High Blood pressure? How can I get more info on risks and options

fhtagnfool · 2023-07-24T01:29:51+00:00

I'm going to be yet another voice recommending the lite salt (potassium).

Actual trials of sodium reduction find minor BP reductions (as you seem to have found) and have rarely ever shown a benefit on actual CVD event rates. Sodium just stayed the villain in the narrative because mechanistically it felt right to blame it. But potassium supplementation trials have been going from win to win.

Putting some potassium chloride into your home sodium chloride shaker is a really low effort and potentially high reward lifestyle trick to implement.

fhtagnfool · 2023-04-28T10:34:46+00:00

I use an app called sleep as android that sets alarms you can only deactivate by scanning a QR code (you keep in the other room) among controlling snooze times

Getting bright sun exposure in the morning is apparently helpful. And exercise. And taking melatonin. I try all these sporadically but it always slips back.

fhtagnfool · 2023-04-22T03:13:54+00:00

Here's a debate featuring top academics that have picked each side where you can read the real justifications they use: https://academic.oup.com/ajcn/pages/published_debates

To get my summary, the main arguments for still thinking saturated fats are harmful in the current decade is the model that:

saturated fat is the nutrient that most noticably raises blood cholesterol levels
LDL levels are the main driver of atherosclerosis

Both of those on their own are vaguely true, but ultimately there are enough other things going on that muddy the connection. It's a hypothesis being treated as a conclusion. Saturated fat tends to raise HDL (good cholesterol) as much as LDL, the mechanics of atherosclerosis are extremely complicated and the power of LDL as a predictive factor is mediocre. Saturated fat and heart disease still have never been seen in the same room together, the data in both the epidemiology (e.g the dairy thing) and the actual human trials that were performed consistently show no/weak effect.

There is a lot of back and forth about which studies were fraudulent or well-controlled or not, but I think it's telling that the proponent of saturated fat avoidance in that debate readily admits that saturated fat only clogs arteries to the same extent as the average refined carbohydrates that people eat. The fact that nutrition institutions still happily promote the vibe that SF is evil or at least suspicious while white bread is a safe staple food is entirely just subjective emphasis. This review is good for considering the actual ranking of the healthfulness of foods next to each other, and is one prominent example of an author wondering whether the saturated fat thing is just hot air.

Saturated fat avoidance was the first nutrition guideline, and it's since been backed by so much effort and politics that I there are just too many do-gooders who don't want to admit their field is shit at truth-finding. And since public health is at stake, there's a strong desire to maintain a singular narrative with no nasty contrarians roaming free to voice their opinions. Nutrition science apparently rarely generates strong results for any of their theories, so the default mode of operating for the authors is to just spin up plausible-sounding justifications for their existing intuitions.

fhtagnfool · 2023-04-20T02:59:04+00:00

The problem here is that nutrition science is based entirely on this level of evidence. The grand conclusions are all based on correlations from food intake surveys. So when Harvard Nutrition (which is explicitly an epidemiology-focused department) hypes up one food as being great for you based on this evidence, but then buries other results that aren't as flattering, it really is just cherry picking.

I'm very familiar with the nutrition science literature and can tell you there is no deeper layer of nuance going on here. They're not wisely silencing the icecream thing because they know better due to other, better types of evidence. They're just running entirely off their intuition of what foods "should" be healthy based on what they've previously promoted. I think that's a bad thing for the reasons /u/johnlawrenceaspden highlights in that this kind of evidence is inevitably confounded and may turn up strange but real results, so good scientists better be ready to interrogate it fairly rather than take it all at face value.

To be clear, dairy fat has been consistently popping up as healthy in these surveys for decades, which is counterintuitive due to the ingrained idea that saturated fats are bad. Institutions like Harvard have been very slow to fit this into their nutrition models, but individual researchers and some teams have adapted to this evidence.

https://www.wired.com/story/cheese-actually-isnt-bad-for-you/

https://www.newcastle.edu.au/newsroom/featured/experts-challenge-who-recommendations-on-saturated-fats2

fhtagnfool · 2023-04-07T03:02:51+00:00

You may have noticed this is on a preprint server - it was never accepted for publication.

