The Surprising Foods That Transformed My Blood Tests

My total cholesterol has gone from 280 to 120. Triglycerides 235 to 81 and LDL cholesterol 150 to 55 mostly in the last 4 years. After 68 years of high numbers, when I first started getting lab tests like these, I thought the lab must have mixed up my blood tests with someone else's. Heart disease runs rampant in my family. Doctors and life insurance companies had been warning me for decades, and I tried a lot of things, but nothing seemed to move the needle. When I mentioned this in a previous episode, people started asking in the comments section how. Well, I'm not 100% sure I do know, but I'll tell you what I think I know in this short episode. My father raised us on the high meat, high cholesterol diets that were so popular in the 50s and 60s. And far as I know, my whole family had high 200s cholesterol. And I know my dad and my sister had a medicine cabinet full of medicine bottles and they both died of fatal heart attacks before my age. I abandoned that diet when I went to college and thought I was eating like 80% Mediterranean as I understood the diet at that time. Although Tony likes to point out that when it came to birthday parties, I didn't refrain from eating the cake and the cookies. When I was 42, my company made me go get a life insurance exam. And when my cholesterol came out to be 280, the life insurance company didn't love that. So they sent me to get an ultrasound of my corateed artery which showed medium blockage and that spiked my life insurance costs a lot and was a bit of a wakeup call for me. So I tried to get better about my diet and I thought that meant avoiding greasy and fatty foods and also the cakes and cookies. And 5 years later at 47 my cholesterol was 280. If I had known to check for familial hyper cholesterolimeia in the day I probably would have checked it but I didn't know. What I thought I knew is that nuts were fattening and oils were refined foods that were no bueno. I was 6'4 and 228 pounds, but not fat. I was working out three days a week for 90 minutes pumping iron. So, I decided to get really serious and spend 3 years training for an iron man for my 50th birthday. I hired a coach and he made me get down to 185 lbs, losing 43 pounds because he said, "Big guys can't run. 185 is your race weight. Get there. " So, imagine my excitement about going back to the lab after losing that much weight and thinking that's going to move the needle. But it didn't. And maybe just a little bit higher because my HDL rose a little bit and I thought, well, maybe I'm eating too many lowquality carbs in the form of sports drinks and goose that you eat when you're doing all that training. I don't know. So, in 2016, I decided to get really serious. I read the book by Caldwell Eelston and watched his talks. I went on a nut-ree, completely oil-free, fully whole plant food diet. And the only really thing that changed is my triglycerides spiked, as you can see in this graph. How could that be? I know a dozen other whole plant food vegans on Caldwell Esson's diet who dropped their LDL 30% by going on that diet, and it didn't move for me. When I was editing this episode, I decided it was probably a good idea to doublech checkck my aging memory and I found out that indeed my LDL did drop a little bit when I first went on Dr. Esleston's diet. But the next time I had it measured, it was back to high again. And what had lodged in my memory was the spike in triglycerides, which stayed high. I don't like anecdotes, so you'll soon see me pivot to some absolutely fascinating and profound science that is so simple everyone can understand it. That foiled my plans for a casual six-minute episode, but it felt crucial to do it now that the new American dietary guidelines are out and so many people are confused about saturated fat. So, I talked to Joel Ferman who said, "Some people just can't lower their cholesterol through diet, but you still get an improvement because of lower oxidation. " That answer didn't seem that satisfying to me. So I talked to a lipidologist who said, "Chris, the smoking gun is your spike in triglycerides when you went on a very high carb diet. That puts you probably in the phenotype sometimes referred to as carbohydrate responder, where the liver gets carried away producing triglycerides when you eat a very high carb diet. " And in the meantime, I have a decent background in epidemiology and we like large long-term studies where we know how the data is collected. And so I thought, dummy, what does the epidemiology say? And with all due respect to Dr. Esleston because I know he's helped a lot of patients, to an epidemiologist, his studies do look a little bit small and anecdotal. I was aware of a crazy result that Advent epidemiologists discovered by accident when they followed 33,000 Adventists for 6 years back in the 90s. They wanted to know why California Adventists had fewer heart attacks than non-Adventists. Was it not drinking, not smoking, not eating meat? A surprise result that popped out of the data was that people who ate nuts more than four times per

