There is pretty compelling evidence though that greater intake of saturated fat leads to greater risk of atherosclerosis. If your ldl hasn't increased (was it already elevated though?) that is unusual, it almost always increases with a higher fat diet.
Mastering diabetes approach - I don't get it!
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Yes GPS love their ranges. As if you are a few points above or below the cutoff for normal or abnormal that makes any actual difference in symptoms etc. How long does it take with daily iron supplements to replenish the iron from a deficient level? Or how long to notice improvements in symptoms?
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There isn't. I am guided by the American College of Cardiology who say there is no robust evidence. They produced this paper in 2019:
This is what they describe as the "Highlights"
The U.S. Dietary Guidelines recommend the restriction of SFA intake to <10% of calories to reduce CVD.
Different SFAs have different biologic effects, which are further modified by the food matrix and the carbohydrate content of the diet.
Several foods relatively rich in SFAs, such as whole-fat dairy, dark chocolate, and unprocessed meat, are not associated with increased CVD or diabetes risk.
There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the United States will prevent CVD or reduce mortality.
It's one theory which does have credible science behind it, but not the only one. Nobody as far as I know has definitely proven the root cause of IR, if there even is one cause. The triglycerides thing is a question I had about that, as triglycerides go down on a LCHF diet yet they have been shown to correlate well with IR in various formulas.Is this true though - see this post and the posts leading up to it:
Food combining?
afaiu having high triglyceride levels in the blood stream does increase insulin resistance - Going down a bit of a rabbit hole, but wanted just to pick at this - It's one of the things that is ... used as evidence ... but isn't quite correct. In a lab (and this is all Ben Bikman, he did the...www.diabetes.co.uk
One paper from 6 years ago does not represent the totality of evidence! I have seen this cited before, it doesn't actually say that saturated fat doesn't contribute to heart disease, it just says there shouldn't be an arbitrary limit imposed because some saturated fat is healthier than others, the part you quoted, and a set limit does not take that into account.
This is a consensus of European cardiologists, looking at a very large amount of data from many, many trials (over 2 million participants) concluding that LDL causes atherosclerosis. I don't think anyone disputes than increased saturated fat intake raises LDL:
Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel - PubMed
Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.
pubmed.ncbi.nlm.nih.gov
This explains the flaws in studies which led to influencers claiming saturated fat isn't a problem, with all sources listed:
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I'm not sure you can have read it. It is not "one paper", it's a review of all the available evidence by the American College of Cardiology. As you'll be aware the ACC was previously a strong advocate for lowering saturated fat in diet. So the review marks a significant change in direction. I also think that the College might just have a greater standing and reputation than individual MDs on YouTube.
here's the conclusions:
here's the conclusions:
The long-standing bias against foods rich in saturated fats should be replaced with a view toward recommending diets consisting of healthy foods. What steps could shift the bias? We suggest the following measures: 1) enhance the public’s understanding that many foods (e.g., whole-fat dairy) that play an important role in meeting dietary and nutritional recommendations may also be rich in saturated fats; 2) make the public aware that low-carbohydrate diets high in saturated fat, which are popular for managing body weight, may also improve metabolic disease endpoints in some individuals, but emphasize that health effects of dietary carbohydrate—just like those of saturated fat—depend on the amount, type and quality of carbohydrate, food sources, degree of processing, etc.; 3) shift focus from the current paradigm that emphasizes the saturated fat content of foods as key for health to one that centers on specific traditional foods, so that nutritionists, dietitians, and the public can easily identify healthful sources of saturated fats; and 4) encourage committees in charge of making macronutrient-based recommendations to translate those recommendations into appropriate, culturally sensitive dietary patterns tailored to different populations.
Yes I have read it. Nowhere there does it say that saturated fat is not correlated to increased risk of heart disease. It is a review of guidelines, again saying that some saturated fat is more problematic than others so saying that any level of and type of saturated fat should be avoided is misleading and not accurate. We need some level of saturated fat, just like we need blood glucose, the issue is excess which this paper does not specify or talk about. Nowhere does it say high levels of saturated fat are not harmful. Quote where is says that, or where it says excess saturated fat consumption is not correlated to heart disease? It doesn't.
Have you read the paper I linked? A consensus of leading European cardiologists, including 2 million participants, far more than in this American paper. This in contrast does make a very clear statement. The video was not the views of one man, it was him considering the evidence which is all linked and quoted.
