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Nutrition Past and Future

The Tokelauans, the Samburu, and the Masai Again

Running a Cholesterol Confusionist Gauntlet, Part 5 – The Tokelauans, the Samburu, and the Masai Again

Our attention now turns to the Tokelauans and the Pukapukans.

Anthony Colpo says I don’t want you to know about them, presumably because he thinks something about their health and lifestyle calls into question the lipid hypothesis. Let’s see if that is the case.

This is the study about them to which Colpo apparently refers. Back in 1981, it was concluded that vascular diseases were uncommon among both populations, and their high saturated fat intake did not seem to cause them any problems. Now let me ask you, honestly, have you ever heard of the Tokelauans or the Pukapukans? Don’t you suspect Coplo is mentioning them here because they are somehow unusual? Do you think this paper about these few island natives in the South Pacific will cause the world to toss out the lipid hypothesis? If you’ve watched my videos, you might be able to guess where I’m going first in my look at these people.

If you guessed I’d be looking for evidence of parasites among these primitive people that might have kept their cholesterol concentrations in check, you are right. Do you think I was able to find a good reference for this? Of course I was.

But it was not easy. There is a lack of material on this subject because these people just have not been studied very much, as far as I can tell. It’s a safe bet that they would have had some parasites, but there seems to be a lack of data on this.

This site says there are 183 infectious diseases that are endemic or potentially endemic to Tokelau. This reference is not good enough.

But here’s a pretty good reference. Filiarial fever was called the principle cause of ill health there. That condition is the result of a tropical parasitic infection by worms.

It’s always a good bet that parasites are present in primitive cultures lacking adequate sanitation. Most parasitic infections are maintained in their human hosts at a low level over long periods of time. Remember, our immune systems were likely strongly affected by the parasites living in our ancestors.

Let’s take a look at that paper on these Pacific Islanders and see if there is not more to consider than just one reference about their parasites. Gary Taubes has mentioned them. In typical fashion for him, he filters out any information that might not align with his single-minded fixation on carbs as a cause of excess body fat. On the right, you can see that he gives the impression these folks consumed no starches at all. If you only went by his book, you would think they traditionally only ate coconuts and fish. I covered the healthy starches consumed by other Pacific Islanders in my video number 69. The Tokelauans ate healthy starches, too, as reported in this very paper, including pandanus, breadfruit, and starchy aroids. For what it’s worth, the Pukapukans ate taro and pulaka. These are starchy carbs that Taubes forgot to mention.

You can see here just how much starch they ate. The Tokelauans ate a lot more saturated fat than the Pukapukans, and the Pukapukans ate more carbs, including cereals.

Taubes also forgot to mention that these people were not exactly slim. Despite a subsistence economy, the Tokelauans were overweight on their high-saturated-fat diet.  The Pukapukans were overweight, too, despite the fact that the authors said they sometimes ate little or nothing for a whole day or more. The Pukapukans were lighter even though they ate more carbs. This should be a another warning for anyone hoping to lose weight on a high-saturated fat diet.  The Tokelauans had saturated fat from coconut at every meal yet they were still overweight. I wonder how the Weston Price people would explain this. Don’t they say you should eat fat to lose fat?

Here’s the cholesterol data on these people. The Tokelauans had much higher cholesterol than the Pukapukans.

The Tokelauans also ate much more saturated fat and less carbs than the Pukapukans. Can we agree that this is yet more evidence that saturated fat raises cholesterol? This is another score for Ancel Keys, right?

The authors of this study say themselves, “These results suggest that the serum cholesterol differences between the two atoll groups may be ascribed largely to differences in saturated fat intake.”

So what about their rates of heart disease? The authors state that the numbers of people available for their study were too small to allow for definitive conclusions about their rates of heart disease. This is the paper that is the basis for claims that they did not have heart disease? This is so weak. Yet Anthony Colpo brings up these people as if they offer compelling evidence against the lipid hypothesis. Once again, his pretense of certainty is a mere fig leaf to conceal his vanishingly small case.

The only diagnostic tool used to evaluate the cardiovascular health of these people was electrocardiography.

Here is a prior study looking at their rates of heart disease. Electrocardiography was the means of testing. An ECG only measures the electrical activity of the heart. From this we can see that those tested had not experienced a prior heart attack, and that their heart function was normal. Modern methods of assessing their degree of atherosclerosis were not used. Assessments of their rates of heart disease were not based on mortality data. Again, this is really weak evidence. Moreover, cross-sectional assessments of their serum cholesterol levels showed patterns similar to those of high-cholesterol, high-heart disease cultures like those measured in the US. Do you see how their cholesterol kept increasing as they got older, and then fell sharply at the end of life?

Do you remember this slide? Do you see how similar these patterns are? Minnesotans and New Zealanders with high saturated fat diets and high rates of heart disease had shown a big upside-down U-shaped pattern, too, as their cholesterol went far higher than necessary only to later come plummeting back down at the end of life as their health gradually fell apart, consistent with Western patterns of chronic disease. This is in contrast to the Asians represented below, who maintained much lower cholesterol levels that only gradually increased throughout life, and did not drop off as decay set in during their later years. Those people were known to remain productive almost all the way through their lifespan.

And here again are the patterns of the Pukapukans and Tokelauans. In the absence of mortality data, I am inclined to think older people in these cultures saw their cholesterol levels plummet due to end-of-life illnesses.

What about the mention by the authors that Tokelauan migrants to New Zealand, who would have left behind their traditional dietary practices, had higher blood cholesterol despite eating less saturated fat? Well, let’s remember that in New Zealand they also ate more dietary cholesterol. That’s an important factor.