week had half the heart attacks of people who ate them one time or less, regardless of age, sex, activity level, or weight. What? Apparently, it so surprised the epidemiologist that they were a little bit skeptical of their own study and sought confirmation from other studies and they got it. Other large studies such as the Harvard nurses study confirmed what the Adventists had seen. This is an example of things you only learn from large observational studies and it was 180 degrees out from Dr. Esleston's intuition and mine. I had been bothered by running into three people who had very serious heart disease despite being very devoted to Dr. Esleston's diet. I am just not aware of any diet that prevents 100% of heart disease in 100% of people. Despite the bold claims made by the promoters of the diet, — coronary artery disease is the leading killer of women and men in Western civilization. And yet the truth be known, it is nothing more than a toothless paper tiger that need never exist. And if it does exist, it need never ever progress. — Like most people, I thought of nuts as snacks, maybe have a small handful of them once a day. For example, I joined my family for a cruise despite my misgivings about the environmental impact. And the cruise had a huge buffet. For breakfast, there was a small dish of peacons to use as toppings for oatmeal along with raisins, but I never saw nuts for any other meal. It took Walter Willlet, the most cited scientist in the world, still working hard at 80 and a huge force in large-scale epidemiology, to convince me that we should think of nuts as a key component of meals, not just snacks. Here's what he said recently on Simon Hills podcast. That was a great interview, and I will link it in the description. At least I grew up thinking of nuts as just a snack, but it actually I think could be the center of a meal many times. And so I probably have nuts three times a day that I'll have it with my oats in the morning and some fruit and some yogurt whereas I grew up having some bacon or something like that. It's so interesting that when people order salad here at a restaurant, it almost always has cheese in it. And that's actually been heavily promoted by the USDA. And it's not just usually a little bit of cheese. It's a lot of cheese. But whenever you see cheese, think nuts. Right at the top of the list, as I mentioned, nuts come in. When we look at almost every outcome, nuts are really right at the top. Walter is a driving force for the famously giant Harvard studies. They went further than just studying heart attack risk, which the Adventist study was focused on. Harvard was also able to report on nuts versus longevity, which they were able to do because their studies were so long-term over 30 years. So, they collected a lot of deaths. They produced this chart 10 years ago, attributing the type of fat and nuts to dramatic improvements in lifespan. What they're saying in this chart is if you were to reduce your consumption of carbohydrates by just 5% of your daily calories and replace those calories with red meat, butter, or cheese, your risk of dying would go up by 8%. If you replaced them with sources of monossaturated fat like olive oil, almonds, avocados, or pumpkin seeds, your risk would go down 10%. But if you did it for sources of polyunsaturated fat like walnuts, salmon, or sunflower seed oil, your risk of dying would drop by over 25%. It's astonishing. I know some of you just screamed when you saw seed oils on this chart. I did too when I first saw it 10 years ago. Stick with me. We'll get to that. But I had a different bone to pick about this chart and I was in Walter's home last month. So I got frisky with him because he's one of the creators of it. So, this is the one bone I have to pick with you when you say that because you use the word carbohydrate and I never know what you mean by that word because it implies white flour, — right? — Can you clarify what you mean when you say carbohydrate because you show that amazing chart. I'm sorry I didn't bring it. — And he was exceptionally gracious about my obviously snotty attitude. — Right. Well, keep picking that bone because you're exactly right. We spend a lot of time really shifting the emphasis from total fat to the type of fat. And actually, I think almost equally important, we've done the same with carbohydrate. — About the time this chart came out, they had actually published a really good paper about the difference between refined grains and saturated fat versus whole grains and saturated fat. Here's the key chart. It shows that trans fat is probably worse than saturated fat. Monossaturated fats are definitely better than saturated fat. The only question is by how much. Polyunsaturated fats are clearly even better than that.