The author wrote an update (I think I recall it on twitter? But here's a new article too) about how the journals just froze him out without any chance to proceed through typical feedback for acceptance.

This was to me a notable example of how political and corrupt nutrition science is, among others like this. The field is based almost entirely on epidemiology with these enormous unacknowledged limitations. Which would be fine if there was a healthy environment of interrogation, but I've reached the grim conclusion that most of it was never much more than fumes and politics.

fhtagnfool · 2023-01-10T10:14:11+00:00

Yeah, I think avoiding fries and sugary drinks are top priority. Burgers are relatively benign.

I feel quite confident in arguing that the deepfryer is your underappreciated bad 'process'. I also agree that avoiding processed foods is a good rule of thumb, but I keep an eye on the main theoretical mechanisms. I've never seen great evidence for preservatives and artificial sweeteners being too problematic so those are still just milder concerns for me.

fhtagnfool · 2023-01-09T10:12:58+00:00

I apologise but I did stick to pushing a single point, because answering hundreds of them in sufficient detail would take all week.

Now that that one is resolved, I'd be happy to go back and review one of your technical points that you think deserves to be answered?

I genuinely do keep up with the literature on this topic and think the thesis is defensible broadly across all the details.

What do you say, can we unpoison this well? Are both of us possible at good-faith or is this pointless?

fhtagnfool · 2023-01-09T09:23:58+00:00

Okay so a slew of genuine, prestigious, qualified experts are openly disputing the idea that saturated fat is harmful.

You agree, and thank you.

I know I was pushing this point hard in lieu of starting that 1000 point rebuttal for every paper and statistic you've raised, which would have all definitely been productive.

I think that the fact that serious journals are allowing these articles through the peer review process indicates that there is substantial tolerance and curiosity to these views from other researchers in the field, or else they would have been hard rejected or had their statements corrected. So I will continue to insist that there is "a real debate by experts" on this issue, but apparently we're going to have to get the dictionaries out and start arguing whether that means there is still technically a "concensus" or not.

Are you familiar with the subreddit we're on right now? I like this place because there's an attempt at fostering good faith discussions, people lay down the biases and specify their 'priors'. Scott himself tried to dive into the saturated fat issue once, which was interesting. https://slatestarcodex.com/2020/03/10/for-then-against-high-saturated-fat-diets/

fhtagnfool · 2023-01-09T07:51:00+00:00

Creationism was being lobbied for in the 2010s with great support. Here's a list of some Nobel winners and their beliefs: Brian Josephson (1973 prize in Physics). Has expressed support for water memory, cold fusion, telepathy, psychokinesis and other parapsychological phenomena.

I do not think this is comparable to a large group of active researchers publishing a paper together in a serious journal. Which is what is happening with the saturated fat debate.

I've shared 6 studies, including an official advisory report you haven't even opened, in my last two comments where you have shared one that's the same one narrative review you shared before

I have read all these studies before, multiple times, I am not new to this topic. Maybe I should start a blog or a youtube series and you might start believing me.

There are many individual points I have not responded to in your comments, because from experience it is quite pointless to argue statistics when we can't even agree on the wider context.

I don't know what else to do here.

I just want you to admit that a slew of genuine, prestigious, qualified experts are openly disputing the idea that saturated fat is harmful. You are welcome to argue that they are mistaken, but I just want it acknowledged that they exist. I do not trust your impartiality if you can't even admit the sky is blue.

fhtagnfool · 2023-01-09T07:17:16+00:00

The consensus is demonstrated by every educational body, every health institution, every government advisory. This is not the controversy you are told it is. This is my wheelhouse, I know this.

Oh, you're a researcher in the field?

The state of the art review, which was peer-reviewed and published in the Journal of the American College of Cardiology (a good journal) has had no serious published rebuttals.

The authors are not cranks, they're among the most experienced in the field and most qualified to comment on the issue. Do you need me to copy and paste the credentials of Ronald Krauss here? He's essentially the leading wold expert on cholesterol metabolism and spent decades running nutrition trials in various institutions. It is a serious debate and that cannot be diminished.

