Great Cholesterol Lie?

[OMGturt1es]

OMGturt1es' experience is what I'm talking about with chasing metrics - a lot of work to alter measurable variables, but extremely limited information on whether that actually means an objectively improved outcome...

Of course, subjectively 'feeling better' is still a legitimate improvement in terms of quality of life, even if one's lifespan hasn't actually been significantly altered, whether that is a specific improvement in fitness, weight loss, or anything that results from a better diet. So, do you feel better for having done it, OMGturt1es? (genuine question!)

Sorry for the delayed response.

First, I should clarify that my dietary change was based on a convergence of factors: Health, animal welfare, and climate change. Each is important to me, so I decided a shift to a less animal-based diet and more plant-based diet was worthwhile. So I'm not just chasing metrics.

Secondly, it honestly hasn't been very difficult. It's not like I never eat meat. In fact, the biggest change in my diet is lunch. If I went to Subway, for example, I used to get the oven roasted chicken breast sub with cheese. Now I get the veggie patty without cheese. And frankly, I like the veggie patty more. If I don't go out, I now eat salad. I typically have a bunch of salad stuff in the fridge, and I can throw together a damned good salad in like 5 minutes. Fast. Easy. Tastes good. And typically cheaper too.

How do I feel from diet alone? Better, for sure. Part of that is because I now eat fewer indigestion-causing foods. I used to get indigestion quite a bit, and it made me feel like ****. So that's a huge improvement. I also generally feel less weighted down and more energetic after eating-- probably because I eat less by weight, so there's less work for my gut? I don't notice this so much anymore, as I've cut back on meat and dairy for so long now, but I definitely noticed when I first switched. And if I'm doing a good job avoiding meat and dairy and eating lots of good fresh veggies, pooping is like it was back in high school: Dependable, satisfying, and easy. Between 9 and 10 AM every morning. No fuss. Wiping is basically just insurance, rather than the necessarily pre-shower, sticky, tedious mess it had become. So that's actually one of the best perks.

The convergence of factors in my general lifestyle change, however, has an even more definite impact on how I feel. Not only do I eat better and exercise more now, but I also have a standing desk at work and home-- mostly due to back issues-- and I try to not short change myself on sleep as much as I used to. When I'm eating well, exercising daily, not sitting for long periods of time, and getting enough sleep, I just feel much, much better in every aspect of life. I have more energy, confidence, and concentration ability. If I slip in aspect, I feel the impacts.

 

[bit_pattern]

Sorry for the delayed response.

First, I should clarify that my dietary change was based on a convergence of factors: Health, animal welfare, and climate change. Each is important to me, so I decided a shift to a less animal-based diet and more plant-based diet was worthwhile. So I'm not just chasing metrics.

Secondly, it honestly hasn't been very difficult. It's not like I never eat meat. In fact, the biggest change in my diet is lunch. If I went to Subway, for example, I used to get the oven roasted chicken breast sub with cheese. Now I get the veggie patty without cheese. And frankly, I like the veggie patty more. If I don't go out, I now eat salad. I typically have a bunch of salad stuff in the fridge, and I can throw together a damned good salad in like 5 minutes. Fast. Easy. Tastes good. And typically cheaper too.

How do I feel from diet alone? Better, for sure. Part of that is because I now eat fewer indigestion-causing foods. I used to get indigestion quite a bit, and it made me feel like ****. So that's a huge improvement. I also generally feel less weighted down and more energetic after eating-- probably because I eat less by weight, so there's less work for my gut? I don't notice this so much anymore, as I've cut back on meat and dairy for so long now, but I definitely noticed when I first switched. And if I'm doing a good job avoiding meat and dairy and eating lots of good fresh veggies, pooping is like it was back in high school: Dependable, satisfying, and easy. Between 9 and 10 AM every morning. No fuss. Wiping is basically just insurance, rather than the necessarily pre-shower, sticky, tedious mess it had become. So that's actually one of the best perks.

The convergence of factors in my general lifestyle change, however, has an even more definite impact on how I feel. Not only do I eat better and exercise more now, but I also have a standing desk at work and home-- mostly due to back issues-- and I try to not short change myself on sleep as much as I used to. When I'm eating well, exercising daily, not sitting for long periods of time, and getting enough sleep, I just feel much, much better in every aspect of life. I have more energy, confidence, and concentration ability. If I slip in aspect, I feel the impacts.