You can believe what you like of course, but to say that there isn't evidence is not correct as I have provided it. If you don't want to even look at it or consider (yes I have read what you linked, which doesn't refute what I am saying) that's up to you but don't say it's not there.
I look at the fact that drugs which raised HDL were not shown to reduce heart disease in this way:
Are those drugs also shown to improve health in other ways?
- No they are not, so why should they be used as evidence against Low Carb when the whole reason those drugs were developed was that there was a correlation between low rates of heart disease and people who had a higher HDL than average. There was plenty of evidence for this 'in nature' - just that it didn't hold true for those whose HDL was 'artificially' raised by drugs.
I consider a Low Carb way of eating to be at least as natural as a High Carb way of eating. High Carb WOE = plant sourced is food of the grain farmers or lower classes, while Low Carb WOE = high animal content is more the food of the better off or at least Hunter/Gatherer food. Note that the introduction of agriculture coincided with a population expansion but poorer health, smaller stature and smaller brain sizes.
None of that is anti low carb in any way, I don't know where that came from. It was purely that HDL is not a good predictor of heart disease risk, and therefore any ratios or calculations using HDL are likely to be inaccurate, nothing to do with any specific diet. That is what many leading cardiologists seem to be saying now, one even called it "highly disappointing lipoprotein"
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Yes - the single-page paper you linked doesn't mention saturated fat at all. It's about LDL and ASCVD which is not really the same thing.
And it is also a review of evidence, not a single piece of research on "2 million" participants. Of course that paper, being published in 2017, a few years earlier than the one I linked, would have been available to the authors of the ACC paper.
So - if I have this right - the Journal of the American College of Cardiology says "Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke" . You say they're wrong.
And it is also a review of evidence, not a single piece of research on "2 million" participants. Of course that paper, being published in 2017, a few years earlier than the one I linked, would have been available to the authors of the ACC paper.
So - if I have this right - the Journal of the American College of Cardiology says "Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke" . You say they're wrong.
No, I am saying the leading European cardiologists say that LDL causes atherosclerosis, and nobody is denying that excess intake of saturated fat raises LDL. It doesn't have to mention saturated fat specifically, that is the reason that it has harmful effects in excess, because it raises LDL. I never said it was a "single piece of research" it is more powerful than that because it draws on a large number of trials which total over 2 million people, as it states clearly in the paper. It is 2 years before the one you mentioned.
It's not difficult to find plenty of evidence that contradicts that statement - this is a big meta analysis from 2020:
"reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% ... Meta‐regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events"
Note again the harmful mechanism of saturated fat being that it raises LDL as said before.
"no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality"
Here is a recent study comparing saturated fat (butter) intake vs plant oils,
"In this cohort study of 221 054 adults from 3 large cohorts, higher butter intake was associated with increased total and cancer mortality, while higher intake of plant-based oils was associated with lower total, cancer, and cardiovascular disease mortality."
There is plenty more. Some of the studies considered by the Americans were flawed in design (and so are often quoted by influencers trying to push an agenda) which is explained in the video I linked better than I could.
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If you look at the ACC's paper, on the first page, in the fifth line of the abstract you will read "Although SFAs increase low-density lipoprotein (LDL) cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL particles, which are much less strongly related to CVD risk. " So a clear recognition of an increase in certain LDL.
I found this in Hooper, the first of the papers you linked in support:
We found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence.
I think that agrees with what the ACC paper says "...no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality"
I guess we'll just have to differ.
I found this in Hooper, the first of the papers you linked in support:
We found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence.
I think that agrees with what the ACC paper says "...no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality"
I guess we'll just have to differ.
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Between your statement and the quote there appears to be no benefit to reducing sat fat/LDL. Even if one accepts saturated fat raises LDL (not sure that I do because it didn’t mine and may others when I increased it hugely on keto) then does it matter in the least, if reducing sat fat (and therefore LDL) doesn’t gain me anything in terms of cvd or mortality gains?
A huge confounding factor may well be those that have ignored the standard advice (of low fat) may also more widely be those who ignore all other health advice (Even if those low carbers dont fall into this category). They may have eaten the butter and may well have also eaten the bread, potatoes, sausage rolls and doughnuts too. And sat on the sofa all day, smoking and drinking.