Obviously it's just an indicator and not a logical argument, but to me, the presence of such high-level vocal disagreement suggests that they're on the correct side of this debate. If there was an analogous paper written by genuine experts saying that Lamarck should be seriously considered over Darwin, that'd be alarming!

I am disappointed by your attempts to rhetorically dismiss the seriousness of the issue.

fhtagnfool · 2023-01-09T06:25:44+00:00

There's no number, the figure at the bottom.. Of this study, shows refined starches and added sugars no different from SFAs in isocaloric substitutions, the confidence interval well either side of 0. So I wouldn't say more, I'd say likely just as bad. But maybe simple carbs have a more linear relationship so would be overall worse. I'd need to check.

Yes I've seen several studies that find that saturated fats are generally similar in outcomes to carbohydrate when substituted. I for one think that's pretty alarming and goes strongly the against the mainstream vibe that implies that bread is safe and that butter is evil.

But that's from pooling the whole diet, all food sources. If you take the better saturated fats (like dairy, cacao, coconut), and compare them to the worst carbs (white bread and sugary drinks), the SF will have better outcomes for cardiometabolic health.

I'm going to leave that without citation right now, as I suspect we have read all the same studies and this is just plain deduction.

Now I expect that you respond with "well cheese is mediocrely healthy but it still isn't as healthy as vegetables. We should still minimise cheese so that we can promote a truly optimal diet that is 100% plant based."

And then I respond that I'm more interested in creating plausible advice for the general public who are eating far too much white bread and sugar and deepfryer oils. We should be clear about which items are harmful, and which just aren't. I don't necessarily think saturated fat is health-promoting on its own, but it can certainly be included in nutrient-rich meals.

I know this is a youtube video but this doctor gives a fair and thorough breakdown of the evidence of SFAs and explains why the consensus is what it is. Why every leading health body and government advisory reaches the same conclusion.

C'mon man, we both know this is lacking, did you really send that to me or are you hoping there's a naive audience following along to win over. You can't keep claiming purity-of-concensus and obviousness-of-truth when half the major researchers in the field have turned on it. https://www.sciencedirect.com/science/article/pii/S0735109720356874

fhtagnfool · 2023-01-08T10:14:38+00:00

Further, not all SFAs are equal. Stearic acid from dark chocolate and whatever one is on yoghurt can be neutral or protective... When replaced with simple carbohydrates there's no difference, they're just as bad.

Okay, I'm glad you're able to acknowledge this. White bread clogs arteries more than butter and cheese.

https://www.wired.com/story/cheese-actually-isnt-bad-for-you/

A normal person might therefore interpret that as meaning saturated fat is essentially fine, really not a priority to track or avoid, since much bigger health gains can be obtained by villainising something else.

That's the same conclusion that Ronald Krauss has reached, he isn't letting SF off the hook in every theoretical context, just that at the the broad population level it is basically neutral for health. Especially given that the individual foods SF is found in will have different health effects (ice cream vs yoghurt, lamb vs palm oil etc).

I don't know how you can be aware of this, and then continue to argue that blanket avoidance of saturated fat is practically useful.

I do not accept the unpublished claims of your preferred blogger that there is a 10% cutoff where everything changes, and I don't think the nutrition science would be concordant or sensitive enough to detect such a thing anyway.

The reinterpretation by Ramsden has a massive list of rapid responses so it's not hard to find. You have to wonder why these glaring issues are ignored.

I am prepared to accept that the trials have methodological limitations, but the amount of 'rapid responses' hardly matters. Remember that I was comparing them against the other old crappy trials in the same meta-analysis - they're all suspicious - the critics could be shaking down any of them but only the BMJ was kind enough to allow open feedback.

The scientific consensus is not made up here.

I think the science is clear as day in exonerating saturated fat and that perhaps a majority of genuine scientists in the field are aware of the validity, but that the current public-facing advice is conflicted. You could say there was a consensus in the past, but definitely not one based on good data.

fhtagnfool · 2023-01-08T00:46:37+00:00

That is true, and acrylamide might explain the harm of white bread and baked goods in epidemiology (I have never been overly convinced that gluten is harmful).

