Six-year diaversary

[Eddy Edson]

I’ve read quite a few studies concluding that satfats from dairy are not at all harmful to CV health, quite the opposite, but I have no view either way, it’s all so darned complicated and confusing.

For me, the overall weight of evidence is pretty clear: replacing satfats with unsaturated is associated with better CV outcomes. This includes dairy.

Studies need to address a big fundamental point: what does this thing replace? If you look at a segment of population with greater dairy intake, what are they getting less of, compared to some other segment? Without controlling for this, the value of a study has to be quite dubious, but it is also pretty hard to do. You need to look to the high quality metastudies and expert reviews, which filter for this kind of thing.

On the common Internet trope that "you need cholesterol for vitamins etc etc". It is absolutely clear that essentially all of the cholesterol you need is produced within cells & is not dependent on the LDL-C in blood arising from diet. LDL-C in blood is essentially a waste product and the particles carrying this LDL-C are directly causal for atherosclerosis. The evidence, from genetics and from PSCK9 inhibitors, strongly supports lower-is-better for serum LDL-C levels, at any rate down to levels below 0.5 mmol/l.

 

[s'nic]

childofthesea43
Yes, it's a minefield of info and opinion. I figure just try aim for a balanced and reasonably sensible diet.
I think I will try asking at my surgery next time I'm there, even if just a sanity check on my diet strategy. I'm not interested in meal plans and diet sheets.
Eddy Edson
I agree
I do think we need a small amount of cholesterol, but even with our best efforts to avoid it, we will consume that small amount (which is ok), but it does seem key to focus on unsaturated fats. This particularly holds true for anyone with elevated cholesterol.

 

[childofthesea43]

For me, the overall weight of evidence is pretty clear: replacing satfats with unsaturated is associated with better CV outcomes. This includes dairy.

Studies need to address a big fundamental point: what does this thing replace? If you look at a segment of population with greater dairy intake, what are they getting less of, compared to some other segment? Without controlling for this, the value of a study has to be quite dubious, but it is also pretty hard to do. You need to look to the high quality metastudies and expert reviews, which filter for this kind of thing.

On the common Internet trope that "you need cholesterol for vitamins etc etc". It is absolutely clear that essentially all of the cholesterol you need is produced within cells & is not dependent on the LDL-C in blood arising from diet. LDL-C in blood is essentially a waste product and the particles carrying this LDL-C are directly causal for atherosclerosis. The evidence, from genetics and from PSCK9 inhibitors, strongly supports lower-is-better for serum LDL-C levels, at any rate down to levels below 0.5 mmol/l.

I’d be interested to know your views on the PURE study which broadly affirmed that Satfats from dairy, even when quite high like mine, did not yield observed detrimental health outcomes. Tho of course there are many complicated strands and caveats within that study.

 

[childofthesea43]

childofthesea43
Yes, it's a minefield of info and opinion. I figure just try aim for a balanced and reasonably sensible diet.
I think I will try asking at my surgery next time I'm there, even if just a sanity check on my diet strategy. I'm not interested in meal plans and diet sheets.
Eddy Edson
I agree
I do think we need a small amount of cholesterol, but even with our best efforts to avoid it, we will consume that small amount (which is ok), but it does seem key to focus on unsaturated fats. This particularly holds true for anyone with elevated cholesterol.

Thank you, and for the interesting private message.

 

[s'nic]

Do you have a link to the study you saw?
I don't know if this is related to it, but I tried a search for it and came up with this 2017 piece about a flawed methodology - however I'm unable to determine if this was related to the study you saw

PURE study makes headlines, but the conclusions are misleading

Last week, The Lancet published results from the Prospective Urban Rural Epidemiology (“PURE”) study that made headlines: “Study Challenges Conventional Wisdom on Fats, Fruits, and Vegetables;” “PU…

www.hsph.harvard.edu

 

[Eddy Edson]

I’d be interested to know your views on the PURE study which broadly affirmed that Satfats from dairy, even when quite high like mine, did not yield observed detrimental health outcomes. Tho of course there are many complicated strands and caveats within that study.

I never looked into PURE; guess I'll have to do it now 🙂

I remember this study which constructed a diet score based on PURE and compared it to Mediterranean, DASH etc: https://academic.oup.com/eurheartj/article/44/28/2560/7192512

This was a bit better for predicting CV etc events than the way they constructed similar scores for the Med, DASH etc diets, but only marginally.

The highest (healthiest) PURE score was for diets which had (inter a whole bunch of alia) a satfat level of 9.8% of calories versus 6.9% for the lowest score, but given that everything else was different also it would be impossible to say that this higher level was in itself "better". Overall the message was that sure, you can eat a bit of unprocessed meat and have a cup of whole fat milk per day if you want to, in the context of an overall healthy diet - but the "overall healthy diet" is the important thing and Med, DASH etc also qualify.

 

[childofthesea43]

High intensity statin generally reduces LDL-C by 50%+.

37g of satfats is high!

My satfat intake is typically about 12g, which is actually even less than the hardcore AHA guidance of no more than 5%-6% of calories. But I have established ASCVD so I care a lot about this stuff.

On a side note, your HDL-C is pretty high. Unusual & I'd be trying to find out more about that.

Having given more thought to my high satfats and somewhat anomalous lipids I have decided to do one of my 3-month experiments (it will be the seventh such). In this one I will cut the satfats from 37g daily to 19g. I will raise my carbs from 150g to 200g which I’m fairly sure will have no ill effect, having previously shown that 180g was ok. My fibre will be 26g and my calories will fall by about 50. So the aim is to see whether the lipid profile changes.