They were also in a more sanitary environment. Perhaps their lack of infections in New Zealand meant their cholesterol would tend to be higher. Yes, I’m speculating here, but this is not accounted for in the Tokelauan migrant study, probably because they did not know about the effects of parasites on lipids. Also, you may remember from my other videos that caloric restriction reduces serum cholesterol. The native Tokelauans may have eaten less. But let’s keep our eye on the ball here. If the lesson from the Tokelauan migrant research is that Tokelauans in New Zealand were less healthy, I think that’s a good lesson. One indication of their worse health was their higher cholesterol levels.

They ate more meat. They had higher uric acid concentrations. They were more likely to have gout. Serum cholesterol was one factor that associated with gout among these people. Once again, high cholesterol does not seem very healthy.

Let’s remember here, Colpo wants to debate the lipid hypothesis. He is saying these people were free of heart disease. But look at their cholesterol numbers. They were well below 200. This is considered the desirable range in the US. So we are to conclude that the lipid hypothesis is invalid because people with relatively low cholesterol seemed to have good heart health? Do you see how unhelpful to your case this is, Mr Colpo?

Even a saturated fat apologist like Stephan Guyenet acknowledges that the traditional and historic Tokelauans had high rates of infectious disease. Perhaps their immunity was weakened by all that fish they ate.

It is amazing to see the mind of a saturated fat apologist at work. Here he says we will never know for sure what Tokelauan health was like when it was completely traditional.

But here he says that traditional Tokelauans appeared to have a low incidence of heart attacks, and he thinks this should be common knowledge. Sure, why not? It’s highly speculative, poorly studied, probably has important confounders, and is focused on a genetically isolated population. We all should know about this so we can close our eyes to all that other research, right? These guys seem to have no awareness at all of their own biases.

The paper authors also did not account for the cholesterol lowering foods they might have eaten in Tokelau. I could not find clear references on this, but it is likely that if they were eating high-fiber, high-quality plant foods, they were eating foods that would tend to lower cholesterol. As this paper says, they consumed a diet rich in fiber-containing foods. They were not consuming the typical saturated fat bombs that Americans eat. They rarely ate pork or chicken or eggs. Gary Taubes forgot to mention that, too.

I include this study on the diets of the Maori people, who are in the same relative neck of the woods, which details the cardioprotective plant foods they ate. This effect of plant foods is probably not clearly accounted for because these protective effects may not have been understood by those researchers back then, but that does not mean that today we should pretend that the other components of their diets were not a piece of this puzzle.

The Maori are mentioned here along with other Pacific peoples in a comparison of stroke rates with Europeans. Pacific Islanders would have eaten a lot of fish. They also had a significantly higher relative risk of stroke compared to Europeans. As I said, high fish intake has made some primitive people into potentially serious bleeders.

Here are other Pacific Islanders studied for the relationship between fish consumption and toxin burdens. The French Polynesians in this study had very high blood concentrations of mercury, about as high as those measured in the Inuit. In the absence of similar research on the Tokelauans and the Pukapukans, I think it is fair to say they were consuming a lot of mercury, too.

You don’t have to be a Pacific Islander or an Inuit to be effected by the toxins in fish. Fish-eating women in San Francisco had a mean level of mercury ten times greater than is typical. Some children there were more than forty times the national mean. Their mercury levels declined once they stopped eating fish.

Colpo mentions other exceptional cultures to distract us. As I said, he thinks I am pretending the Masai never existed, when actually he is pretending that my videos about the Masai don’t exist. So what about these other people, the Samburu?

Here is the paper to which he is likely making reference. As you can see, the Samburu are another pastoral, blood-and-milk-consuming culture in Kenya like the Masai. Again, if your big argument requires you to draw conclusions based on a few exceptional cultures, your big argument probably has some weaknesses. To understand the Samburu, I am going to simply refer you to my videos on the Masai since their circumstances were so similar.

Here is a reference to help you see that their dietary practices were very similar, and that they had their own concerns with parasites as well because of these practices.

Something I left out of my Masai videos which I’ll throw in here is this evidence of the unique characteristics of the Masai with regard to their cholesterol metabolism. This paper informs us that the Masai were shown to have a highly efficient negative feedback control that allowed them to modulate their blood cholesterol based on the dietary cholesterol they consumed. Their blood cholesterol would not get very high because of this. This is called a long-term biologic adaptation here, and this is an adaptation that Anthony Colpo lacks.

Here is another reference for this. The Masai are protected by genetic adaptations from high serum cholesterol. So you see, Mr Colpo, there are other important issues to be considered here before jumping to conclusions about the lipid hypothesis.

We’re back to modern epidemiology in the next video.


Fish Oil

Running a Cholesterol Confusionist Gauntlet, Part 4 – Fish Oil

How many times have you heard that we should eat fish if we want healthy hearts? Anthony Colpo’s interest in fish oil gives me the chance to get into that subject again.

He says I don’t want you to know that fish oil seems to reduce heart disease mortality despite the fact that it increases LDL levels. This is a part of his argument against the lipid hypothesis. He is saying there may be a circumstance in which LDL might go up yet heart disease deaths might go down. Therefore LDL cannot be linked to heart disease. This is typical of an overall strategy of the confusionists of making way too much out of apparent minor inconsistencies. As I go through this explanation, please consider something. Think how few words Colpo needed to state this point. It’s very easy for someone intent on spreading misinformation to sew doubt. I will need far more words to satisfactorily explain this. Understanding this effect of fish oil takes time and research. It’s always easier to make a mess than to clean it up. In this video, I am cleaning up the mess purposefully caused by Anthony Colpo.