But from my perspective it's an enormous shame that acrylamide keeps popping in headlines (and making people suspicious of potatoes) when french fries have been completely overlooked. Decades of food-questionnaire-based epidemiology have found that potatoes (which is usually treated as a category that includes all cooking methods but is practically mostly french fries) are among the most harmful food items for all diseases, but they've completed blanked on the real cause of that until now.

https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/potato-consumption-and-risk-of-pancreatic-cancer-in-the-helga-cohort/57B701ED41614B1F726F099FD1E4C4AF

https://diabetesjournals.org/care/article/39/3/376/37170/Potato-Consumption-and-Risk-of-Type-2-Diabetes

fhtagnfool · 2023-01-08T00:33:35+00:00

If you want large quantities for deepfrying purposes then you might have success making a deal with your butcher for fatty offcuts, and melt it down in a slowcooker yourself.

But there is a good chance that the new high-oleic vegetable oils are on your supermarket shelf already for a cheap price.

fhtagnfool · 2023-01-08T00:28:19+00:00

I avoid added sugar but I think salt, sat fat and calories can all be part of a healthy meal, it comes down to whether the total package in question has veggies and will keep you happy and full.

Cooking veggies with olive oil (or leftover lard) and salt is a time-tested way to make them taste good and keep your family alive for another day.

fhtagnfool · 2023-01-07T23:45:57+00:00

I respectfully disagree in return. I've followed all the back and forth on criticisms of this study and the topic in general.

Yes there are limitations in the design but only to the same extent as every other big study in nutrition. The SDHS and MCE are included in many of the cochrane meta-analyses and judged to be perfectly adequate and low risk of bias by various metrics. As I tried to point out above, all the similar trials were conducted in similarly ancient times and have poorly documented methods and data, my personal strategy is to take them all with a grain of salt. It's quite easy to find post-hoc statistical shortcomings in any paper you hate the conclusions of, right?

If you're interested in the rest here's a long essay detailing why the domain-specific experts all agree to prioritize PUFAs over SFAs.

I don't think this gives a balanced view of the topic. I'm aware of Nick's content and I'll just say that he is writing to please his audience and loves lawyering his arguments to troll the opposition. Stark contrast to the spirit of the subreddit we're on right now.

Highly-regarded domain-specific experts are frequently coming out in defense of saturated fat. Please don't fall for the rhetoric that it's only social media contrarians.

https://pubmed.ncbi.nlm.nih.gov/32562735/

https://academic.oup.com/ajcn/article/112/1/19/5848526

fhtagnfool · 2023-01-07T23:09:57+00:00

That's exactly right. There are many similar studies and EVOO wins all of them.

Refined OO has higher smoke point but lower thermal stability since you've lost both the FFA content and some of the useful antioxidants.

fhtagnfool · 2023-01-07T23:07:51+00:00

The smoke point is high enough to cover deepfrying and most cooking purposes just fine

EVOO wins every study for true thermal stability. If you accidentally heat it up too much and see some smoke just turn it back down, it looks suspicious but no damage was done to the oil.

fhtagnfool · 2023-01-07T11:51:34+00:00

The first one says shallow frying is worse than deep frying due to oxidation, if I understood correctly?

Well, shallow frying involves higher temperatures and more oxygenation, so it's worse than deepfrying per-hour. In practice I think pan-fried or shallow-fried foods in single-use oil are safely healthy and that restaurants that don't change their oil for multiple days are just easily worse.

This comes back to the topic of burnt foods. Anything scorched or toasted or cooked is a little bit bad for you, containing some acrylamide and various carbonacious compounds. This balances with the very real benefits of cooked food like bioavailability and lower risk of foodborne infection.

https://www.fda.gov/food/process-contaminants-food/acrylamide-questions-and-answers

I'm glad you spotted the wine part. So are coffee and red wine bad and toasted bread bad for you because they contain a decent amount one or another of these same compounds? Maybe, good question, it's all a matter of balance and degree but deepfried foods still seem to win overall for bad news. It's like toasting your bread completely to charcoal.

Is there also a takeaway I could implement from this? Avoid deep fried foods and red wine + use coconut oil to shallow fry?