This pretty much sums up my approach to diet too

 

[OMGturt1es]

So in spite of you being completely wrong about there being any studies at all, and in fact there having been numerous large RCTs showing exactly what you don't want believe, you still don't want to believe it? Because you suspect the medical establishment of collusion with big pharma (conspiracy) in 9 very large studies of 10s of thousands of patients?

To be fair, there have been numerous incidents of big pharma dishonestly interpreting and presenting its clinical data. These incidents have been well documented in many books and acknowledged by prestigious journals. Big pharma has also used its deep pockets for influence. Again, this is fairly well documented and acknowledged by prestigious journals. I don't think it's necessary to provide links here. You can do your own searching of journal editorials.

That said, it is absolutely clear that big pharma has also created countless drugs that absolutely work. No question. It is unjustifiable and foolish to discount evidence from big pharma simply because it came from big pharma. But I think we should be careful here not to ignore an acknowledged problem that does exist-- if we want the most out of big pharma, we need to be aware of real problems so that we can push for reform.

With respect to statins specifically, clinical trial results are probably believable. They've been around a long time now, and statins are widely prescribed, so I'd imagine numerous independent researchers have combed through the source data to ensure it wasn't misintentionally interpreted to generate profits. More importantly, however, is that statins should work according to the casual relationship between cholesterol and heart disease-- a relationship that was developed prior to statins and has generally held up for decades.

I'm sure the relationship isn't complete. It appears certain lipids can move cholesterol around, so they probably have an impact as well. And it appears inflammation increases the likelihood of cholesterol buildup, so it probably has an impact as well. But none of that would indicate that following basic cholesterol guidance isn't still good advice. Nor would it indicate we should expect different outcomes from statin clinical data.

Finally, I don't understand why it is becoming so popular to see this as an "either/or" situation. Admittedly, I know very little about heart disease. But I see a lot of other folks who I know also know very little absolutely convinced that cholesterol has no impact-- or very little-- on heart disease. And when I follow links, I usually find bloggers or others interpreting evidence that inflammation is also implicated as evidence that cholesterol is not. And it really seems that people want to believe this. Why?

 

[casebro]

Cholesterol is fairly complex with HDL, LDL, and then multiple subtypes of LDL. The pattern of blood cholesterol associated with a risk for heart disease is caused by a high carbohydrate diet, not by too much fat.

Recent studies (the most comprehensive to date) have failed to link dietary saturated fat with cardiovascular disease risk, much to the chagrin of those scientists who have staked their careers on the current guidelines.

http://www.ncbi.nlm.nih.gov/pubmed/20071648
http://www.ncbi.nlm.nih.gov/pubmed/24723079

The first link is to a robust study showing no link of saturated fat to CVD. Mehta study with a total 347,000 subjects.

Second study, 330,000 subjects:

"CONCLUSION: Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

More to follow.

 

[Belz...]

Why is it that most people have no problem believing eating red meat is unhealthy? [snip] But they have huge problems with accepting that eating animals that were raised in CAFOs, living in their own feces and eating diets that they clearly didn't evolve to eat has any effect on human health?

I'd venture to guess: one has a lot of in its favour studies, the other doesn't ? Do I win something ?

 

[Red Baron Farms]

Finally, I don't understand why it is becoming so popular to see this as an "either/or" situation. Admittedly, I know very little about heart disease. But I see a lot of other folks who I know also know very little absolutely convinced that cholesterol has no impact-- or very little-- on heart disease. And when I follow links, I usually find bloggers or others interpreting evidence that inflammation is also implicated as evidence that cholesterol is not. And it really seems that people want to believe this. Why?

People want simple easy answers. They don't want to hear that the combination of inflammation and cholesterol and omega 3s and antioxidants and genetics and lipid balance etc... are all additive factors.

I'd venture to guess: one has a lot of in its favour studies, the other doesn't ? Do I win something ?

Bad guess since there are multitudes of studies.

 

[Belz...]

Damn. I really wanted that trip to Athens.

 

[Belz...]

What is it, specifically, that "CAFO" changes about organisms' chemistry ? The cages ? As long as they're being fed pretty much what they'd get normally, but in the quantitied we want to fatten them up, I don't see the problem.

In other words, what do those studies say ? I'd like to know why I'm not going to Athens.

 

[casebro]

Statins seem to work.

http://www.ncbi.nlm.nih.gov/pubmed/23440795

I dug out the list of trials that were included in the meta study. And then tried to look up the full text of the articles in the journals for six trials. The first two gave acknowledgement to the drug companies, Merck/Sharp/Dohm, and Pfizer. The rest either listed no acknowledgments at all, or the full report was behind a membership required. So 100% of the trial I could find info on were sponsored by the Pharms. You can try some more, there were 20-30 trials listed.