Do you remember Climategate? How easy was it was to allege that climate scientists faked their data? That’s an easy concept. It takes much longer to explain what actually happened. The subtleties of dendrochronology aren’t reducible to sound bites. It’s really easy to take quotes out of context, though. This video attempts to clean up the mess caused by Climategate. Yet how many people have seen it? Do you think the misinformation of the Climategate fiasco has been undone by only 33,000 views? Like the purveyors of climate confusion, Anthony Colpo seeks to undermine the work of responsible scientists, and unfortunately, that doesn’t take much effort.

I commented in my video 39 that Uffe Ravnskov uses this same confusionist tactic of latching onto tiny inconsistencies without bothering to try to explain them. In Ravnskov’s mind, atherosclerosis cannot be a complex disease. It must be caused or affected by one thing and one thing only. If cholesterol levels don’t match up exactly with death rates in every imaginable circumstance, that must mean cholesterol is completely innocent of any involvement in heart disease. This is totally unrealistic and illogical. The confusionists cannot name any alternative cause for heart disease that meets this standard. So are we to conclude therefore that they think nothing causes heart disease? Don’t you think that if some other risk factor out there tracked more closely with cardiac death than the lipid biomarkers, we would know about it by now?

It should be obvious that if heart disease mortality always went down when LDL levels went up, Mr Colpo would just say that and not even bring up fish oil, because that would completely refute the lipid hypothesis. But he cannot say that. So he is off to a weak start before we even look into this. By even bringing up this issue, he is actually implying that as LDL concentration goes up, usually the risk of death from heart disease does, too, but fish oil seems to create an exception to that relationship under the right conditions. Anyone with rudimentary critical thinking skills should then deduce there must be something special about fish oil because that’s the added wrinkle here. The topic is not LDL anymore. It’s fish oil. It’s clear we’re in for more games from Anthony Colpo.

I’ve already discussed the superiority of plant-based and algal omega-3’s over fish oils in my video number 66. In this study, they were not associated with diabetes, unlike fish oils. As a whole food vegan, I don’t see much reason to be interested in fish or fish oil. They are promoted as half-measures to diminish risk factors that a plant-based diet would have addressed even better. Just like other whole food vegans, I have very low cholesterol and triglyceride numbers. Why on Earth would we take fish oil? To prevent a heart attack? The fish oil companies will need to sell their products to someone else.

In vulnerable patients who are having their various risk factors controlled by drugs, fish oil failed to show any benefit. My foods do for me what drugs did for these patients. I don’t expect fish oil would help me, either.

Look at populations that eat a lot of fish and what do you see? I see high toxic burdens due to the contaminants in fish. More on that soon. I see suppressed immune function. Greater vulnerability to tuberculosis? More upper respiratory tract infections? Delayed virus clearance? Imagine if those issues were associated with soy what the Weston Price Foundation would say. Anthony Colpo should note this immuno-suppression by high fish consumption might be due to increased lipid peroxidation and decreased antioxidant status, according to this paper.

Here fish oil was said to lead to increased LDL oxidation both in vitro and in vivo.

Antioxidant benefits have been demonstrated only for extracted EPA and DHA for people with so-called normal cholesterol and higher. As a whole food vegan, my cholesterol is far below the norm in the US.

Yes, fish oil seems to help people like Anthony Colpo who insist on eating saturated fat. It appears it enhances reverse cholesterol transport, meaning it helps to return cholesterol to the liver.

And fatty fish can decrease platelet aggregation and coagulation. This is why a diet high in fish can increase bleeding and stroke risk. The first paragraph here is worth reading. Someone put himself on a diet for 100 days of only marine animal foods. He experienced greatly increased bleed times. Now I’m not saying small amounts of fish oil will do this, but decreased platelet activity is not going to be very interesting to a whole food vegan. My platelets are fine, thank you. I don’t need to compensate for eating saturated fats.

When we discuss the effects of fish oil on heart disease risk, it matters what the background diet is, as well as the background risk for heart disease. As a whole food vegan, I’m not exposed to the risks that Anthony Colpo is.

I’m not aware of any normal plant food that was linked to sudden cardiac death in a study, as fish oil capsules were here. This says, “Men advised to eat oily fish, and particularly those supplied with fish oil capsules, had a higher risk of cardiac death.” This study is probably an outlier, but I think I’ll save a few bucks on supplements and spend it on food instead.

Omega-3 fatty acids do seem to improve LDL phenotype, but as I discussed in video 43, my diet does that, too, but without the saturated fat and with healing phytochemicals.

Another possible plus for fish oil is its ability to prevent arrhythmias in patients with heart disease. Again, this is not something I’m concerned about for myself.

So what about Colpo’s claim that fish oil raises LDL? Once again, unsurprisingly, Colpo has either not done his homework or he is not giving us the full story because as a confusionist, that’s what he does. Fish oil increases LDL in patients with high triglycerides. This slight increase in calculated LDL probably reflects an increase in LDL particle size rather than an increase in particle number. Mr Colpo, are you telling us your triglycerides are out of control, and that’s why you need fish oil capsules?

Because if you had normal triglycerides, fish oil would likely lower your cholesterol.

In normal subjects, fish oil causes a decreased synthesis of LDL.

And therefore a decrease in plasma LDL. This was an important oversight by Mr Colpo, don’t you think? It was just an oversight, right?

