believe each is worthy of the standard they set.

If this is about politics:

  • They may ignore critiques of this advisory entirely, insisting their release adequately addressed all possible concerns.
  • They may set up a false dichotomy with regard to response effort — “Hey, we can’t answer every criticism of this work.” In other words, if we have to answer even one, then we’d have to answer all. Therefore the prudent thing would be to answer none.
  • They may employ political tactics such as singling out an extremist voice in order to set up a Weak Man Argument. This hasn’t happened yet, but let me go on record now to say it is a very, very common practice in politics of the modern era.

Thanks!

I’m being sincere here – I’m genuinely happy the AHA took this action as I can now observe how much of the institution is acting on science vs politics.

Ketofest Cholesterol Experiment – Sign Up

I’m pleased to announce there is a study being organized around Ketofest! We’re partnering with PTS Diagnostics, who is graciously providing the supplies and service to support this study.

Volunteers for the study will be following the Cholesterol Drop Protocol (“Feldman Protocol”) and will get free cholesterol blood tests and results.

To qualify, all volunteers must meet these requirements:

  • Have been on a Low Carb High Fat (LCHF) diet for at least three months prior to Ketofest.
  • Be present on the morning of Friday the 14th and morning of Monday the 17th.

Schedule and instructions

schedule

  1. Low-Calorie Phase
    • You must be either fasting or eating low calorie (but still LCHF) for a three-day span on July 11th, 12th, and 13th — the Tuesday, Wednesday, and Thursday before Ketofest. (see timeline).
  2. Fast before 1st blood test
    • You must fast for 12-14 hours between the last meal on the evening of the 13th and the following morning blood test on the 14th.
  3. High-Calorie Phase
    • You must eat very high calories (but still LCHF) for the following three-day span on July 14th, 15th, and 16th — the Friday, Saturday, and Sunday of Ketofest. (see timeline).
  4. Fast before 2nd blood test
    • You must fast for 12-14 hours between the last meal on the evening of the 16th and the following morning blood test on the 17th.

Interest List

If interested in participating, please fill out the entry form below:

Interview on Biohackers Lab

I’ve been a bit busy lately, but not so busy I couldn’t take a little time to chat it up with Gary at Biohackers Lab.

We covered a wide range and I enjoyed getting in a bit deeper to the core concepts and why I have so many doubts about the lipid hypothesis as it stands.

And without question, Gary has the most comprehensive show notes I’ve seen for any podcast I’ve been on. Really impressive work!

The Fasting Disaster Part II

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I’ve been getting pinged by a lot of follows this week who noticed I was being talked about at toward the end of the most recent episode of Fasting Talk with Jimmy Moore & Dr. Jason Fung, episode 22. They were discussing my blog post The Fasting Disaster from last April (starts around 49:20) . Apparently, some people were concerned I was claiming fasting was generally deleterious to health in general and with regard to cholesterol specifically.

Now before responding, let me deflate any expectations you might have of a back-and-forth beatdown (as some of you have suggested) — as I actually have enormous respect for Dr. Fung and agreed with quite a few things he was saying regarding cholesterol. A few have mentioned he got “personal” with some of the comments, but honestly, I was laughing throughout. You just have to know the guy, he’s actually very entertaining. (Side note: he’s a lot like Ivor Cummins in they both get very colorful with their language and some take this very personally, but they shouldn’t.)

Cholesterol Jump with Fasting (And Why I Don’t Believe It’s Bad)

One of his early statements I liked enough to transcribe personally:

The question is, do these short term manipulations of your cholesterol make any difference to heart attacks and strokes, and the answer is, nobody knows. There is zero data out there that says, oh if it goes up really high due to — whatever — what you ate or if you fasted or whatever. Is that bad? I don’t know. Is that good? I don’t know. I have no idea, so why do we care about short term movements of cholesterol?

To be sure, if you’re a long time reader of this blog, you know I’m extremely obsessed about the movements of cholesterol! Which is why I know his larger point is well taken. This short term shift was of little relevance to me in terms of overall health because I knew what was going on and fully expected the result.

Quite simply, cholesterol from a blood test is likely higher in the short term due to getting more energy from fat in the body (adipose). In order to traffic that fat to your cells, your liver places them as cargo in boats known as lipoproteins. Those storage-based lipoproteins (VLDL – Very Low Density Lipoproteins) also carry cholesterol, but while most of the fat-based energy (Triglycerides) gets used from these boats, most of the cholesterol doesn’t. The vast majority of cholesterol ends up back at the liver for other possible fates like bile salts and hormones.