So, I do question the bias of the studies. Others do too, to the point that more recent studies must list author affiliations w/ drug companies, if they EVER took money from ZANY drug company. Latest study I looked at at there was 2006.

Meta studies of biased trials by drug companies are only going to be biased.

That is why, waaay up thread, I asked for a study by , oh, say, an HMO.

And re: side effects, their threshold was "CK values 10x normal". Yeah, if you are less than one order of magnitude out of norm, you are juuuust fiiine. Yeah.

Hey, I have a congenital myopathy, and my CKs were only 4x the normal high. 10x is probably bedridden from the pain. Which several statin patients told me they suffered.

eta: My goolefu is weak today. Can anybody find the usual CK level of flu sufferers? Just trying to relate the "not ill" level of 10x for Statin studies to the "ill" level of the flu.

 

[Red Baron Farms]

What is it, specifically, that "CAFO" changes about organisms' chemistry ? The cages ? As long as they're being fed pretty much what they'd get normally, but in the quantitied we want to fatten them up, I don't see the problem.

In other words, what do those studies say ? I'd like to know why I'm not going to Athens.

It is not the cages, barns and/or stockyards. It's the diet primarily. Although metabolic modifiers also have some effect.

A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef

Research spanning three decades supports the argument that grass-fed beef (on a g/g fat basis), has a more desirable SFA lipid profile (more C18:0 cholesterol neutral SFA and less C14:0 & C16:0 cholesterol elevating SFAs) as compared to grain-fed beef. Grass-finished beef is also higher in total CLA (C18:2) isomers, TVA (C18:1 t11) and n-3 FAs on a g/g fat basis. This results in a better n-6:n-3 ratio that is preferred by the nutritional community. Grass-fed beef is also higher in precursors for Vitamin A and E and cancer fighting antioxidants such as GT and SOD activity as compared to grain-fed contemporaries.

 

[casebro]

RBF, from you latest post: "This results in a better n-6:n-3 ratio that is preferred by the nutritional community. "

But is there any proven benefit in health there from?

Sure, we can measure levels of micronutrients to a bazzillion decimal places, but that does not mean that a low level is of any consequence. Sow me a study that proves a link of poor ratio to in vivo disease.

 

[Red Baron Farms]

RBF, from you latest post: "This results in a better n-6:n-3 ratio that is preferred by the nutritional community. "

But is there any proven benefit in health there from?

Sure, we can measure levels of micronutrients to a bazzillion decimal places, but that does not mean that a low level is of any consequence. Sow me a study that proves a link of poor ratio to in vivo disease.

Slightly off topic, and "prove" is an inappropriate word. But I can post some studies on the effect the ratio has on risk factors.

The importance of the ratio of omega-6/omega-3 essential fatty acids.

Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids

Effects of the n-6/n-3 polyunsaturated fatty acids ratio on postprandial metabolism in hypertriacylglycerolemia patients

A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer.

 

[GlennB]

Damn. I really wanted that trip to Athens.

Athens Texas or Athens Greece? Make it to Greece and head south and we could meet up for beer and beef (pasture-fed rosé veal, specifically, not that evil greyish shed-enclosed vealy stuff that will damage your health and doesn't make the calves terribly happy either). Man, it's hard to find old beef around here, though I found a tray of shin of beef at Lidl's a few days back and stewed it up with carrots and leeks and barley tonight. mmmmm. [/monumentally ot but with a distant reference to the subject so that's all right, right?]

 

[casebro]

One gemfibrozil trial, by the drug company: "The decline in incidence in the gemfibrozil group became evident in the second year and continued throughout the study. There was no difference between the groups in the total death rate,.."

 

[casebro]

And this from another Gemfibrozil study: "The findings suggest that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels."

 

[casebro]

Hey RBF, here are som enumbers from the link below. Beef, brisket, flat half, separable lean and fat, trimmed to 1/8" fat, all grades, cooked, braised

Read More http://nutritiondata.self.com/facts/beef-products/3680/2#ixzz3FUddXLm0


Total Omega-3 fatty acids 764 mg

Total Omega-6 fatty acids 1741 mg

Read More http://nutritiondata.self.com/facts/beef-products/3680/2#ixzz3FUcoGh9V

They seem pretty well balanced, so how much better than CAFO are your numbers?