Here’s Colpo’s reference to fish oil in his vanity journal article. He tells us that in a two-year-long trial, fish oil recipients had fewer cardiovascular events but higher LDL. This must be what he is referring to in his blog about me. If you look at this paper closely, you’ll see why I don’t see much here to interest a healthy person. Look at the bottom left paragraph. Colpo is taking his cues from studies of sick people. Look at the right to see their triglyceride numbers. All of the groups in the study had mean triglycerides that were too high. Are you combing the medical literature to see how to bring down your high triglycerides? Me, neither. But apparently Mr Colpo is.

Here’s another opinion on fish oil and LDL. The perceived increase in LDL for some patients may not be real because it is a calculated value. I alluded to this earlier.

If you want the effects of fish oil, algal oil can deliver them. That’s where the fish get their omega 3s. You’ll be eating lower on the food chain, avoiding toxins, and sparing the lives of fish.

As for the next issue Colpo brings up in his bullet points, he offers no references so I don’t know what he has in mind. You can pause the video to read this. I’m guessing he is thinking of Uffe Ravnskoff’s ploy comparing cholesterol levels before death with atherosclerosis measured at autopsy. Ravnskov says that when bodies are examined after death in some studies, the amount of atherosclerosis measured in them is not related to the cholesterol levels measured when the subjects were recently alive. I covered this one in video 40 so I’ve made it easy for Colpo to educate himself a little by watching that. Suffice it to say that atherosclerosis builds over decades, so cholesterol levels at the end of life don’t mean much.

I said earlier I would return to the topic of high-marine-animal-consuming cultures and their exposure to toxins. Colpo gives me that opportunity by raising the Tokelauans and the Pukapukans in the third bullet point. That’s the topic I’m addressing next.


Colpo's Journal Article

Running a Cholesterol Confusionist Gauntlet, Part 3 –
Colpo’s Journal Article

I’ve talked to you already about Mr Colpo’s attempt at a serious journal article and the not-very-serious journal in which he published it. Let’s look a bit at its content.

Much of its content relates to various drugs. I’ll save my comments about drug trial findings for my last video of this set.

It would take too long for me to comment on everything in his article, in addition to his blog post about me, so I’ll just make some general observations. Here is an example of his scrambled thought process. See if you can follow his logic. He starts this paragraph by saying that what he calls “the war on cholesterol” has been lucrative for the drug companies even though it has delivered no benefit to public health. That’s a pretty unequivocal statement. No benefit. I should be unable to find any evidence of any favorable health trends related to cholesterol lowering in recent decades if he is right. Then he says that the number of deaths from coronary heart disease, the leading cause of death, has indeed decreased. Well, I don’t know, Mr Colpo. Fewer deaths? That sounds like a benefit to public health to me.

Then he says that modern medicine has indeed extended the lives of people who have already had heart attacks. Mr Colpo, are you including those greedy drug companies in “modern medicine”? Are you saying that maybe their drugs work and therefore they have earned their money? Lastly, he retreats to the position that the rate of heart disease incidence, rather than the rate of mortality, has not been affected by the “war on cholesterol”. Is that your final position, Mr Colpo? It’s quite a bit different from saying that the war on cholesterol has had no benefit to public health.

Colpo’s claim is not worth a lot of effort for me to debunk. It is just clearly wrong. But let’s look at it anyway.

Do you remember this slide from my earlier video? Do you see how heart disease deaths started dropping in the 1970s?

That drop in mortality coincided with a drop in cholesterol.

This study sought to explain the reasons for falling death rates from coronary disease in the following years. The researchers attributed some of that drop in deaths to cholesterol lowering.

What about the incidence of coronary disease? Remember, this is Colpo’s final position in that paragraph. He says incidence rates have not changed. Here is a study that found a 31% decrease in the incidence of coronary disease between the early eighties and the early nineties. Improvements in diet, which means a lowering of saturated fat and cholesterol, explained 16% of the decline.

Just between the years 2006 and 2010, prevalence has had a measurable decline. The editorial to this study makes a great point. Mr Colpo, don’t miss this. One might think that with a decrease in coronary deaths, there should be an increase in the number of people receiving treatment for heart disease. There should be more prevalence because people are not exiting the treated population by dying. If people with coronary disease are dying less, these patients are alive and can be counted in the prevalence statistics. But instead, prevalence rates are going down. One of the reasons for this is said to be improvements in LDL levels.

You can see here that in recent years the treatment of people with high LDL has increased substantially. So we see that heart disease deaths have decreased, prevalence of coronary heart disease has decreased, cholesterol levels have decreased, and either drugs or diet have been a part of the explanation for this. This totally refutes Colpo’s ill-informed claims.

He links to this factually challenged journal article of his in his blog post about me, and he also links to a reply made to his article by researchers who he calls “Pee Pee-minded doctors”.

Here is the response from the said doctors who criticized his paper. They said it was critically flawed.

They fairly stated that his paper revealed major gaps in his knowledge. I agree with these comments. I’ll add some observations of my own.

Here’s an example of his difficulties in this article. Colpo does know that cholesterol is insoluble in water, so it must be transported in lipoproteins.

He should know that this very property makes cholesterol very dangerous. If it forms a deposit where it does not belong, it cannot be readily removed. This is why cholesterol is so carefully regulated by its lipoproteins and receptors. We have evolved systems to tightly control it.

Here’s another basic gap in his knowledge. He breaks out the scare quotes again for the phrase “fatty deposits”. Apparently he doesn’t buy the idea that atheromas are filled with lipids. He goes on to say that plaques contain many things, and cholesterol and various fatty acids are merely some of them. How he could question that they contain substantial fatty deposits, I have no idea. Atheromas are said to have lipid-rich cores for a good reason.