Without checking all those studies are they really considered all those factors effectively? Have they studied those that only ignore the low fat advice but otherwise look after themselves and reduce the junk, and carbs (a small but growing minority)? Is it the combination of fat and carbs together and fat alone is ok?
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For what it's worth (I'm only N=1), this is what happened to my lipid levels from the point of diagnosis and during the past 8+ years. No statins except for a month or two after diagnosis (the initial sharp decline). https://www.diabetes.co.uk/forum/th...tion-book-recommendations.201616/post-2674018
For me, having a higher fat diet (to compensate for the carbs I don't eat) has only improved my lipids.
No way to tell what it will do for you though.
I've been happily eating pork scratchings, mayo, fatty cuts of meat, and frying my food in butter, and I've reduced he carbs.
I'm an overweight T1 and I've been on relatively high doses of insulin for the past 8 years, which keeps my bg mostly in range.
N=2. My lipids have also improved since adopting a higher fat diet. I once told my DN I was following LCHF and she said ' but your cholesterol level...oh it's gone down'. She sounded very disappointed that the figures hadn't responded as she expected them to.
Well your same ACC concluded not long before that "The attenuated associations of lipoprotein particle measures with CHD after the adjustment for lipids indicate that their measurement does not detect risk that is unaccounted for by the standard lipid panel" - particle size is largely seen as less important now, all LDL particles are atherogenic.
Here is a discussion on the evidence (again, NOT his opinion) about whether particle size matters with a leading lipidologist:
If you accept that saturated fat generally raises LDL which doesn't seem to be in dispute, the EAS paper I linked first considers far more evidence, trials and people that anything else, that is why they did that to answer the question based on the totality of evidence. Their conclusions are pretty clear. But of course, people can do and believe what they like and I accept that science often has contradictory findings which muddy the waters.
Yes there are confounding factors, but well designed trials account for those as much as possible and mention them. A big one is weight loss - that will usually result in better lipid results regardless of the diet. Yes there certainly is strong evidence that LDL causes atherosclerosis, here it is:
Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel - PubMed
Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.
pubmed.ncbi.nlm.nih.gov
This is a consensus of leading European cardiologists, considering all of the evidence from previous trials so a very large amount of data (over 2 million participants in total) which is the most comprehensive review to date. It's difficult to argue with that in my opinion.
There are many mitigating factors - had you lost weight? Weight loss usually causes improvement in lipids regardless, at least in the short term. Was cholesterol raised already? Were you doing more exercise? Eating more fibre? This is why we have to look at large populations to see trends to average out for some of these factors.N=2. My lipids have also improved since adopting a higher fat diet. I once told my DN I was following LCHF and she said ' but your cholesterol level...oh it's gone down'. She sounded very disappointed that the figures hadn't responded as she expected them to.
Well yes, the DN asked how I had at last managed to lose a little weight. That's when I said it was by following LCHF. So win, win for me. Lower cholesterol, lower weight.
Also, I understood from various posts here that losing weight can put cholesterol UP temporarily?
I'm not too worried about trends re large populations. I know what works for me and also my non diabetic husband (whose cholesterol level and weight also went down on LCHF)
When I asked about LDL rising on a low carb way of eating, the reply I got from the most well-known 'Low Carb' GP surgery in the UK was;
'We have never seen that.'
Note both question and answer were in public on Twitter/X some time ago and at which time the surgery had over 100 T2D patients in remission on a Low Carb way of eating.
From that I deduced that on a Low Carb way of eating, only slim diabetics (like myself) tend to see a significant rise in LDL. However, in my case I'm content that the nearly halving of Trigs and near doubling of HDL more than compensates for large rise in LDL. Note that my LDL still isn't quite high enough for me to qualify for Dave Feldman's 'Lean Mass Hyper-responder' phenotype, but I am following the medical studies on those people with interest.
'We have never seen that.'
Note both question and answer were in public on Twitter/X some time ago and at which time the surgery had over 100 T2D patients in remission on a Low Carb way of eating.
From that I deduced that on a Low Carb way of eating, only slim diabetics (like myself) tend to see a significant rise in LDL. However, in my case I'm content that the nearly halving of Trigs and near doubling of HDL more than compensates for large rise in LDL. Note that my LDL still isn't quite high enough for me to qualify for Dave Feldman's 'Lean Mass Hyper-responder' phenotype, but I am following the medical studies on those people with interest.
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