Fung effectively brings this point home as well:

Well, where is that cholesterol coming from? You didn’t put in your body by eating . You didn’t put it [in by] intravenous, you didn’t inject it into yourself. So that cholesterol had to be manufactured by your liver. It was in there anyway.

Which is why I don’t care that my cholesterol is going up or down in the short term because I know it’s a passenger, not a driver. But more importantly, I’d want everyone to know this as well given I’ve had many who have written to me after having done a fast for 2 or 3 days and, like me, saw their cholesterol skyrocket. I discuss one of them in my Breckenridge presentation (the story of Jill, near the very end).

In other words, my research doesn’t showcase why this jump in cholesterol from a 2-3 day fast is likely bad – it is demonstrating why it likely is not bad!

Was I Dehydrated?

Another interesting area Fung touched on was the likelihood I was dehydrated due to my hemoglobin going from 15.3 to 18.1. I’m fascinated by this possibility as it was probably the area I was trying to most guard against. The fasting friends who were giving me advice were very insistent I drink lots of water and to be sure I got plenty of electrolytes. One had handled the latter for the last several years by adding Himalayan pink salt and Morton’s lite salt to his water during fasting periods, which I did as well. (Lite Salt has 350mg potassium per 1/4 tsp).

Here’s what I had on Day 1:

day1

And here was Day 2:

day2

Each bottle of water was 500ml. Whenever salt is pictured with it, presume 1/2 tsp added. This makes it pretty easy to calculate.

Still Water Mineral Water Morton’s Lite Salt Himalayan Pink Salt Magnesium Malate Misc Supplements
Day 1 3500ml 1500ml 1 tsp 1 tsp 425mg K2,D3,C
Day 2 2500ml 2000ml 1 tsp 1/2 tsp 425mg K2,D3,C

Again, I freely concede my naivete on fasting, and outside of watching Fung’s 2016 lecture in person along with my friends’ advice on the subject, I wasn’t coming into the experiment with a ton of studying. Thus, I was exceeding a gallon of water for each day, which is why I was worried I might be overdoing it. But this being my first multi-day fast, I didn’t know for sure.

I Know Many Who Fast and Swear By It

While I might have had a negative experience of my own, I would definitely want to emphasize it doesn’t change my opinion of fasting in general. I know many people who both fast and insist it’s one of the best changes they’ve made in their lives.

Lighten Up, Everybody

On a final note, I’d love to encourage everyone to relax! 🙂

In both high school and college, I competed in forensic debate. (Am I nerdy enough now?) So I rarely if ever take anything personally. A few of you got rattled by this podcast and I can assure you there’s nothing to be rattled about. If anything, I’m ecstatic to get further expert feedback on my experiment and welcome more.

I consider Dr. Jason Fung is an asset to the low carb community and I look forward to every time I can watch his live presentations.

My First Study

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While I’m in the process of refilling the coffers and am pretty limited on time, I am starting to lay some groundwork for my first study. It is my hope I can conduct it in the fall of this year, but that’s still to be determined.

The study will need 12-20 volunteers who will be eating to a meal plan throughout 14 days while likewise taking many blood draws for cholesterol testing throughout. Moreover, they will be sequestered to a large house in Las Vegas that will serve as the staging area, where we will record all key activities associated with the experiment. (The large house has been volunteered by a friend for the use of this experiment)

One-half of the participants must be already on a ketogenic diet and will eat to a ketogenic meal plan. The other half must have already been on a carb-centric diet and will be eating to a carb-centric meal plan.

The participants can make phone calls, work from computers, watch TV, play video games, etc. as they wish during this period. But food intake and blood draws will be taken on a prescribed schedule. While not scheduled, proper sleep patterns will likewise be expected. Unfortunately, working out or other forms of intensive exercise will be prohibited during the experiment period as they will likely impact the lipid data.

There is also a likelihood this will be captured by a camera crew for a documentary (more on that later).

If you’ve followed the work I do with myself and others, you know I’m extremely motivated to be as precise and transparent as possible. I expect the data from this experiment to by highly scrutinized given what it will be showing and thus, I’m very serious about keeping it well controlled.

My plan is to first secure a group of motivated volunteers before preparing a Kickstarter campaign to raise money for the experiment. Requirements for volunteers:

  • As stated above, must be comfortable with 14-day sequestration, eating to meal plan times/quantities, and having several blood draws over the course of the experiment
  • Cannot be on any medications
  • No recent significant illness or injury
  • For Keto diet volunteers, you must have been on diet for 12 months or more

If you’re interested, feel free to comment as such below and I’ll add your name to the Interest List.