I’ve covered this already. There is a lot of cholesterol in there.

The lipid-rich core is the most obvious characteristic of the atheroma. Its cholesterol does not remain neatly sequestered in macrophages and lipoproteins, as Colpo would have you think.

Those fatty deposits are filled with extracellular cholesterol that Colpo should know is not water soluble and not easily removed. This is true of preatheromas as well.

The bigger the fat-laden core of the atheroma, the more likely the plaque is to rupture and cause a heart attack.

That cholesterol gets there in part as the macrophages disintegrate during a maladaptive immune response.

Here is more on that. This is common knowledge yet he puts the phrase “fatty deposits” in sarcastic quotes. Unbelievable. We know that the inflammatory process that causes this cholesterol to penetrate the artery wall is not self-sustaining in a low-LDL environment, as I have shown you already.

Colpo is evidently a believer in the oxidative modification hypothesis, conceding that oxidized LDL may be a cause of atherosclerosis. I covered this issue a bit in video 44. It is indeed true that the oxidative modification of LDL is a part of the pathogenesis of atherosclerosis. Oxidized LDL is not easily cleared. These particles attach to the artery wall and provoke an immune response. It is true that statins deliver an antioxidant benefit. But if you saw my video, you may remember that Daniel Steinberg, a top researcher who accepts the oxidation hypothesis, does not consider it to be contradictory to the lipid hypothesis in any way. Only someone with a confusionist agenda would pretend these ideas are in opposition. If Colpo really wanted to be true to his belief in the oxidative modification hypothesis and if he wanted to help people avoid heart disease he would have to change his diet recommendations.

Dietary saturated fat promotes the adhesion of immune cells to the artery wall. Dietary saturated fat promotes LDL oxidation.

Fatty meats typically contains high levels of advanced glycation end products, and these cause uncontrolled and damaging oxidation reactions.

If you want to reduce LDL oxidation, improving your antioxidant status is not the only way to do that. Here’s where the obvious must be said. If you reduce your saturated fat intake, you will have lower plasma LDL, and consequently less LDL will be exposed to oxidative modification. This is a simple idea, isn’t it? If Colpo believes oxidized LDL causes atherosclerosis, why does he think we should eat foods that raise LDL far beyond our body’s needs?

Again, this should be obvious. More LDL in the blood plasma means more LDL exposed to oxidation in the artery wall.

Moreover, dietary cholesterol itself increases LDL oxidative modification.

If you lower dietary saturated fat, you have less oxidation of LDL. Are you taking all this in, Mr Colpo?

Colpo puts a lot of faith in antioxidant status. I remarked in video 18 that antioxidants can be either good or bad under different circumstances, and I said in video 44 that trials of antioxidants for the prevention of cardiovascular events have produced disappointing results. Just to remind you that the oxidative modification hypothesis isn’t the simple explanation for heart disease the confusionists want you to think it is, this paper tells us that oxidized LDL might have favorable effects.

This paper tells us that it would be overly simplistic to consider all oxidative reactions of lipoproteins to be adverse. The authors suggest utilizing a heart healthy diet over antioxidant supplements. That seems like very good advice to me.

When something is said to be endogenous, that means it is produced from within us. We don’t get it from outside sources like food.

With that in mind, let’s contemplate this slide. As you can see, an endogenously produced antioxidant, uric acid, is by far the most important antioxidant in the human body. The levels of antioxidants from food are dwarfed by your levels of uric acid. If you buy in on the antioxidant strategy for preventing heart disease, as Anthony Colpo does, you might suspect that the higher your uric acid levels are, the better your heart health is. But the opposite is true. Elevated uric acid levels are often observed in patients with heart disease and metabolic syndrome. What foods elevate uric acid? The same ones that contribute advanced glycation end products. The same ones with heme iron. The same ones with artery destroying saturated fat. They include all the Weston Price Foundation favorite foods, like organ meats. They include the supposedly heart-healthy meats like chicken breast and lean beef and fish. They are the foods you don’t bother with when you are a whole food vegan.

Colpo’s belief seems to be that your cholesterol can be as high as you want as long as you consume enough antioxidants. But supplemental antioxidants have actually been shown to be harmful in some trials. The argument he makes is illogical and weak compared to the lipid hypothesis.

Of course, I think it is great to eat lots of antioxidant-rich plant foods. Practically every single thing I eat could be described that way. However, antioxidant power is only one asset of plant foods, and their other benefits, such as their effects on gene signaling or cholesterol lowering, may be more important. Whole plant foods have one enormous advantage over animal foods: they do no harm. It is the relentless, three-times-a-day damage done to the body by meat and saturated fat that I avoid entirely with my strategy. A diet composed of whole plant foods actually gives your body the opportunity to heal itself.

Fatty animal foods raise LDL. LDL is central to the pathogenesis of heart disease. I’m not going to accept high LDL in my body just because I’m crossing my fingers hoping that the antioxidant fairy that Anthony Colpo believes in will be my guardian angel, keeping my heart out of trouble. Consuming antioxidant-rich foods while tolerating high cholesterol is an incomplete strategy for long term health at best.

Colpo wants me to talk about fish oil and some fish-eating cultures. I’ll do that next.


The 2010 Meta-Analysis

Running a Cholesterol Confusionist Gauntlet, Part 2 –
The 2010 Meta-Analysis

High-strung blogger Anthony Colpo wants me to talk about that 2010 Meta-analysis again. Very well.