 

[Reality Check]

The first two gave acknowledgement to the drug companies, Merck/Sharp/Dohm, and Pfizer. The rest either listed no acknowledgments at all, or the full report was behind a membership required. So 100% of the trial I could find info on were sponsored by the Pharms.

Sorry, casebro, but a touch of paranoia about "Pharms" does not excuse the inability to count !
Pharmaceutical company acknowledgement: 2
No pharmaceutical company acknowledgement: a unstated number
That is not 100% of the trials you could find information on !

Also what you really want is the declarations of interest. Acknowledgements could just cover acknowledging the source of the drugs used in the trials.

ETA: You might want to actually read the paper. They do analysis of the possible sources of bias in the studies that they reviewed:

We judged 13 of the trials to be free from selective bias.
...
The funnel plot for all cause mortality showed no sign of publication bias (Figure 3). Only one trial was funded from taxation (Ministery of Health) whilst the authors of nine trials reported having been sponsored either fully or partially by pharmaceutical companies (five by Bristol Myers and Squibb; two by Pfizer).

and later:

Caution also needs to be taken regarding the fact that all but one of the trials had some form of pharmaceutical industry sponsorship. It is now established that published pharmaceutical industry-sponsored trials are more likely than non-industry-sponsored trials to report results and conclusions that favour drug over placebo due to biased reporting and/or interpretation of trial results (Als-Nielsen 2003).

So once again - not 100% "sponsored by the Pharms".

 

[Ziggurat]

RBF, from you latest post: "This results in a better n-6:n-3 ratio that is preferred by the nutritional community. "

But is there any proven benefit in health there from?

Sure, we can measure levels of micronutrients to a bazzillion decimal places, but that does not mean that a low level is of any consequence. Sow me a study that proves a link of poor ratio to in vivo disease.

The problem is actually quite subtle. I haven't gone through all RBF's links, but I suspect that most of them will be observational studies. The problem with these is that it can be damned near impossible to reliably extract causation from correlation in such studies.

Here's an interesting article about the health effects of eating meat, the conventional wisdom of why it's not good for you, and why the conventional wisdom cannot be relied upon when it's only backed up by observational studies:
http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/
No matter how many confounding variables you think you've accounted for, it's basically impossible to completely eliminate the compliance effect: people who do what you're supposed to do are a different (and generally healthier) population than people who don't do what you're supposed to do. So when you look at people who follow the conventional wisdom versus those who don't for any single issue, you can expect to find that the people who follow the conventional wisdom will probably do better than those who don't, even if the conventional wisdom is wrong.

So: expensive grass-fed beef is supposed to be healthier than that cheap factory farmed beef. So people who care about their health and have money to spend will eat it, people who don't care about their health/don't have money will buy the cheap stuff. But how can you tell if it actually makes any difference? Well, you probably can't with an observational study.

 

[casebro]

Sorry, casebro, but a touch of paranoia about "Pharms" does not excuse the inability to count !
Pharmaceutical company acknowledgement: 2
No pharmaceutical company acknowledgement: a unstated number
That is not 100% of the trials you could find information on !

Also what you really want is the declarations of interest. Acknowledgements could just cover acknowledging the source of the drugs used in the trials.

ETA: You might want to actually read the paper. They do analysis of the possible sources of bias in the studies that they reviewed:

and later:

So once again - not 100% "sponsored by the Pharms".

Using your logic, and the numbers in you postr today at 2:11, I would have said 92%. Sorry.

But I told you I looked at 6, and found info for 2, and 100& of those were sponsored by Pharma. I was right. But your link was more better at what I had to say all along.

Long ago I heard it as "Studies backed by Pharma are 8 times as likely to find benefit from Statins compared to studies NOT sponsored by the drug Companies".

 

[Reality Check]

Using your logic, and the numbers in you postr today at 2:11, I would have said 92%. Sorry.

My point was rather that you could not make any conclusion at all, casebro:
Pharmaceutical company acknowledgement: 2
No pharmaceutical company acknowledgement: a unstated number
(plus some you could not access)

Think about this hypothetical: What if the only paper you could have got information about was the one that was not sponsored by a pharmaceutical company. Would you then have written "100% of the trial I could find info on were not sponsored by the Pharms."?

It is actually the not surprising "industry-funded trials were twenty times more likely to give results favoring the test drug" (after all why would a company sponsor trials on drugs that they already know not to work!): Trial sans Error: How Pharma-Funded Research Cherry-Picks Positive Results [Excerpt]