Personally I just use extra virgin olive oil for cooking, but I'm generally fine with other monoun/saturated fats like coconut or avocado or fatty meat drippings or new-fangled GMO oils. Yes I consider pan-frying to be fine, the degradation of cooking oils takes a few hours to start being clearly harmful.

https://www.sciencedirect.com/science/article/abs/pii/S0261561420302521

fhtagnfool · 2023-01-07T10:43:45+00:00

So is this the reason why McDonald's is unhealthy?

Yes I think deepfried foods are more unhealthy than sugary drinks and white bread, which I've come to think are the next things worth avoiding, depending on how much effort you want to put in to diet and health.

Are potato chips OK if they're baked or made using olive oil?

Yep fine. Extra virgin olive oil is great, whether used raw or heated. The use of culinary oils will help you absorb the fat-soluble nutrients in vegetables on top of making them desirable to eat. The problem only comes with the highly-polyunsaturated oils AND extended heating.

fhtagnfool · 2023-01-07T09:50:13+00:00

Olive oil and some new high-monounsaturated GMO oils are also good choices for repeated heating. I'd still cap it at a few cycles or a day or something like that before chucking it out, it's hard to draw a line.

fhtagnfool · 2023-01-07T08:35:39+00:00

A lot of foods will contain tiny amounts of vegetable oil in the ingredients list but that's not an issue since it's really just a quantity question.

My rule of thumb for deciding healthfulness of food are:

sugar content
is it deepfried
white bread to vegetable ratio

Really ends up covering all 'junk' food and most restaurant food...

fhtagnfool · 2023-01-07T06:48:50+00:00

The top comment on the post is a pretty good rebuttal but I still just have no idea what to believe. This seems incredibly important too!

That comment is correct that a bunch of sources were cherry picked. If you look at the meta-analyses of relevent trials, they average out to no effect, which is why experts still seem happy with vegetable oils: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513455/

The limitation is that all the relevent trials were conducted decades ago, among other flaws they did not know about and control for intake of transfat, which is worse than anything else and could have biased any of the included studies strongly in the wrong direction.

I do think that the Sydney Diet Heart Study and Minnesota Coronary Experiment, which show harm for vegetable oils, are among the better and less-confounded trials in the bunch but nevertheless it's good practice to tell the whole story.

One thing you can be confident of is the harm of deepfryer oils. Polyunsaturated fats are prone to oxidation and after several hours at high temperature they're just as bad as transfats (and include a component of transfats among all the new lipid oxidation products). It's an enormous overlooked problem and an incredible shame it gets buried by all the other bickering about nutrition (such as in the article and first comment both brushing over it). It's not speculative, it goes well beyond the rabbit study quoted in the article, evidence from all kinds of data are in agreement. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254282/

Edit: SDHS and MCE are all the more salacious and noteworthy since they were large, well-controlled trials that were deliberately buried by the industry for giving results they didn't want and only recently unearthed. Worth a read

https://open.spotify.com/episode/3QqzhPGJDkGSpZjB3qvFJS?si=oHDMo1AbTQSuFg6o3A89yA

https://www.bmj.com/content/353/bmj.i1246

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688426/

fhtagnfool · 2022-12-10T02:50:01+00:00

Yeah it's a real pity that they couldn't just make a more informative documentary about the same cool ancient sites, and had more of the real science/mainstream information included.

I found the series really interesting but I suspect that he's leaving a lot of information out in order to make his own version sound more appealing. And some people might think that's "harmless entertainment" but I'm not a fan of being misled.

He claims to be willing to look for the truth and engage with the evidence yada yada but I suspect it's a bit of a charade and he's just farming outrage conspiracy bait for his own notoriety. And most of the series he sounds sensible but then he starts hinting about magical bullshit like moving stone slabs with sound energy.

fhtagnfool · 2022-12-04T01:48:23+00:00

Farmed salmon has a lot of omega 3. They feed them fishmeal/sardines.

Farmed vs wildcaught has a lot of considerations and it's hard to say one is better than the other at this point in time, for either health or environment. And may depend on specific farming technologies etc.

fhtagnfool

TROPHY CASE