Here’s his account of it. Once again, Colpo feels so sure that I have completely ignored this that he feels safe in calling me a hypocrite, even though he is completely wrong. I did not ignore this study. It’s in my first The Best Low Carb Research video, video number 52 . This study looked at several prior studies to produce a meta-analysis, looking for correlations between saturated fat intake and cardiovascular disease. The authors stated that they found nothing to support this link. They said there is no significant evidence that saturated fat is associated with heart disease. This contradicts most prior research on this matter. This study was published in 2010.

Curiously, Colpo is a bit less interested in this meta-analysis examining saturated fats from a year earlier, which concluded that replacing saturated fats in favor of polyunsaturated fats would prevent coronary heart disease. This study got less attention than the one Colpo likes because it was not an outlier. It reaffirmed the consensus view so it wasn’t in anyone’s interest to blow it out of proportion.

 Because I have addressed this study in a video already, I won’t repeat my comments about it here. I had recommended that my viewers read Jeremiah Stamler’s critique of it to learn about its flaws but I’ll take this opportunity to highlight some of his observations now. Stamler makes a similar comment about this one as to what I have said about the Swedish farmers study. Stamler says no accounting was made of at-risk individuals eating lower saturated fat diets in an effort to lower their cholesterol. It’s a valid point, don’t you think? Stamler also talks about the Women’s Health Initiative Trial. Colpo wants me to talk about that study, so I will a bit later. Stamler points out something obvious about it: minimal changes in diet produced minimal changes in lipids and consequently minimal changes in the frequency of coronary heart disease. You need substantial differences between diets for their health consequences to be obvious in a study. These are typical problems with modern epidemiological studies of homogeneous populations, and this was a problem in this meta-analysis.

I need to point out that the cross-cultural studies by researchers like Ancel Keys and T Colin Campbell are the most valuable population studies because the people they studied were not fibbing about their diets, or taking statins, or trying to lose weight. They were just doing what they normally do, just like most everyone around them. The accuracy of observations of their habits could be trusted. I’ll come back to this point later. Next, Stamler goes on to note that some important studies were not reviewed in this paper, studies that might have affected their conclusions. Stamler’s last sentence here is important. He says that no definitive diet-heart trial has been done, and it is unlikely that one will ever be done. Quoting myself from video number 48, “You can’t take people and put them in controlled lab conditions for decades. There will probably never be a perfect study assessing diet and mortality for this reason.” If perfectly controlled long term trials were absolutely required to assess the effects of environmental factors on degenerative diseases, we would not be able to say smoking causes lung cancer today. Confusionists let the perfect be the enemy of the good just to serve their agenda.

We have plenty of animal studies to fill in any gaps in our studies of humans. As Stamler says, ignoring this body of research implies that the Darwinian foundation of biomedical research is invalid. This puts Colpo in the same bind as the Paleo people. He accepts speculative diet concepts based on evolution, but he rejects hard science based on evolution.

 When I discussed this study in my prior video, I was critical of Frank B Hu’s participation in it. I was disappointed to see him associated with a study providing support for the consumption of saturated fat.

Here you see he is listed as an author of this meta-analysis. This was surprising to see considering his other publications.

Last year, without the involvement of the other authors, he made his own views clear. An unhealthy diet raises LDL. Diet quality can be improved by reducing or eliminating saturated fats. Plant foods have proven their benefits through clinical trials. These ideas are all mainstream and well-supported by evidence.

Professor Hu is named here as the lead researcher in a study linking even a small daily serving of red meat with an increased risk of type 2 diabetes. He says, “saturated fat, which can lead to cardiovascular disease, is really just the beginning of the story” of how red meat harms us. Mr Colpo, will you be promoting the results of this study on your blog?

And what do you think of his participation in another study saying that red meat eaters suffer more strokes? Maybe your readers should have this brought to their attention as well, Mr Colpo.

Another author of this meta-analysis was Ronald Krauss.

Colpo is familiar with him. He says that anyone suspecting that a study with his name on it might be the result of influence from the meat or dairy industries is mistaken. Colpo has once again done no research to support one of his statements.

Ronald Krauss has received funding from the National Dairy Council, the National Cattleman's Beef Association, and the Atkins Foundation. Mr Colpo, the National Dairy Council represents the dairy industry. The National Cattleman’s Beef Association represents the meat industry. And of course, the Atkins Foundation exists to promote high-animal fat diets.

Here he is advocating low-carb diets for the 2007 Protein Summit. That was supported by the egg, dairy, pork, and beef industries. Nope, no industry influence here.

Yes, you can see at the bottom that Krauss is a low carber who thinks the blame for heart disease doesn’t belong with high LDL or saturated fat. He thinks lower carbohydrate intake will improve things. You can see why those industries like him.

To his credit, Anthony Colpo has said carbs don’t make you fat, excess calories do. And he has said that Gary Taubes is a source of nonsense ideas these days. Yet Ronald Krauss agrees with Taubes here about carbs, saying people should limit their carbs because they are too dumb to eat natural high-fiber carbohydrates. No, in his mind, it’s safer to recommend saturated fat. Just try making sense of this quote. That’s my best guess as to what he is saying.

By the way, this is another example of an apparent disagreement between the saturated fat apologists about the cause of heart disease. Krauss thinks carbs are to blame. Colpo thinks antioxidant status is the key issue. Once again, there doesn’t seem to be an obvious alternative to take the place of cholesterol as the most important cause of heart disease. I made this point in video 34 as well.

Here you see in a journal abstract that Krauss subtly implies that the only diet choice left to us to make is between low carb diets and high-glycemic diets. That’s it. No other options. As long as simple sugars exist in the marketplace, we should recommend people limit all carbs. What a wonderful contribution to educating the public he is making!

This may seem like an obvious false choice to you, but then your work probably isn’t being sponsored by the dairy and beef lobbies.

Mr Colpo, even Ronald Krauss has authored a paper suggesting that low-carb diets are less atherogenic with less saturated fat. Not very consistent, is he? Why does he think these cholesterol-related measurements are of interest?

Colpo did include another reference in addition to the Swedish farmers study and that meta-analysis in the original post that got my attention. I’ll return to this in my Confusionist Gauntlet video number six. But right now, I’ll address Colpo’s very own published journal article. Part 3 is next.


The Swedish Farmers

Running a Cholesterol Confusionist Gauntlet, Part 1 – Swedish Farmers

As I go through all this material, remember that the confusionists are not saying there are other important risk factors for heart disease in addition to cholesterol. No, they are actually claiming that saturated fat and cholesterol are totally innocent of any connection to heart disease. My prior videos, and especially my Futility of Cholesterol Denialism videos in the current batch, should at a minimum give you enough reason to doubt that high cholesterol is completely benign. Also, consider that in the present day hyper-competitive world of biomedical research, the specialists in cardiovascular disease are not debating the guilt or innocence of saturated fat and cholesterol. This should give you a moment of pause before believing the deniers. While one should not dismiss a contrarian scientific opinion out of hand, plenty of skepticism for it would be justified. I really shouldn’t have had to go through so much material, but I did anyway, just to try to make you completely impervious to these ploys in the future. By the end of this batch of videos, I think I will have convinced any fair-minded person that the lipid hypothesis describes reality pretty well. The counterarguments to it just are not very strong.

Let’s begin our look at Colpo’s very best material with the portion of my videos that caused him to engage me in the first place. In video 41, I took him to task for finding significance in a study of Swedish dairy farmers that gave the impression that the consumption of fruits and vegetables were only associated with lower rates of heart disease if they were accompanied in the diet by high fat dairy products. Colpo apparently felt this strange study supported the title for his post, “Saturated Fat Is Not Associated With Cardiovascular Disease”.

Here is his response to my criticism of his use of this study. His defense is limited to a few trivial ideas. The first is that he didn’t like my use of the word “proof”. OK, it might be true that he didn’t directly say that this study proved anything, if you want to quibble about semantics.

But he did use it as one of only three studies to support his claim here that saturated fat is not associated with heart disease, an idea this study did not really address. More on that in a moment. Since this was how he chose to title his blog, is it not fair to conclude he must believe that this study together with the other two do support this title? Looked at singly or together, they do not. My take on the other studies is coming up, too.

Colpo thinks I should have examined all his many other writings to have the right to criticize his completely dishonest use of this particular study. I’ve seen this defense before from other crackpots. In effect, he is saying that his writings should be studied and understood as a whole like a religious text, as if he were laying out some fully formed, carefully constructed grand vision, before anyone can point out that any single claim he puts forth makes absolutely no sense at all. I see this as an example of special pleading as well as a defensive attempt to change the topic. Colpo wants to change the subject to all his other ramblings because he knows I am right in my criticism of him in this case.

Colpo then compares himself to the first people to understand that the world isn’t flat. Once upon a time, they were on the fringe, just like he is now.

Cranks like Colpo often believe that they have the misfortune of being radically ahead of their time. I’ve shown you how Loren Cordain thinks he is initiating a Copernican Revolution in nutrition. He is on the leading edge of nutrition science in his mind.

Here are a couple of Paleo true believers quoting Gandhi. “First, they ignore you. Then they laugh at you. Then they fight you. Then you win.” These anti-bean trailblazers are sure that with the passage of time, their fad diet will be better appreciated.

It’s too bad for them Gandhi probably never said this.

And it’s too bad for Gandhi his name is being used to promote the fad Paleo diet, as he was a vegetarian of strong conviction.

He was really into that whole nonviolence concept, you know. Maybe those bloggers should contemplate the meaning of ahimsa the next time they are consuming a once-living animal.

Donald Miller fantasizes that the future will play out as depicted in Woody Allen’s comedy, Sleeper. He is sure that in a short 200 years his belief in the goodness of saturated fat will be vindicated.

A crank might cast himself as a modern day Galileo as well. Of all the humans that lived over the last four hundred years, surely Galileo was the one who had the most in common with the crank.

Then there is that ubiquitous Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” Thanks to this one, cranks can feel assured that their opinions will be seen as totally obvious by future humans. Today’s humans aren’t sufficiently advanced to appreciate them.

So you see, Colpo is just taking part in crank tradition here. The problem with all these fantasies is that they only inform us of the state of mind of the crank, since no one can see into the future, not even Anthony Colpo. Despite the fervent wishes of these dreamers, if their ideas are seen as nonsense during their time, their ideas will likely remain nonsense forever. Colpo and the other cholesterol deniers are likely to join all those fringe-dwellers of the past in oblivion. Guys, if you think this crank tactic is a good trick, try telling some gorgeous woman she should go on a date with you now because in the future you will be a billionaire dictator with an invincible robot army. My guess is that even the most suggestible woman out there won’t buy it and the best reaction you might get is a laugh.  When Colpo tries to suggest that all those brilliant researchers are like flat earthers, he is using the same desperate tactic. Colpo is about as likely to be way out ahead of everyone else as you are to have a robot army one day.

His next defense against me is in the middle of the last paragraph. It’s a riff on the Swedish farmers study authors’ speculation that the fat in the farmers’ milk aided in nutrient absorption, or that the fatty milk gave them key nutrients. Look closely at his choice of words. Notice he is not saying high-fat diets improve nutrient absorption. He is saying higher fat diets. Well, “higher” is a relative term, Mr Colpo. Higher fat than what? Higher than zero fat? Higher than 10% fat? Higher than 20%? What are you saying, exactly? He knows he’s not on firm ground here.

Here you see this speculation from the authors about the dairy fat helping their nutrient absorption.

I wouldn’t be so quick to assume this mattered. We don’t know what the total fat intake of the farmers was. It’s just not in the study. Were some of the farmers on extreme low fat diets? I really doubt it. Also, dairy may blunt the beneficial effects of some foods. Lastly, I am not aware of any research stating that fat-soluble nutrients are absorbed better with saturated fats than other fats. This seems like a very unlikely explanation.

Fat is needed for the absorption of some nutrients, this is true. Studies like this support that view. But notice total saturated fat intake was not revealed in the Swedish farmers study, and the amounts of fat believed to optimize absorption really aren’t very much. Colpo’s claim is weakly supported, and that’s being generous.

Here are the three authors of Colpo’s study of Swedish farmers: Holmberg, Thelin, and Stiernstrom. Are they leading researchers in the study of diet and heart disease?

These are search results for the lead author’s name along with her affiliated institution. I see papers on knee injuries, low back pain, arthritis, and more back pain. You get the idea. Not much here on heart disease or nutrition.

Here’s another of the authors. I see back pain, joint problems, arthritis, aortic aneurism – that’s a little closer to our topic.

Here’s the third author. This looks like a diverse collection of work. What you’ll notice is that they have all published together using data from these Swedish farmers. Frankly, it seems to me they had been studying this cohort of farmers for a variety of issues and they decided to extract some data to put together an agenda-driven and poorly conceived paper on the topic of dairy fat.

If they knew what they were doing, why didn’t they mention lipid lowering drugs in this unhealthy, older population?

If they were not pursuing an agenda, why did they reference someone who clearly does have one, someone who is not taken seriously by specialists in heart disease? By the way, Mr Colpo, I talked about Ravnskov already in other videos which you didn’t watch.

These authors also suggest that a nutritional factor at play here is some special effect of fats, and they base this speculation of theirs on the qualities of the Mediterranean diet. Think about it, Mr Colpo. The Mediterranean diet. You think this study is going to help you? You see the reference they are using, number 11.

Here is that reference. The Mediterranean diet described in this paper consists of less milk, not more. This is the opposite of the impression your study gives. More cheese was eaten, however.

Yet this study didn’t look at cheese at all.

Let’s think about the Mediterranean diet. Also in the original post of Colpo was another study, which I’ll discuss soon. Although you can’t see it here, reference one was coauthored by someone named Frank B Hu.

In Dr Hu’s prior writing about the Mediterranean diet, he didn’t seem to think a recent trend toward increased consumption of saturated fat in the Mediterranean countries represented an improvement in their nutrition.

It’s surprising that the authors of this Swedish pro-dairy fat study that Colpo thinks is so valuable would reference the Mediterranean diet, which was first described by Ancel Keys. Yes, the same Ancel Keys who helped the world understand how harmful saturated fats are, including dairy fats.

As a reminder, Colpo thinks Keys followed an “idiotic agenda”, as he says, and he bases this belief upon an incorrect account of history that he mindlessly parrots.

Before I move on from this study, remember for a moment how long Colpo’s response to me was. He used a lot of words. He had no lack of space to respond to my specific criticisms of his use of this study. Therefore, I find it interesting that despite all his verbosity, and despite all his sarcasm and scorn, and despite all his arrogance, he completely avoided responding to my specific criticisms.  Maybe he was too angry and emotional to think straight. Therefore, I’ll try to help him face the actual questions I raised.

To be left out of this study a farmer had to have been actually hospitalized with heart disease.  So if you had a history of heart disease in your family, or if you had high cholesterol and were put on statins, or if your heart disease had not yet put you in the hospital, you would be put in this study's cohort anyway.

As you can see, statins are not mentioned in this study, nor are any other lipid-lowering drugs.  This study lacks basic and necessary information, so it should be viewed with skepticism.

So these men did worse if they used lower fat dairy products.  Are we to assume that the people opting for lower fat intake always ate lower fat over their whole lives?  Don't you think the people told by their doctors that they were at risk for heart disease might be the same ones who disproportionately chose to eat less saturated fat?  No adjustment is made for something so obvious. 

Here’s something else that’s strange.  Saturated fat was looked at in detail for dairy, but no other sources of saturated fat, beside fish, were mentioned.  Therefore, if someone preferred skim milk but ate many more high-saturated fat meats than the rest, eating bacon and burgers and liver every day, they would fall in the low dairy fat segment of this study anyway. 

Here is some of the text that I read. The subjects of the study could have had poor risk factors to begin with. Cholesterol-lowering medications were not considered. We don’t know why some farmers were consuming low fat dairy or for how long prior to the study’s conclusion. We don’t know about the other sources of saturated fat in their diets. Colpo addresses none of this. He ignored all this but he found the space to insult me at length. I’ll take that to mean either he did not think of these issues or he chose not to mention them because of his irresponsible agenda to spread misinformation.

In that original blog post of Colpo’s is another study, number one here, and he references it again in his angry blog about me. I’ll look at that next.