Refined grains appear pretty much neutral compared to saturated fat. Whole grains, however, are pretty much better than saturated fat. So the answer is the carbohydrates that they list in this chart represents the average of what the nurses and health professionals in their study eat both refined and whole. But the association between nuts and seeds and oils on this chart caused a raging battle between my intuition and the data. My intuition was also raging. But they're processed. There's sometimes chemicals involved and heat. They're stripped of protein and fiber. they just can't be that healthy. Those are the kind of findings that shake the faith in nutrition science among people who don't have an epidemiology background, including many social media doctors. Just search social media and you'll get a faceful of this. Could the seed oils be the primary cause of the diseases of civilization? heart disease, hypertension, stroke, cancers, type two diabetes, metabolic syndrome, obesity, Alzheimer's disease, macular degeneration. The list goes on and on. This is exactly the hypothesis that I will present and defend today because I believe in it. — Dr. Kenobi is probably a very skilled eye surgeon, but that is miles away from being a scientific researcher or epidemiologist. You also wouldn't ask him to operate on your liver, even if he had been surfing the internet for 2 years to see what people are saying about how to do it. And that is much closer to his expertise than epidemiology is. I was involved in environmental epidemiology related to the water testing my company was doing. I have seen this movie. Epidemiology was showing that POS forever chemicals were toxic in concentrations of four parts per trillion. That's one drop of water in 250 Olympic size swimming pools. No, that feels impossible. POS chemicals are related to Teflon, which should be inert. That concentration is insanely low. And yet, the epidemiology proved correct yet again and everyone's intuition wrong. I am very familiar with POS epidemiology and those studies are not nearly as large or as long-term and they have much less lifestyle data than Harvard nutrition studies have. Walter has some things to say about seeds. So, at least in America, everybody's insanely gripped by seed oils, you know, being so bad for you and everything. It's not intuitive to me that those oils are healthy. Why are they so healthy? There have been countless studies going back to Ansel Keys studies back in the 1950s and60s showing that — I love those studies — right that well controlled randomized trials polyunsaturated fat reduces LDL cholesterol especially if it's replacing saturated fat you can't account for all of that benefit with just uh the change in LDL cholesterol that they also come with a lot of minor constituents basically have to go back to seeds which are So interesting. They're little packages that contain a living organism there, the embryionic plant. These seeds are designed to protect that living tissue. Uh first of all, you seal it off with lipid so oxygen can't get at it so well. And then you put lots of antioxidants and protective things that protect the tissue in there. So these oils are loaded with other minor constituents. So, seed oils are healthy. — Yes. If you look all over the internet, the belief is that they're pro-inflammatory. And there's really no evidence for that. And there's a massive body of evidence saying that seed oils are not pro-inflammatory. There are, I think, about 20 now randomized trials showing no increase in inflammatory factors in the blood. So, I finally gave into the data. I started eating bitchin sauce whose first ingredient is sunflower seed oil and second is almonds. I never thought I would eat anything like that in my life. It's really yummy, by the way. And no, I'm not sponsored. I mentioned at the beginning of the episode that I wasn't 100% sure why my numbers have dropped so dramatically over the last four years. And that is because maybe a year before I gave into the oils and the nuts, I gave into statins and started to take 40 milligs of a tovastatin on the daily. Statin seemed to reduce my LDL maybe 30% down to 100ish, but didn't move my triglycerides much. But it looks to me like it could have been a double whammy because when I eased way up on the oils and the nuts and I cut back on potatoes because Harvard has been saying they're like a refined carbohydrate, I saw numbers like I'm seeing now. So why did it take me so long to come to this?

After all, we have very wellrun many randomized control trials showing that polyunsaturated fats lower LDL. There are equations which I'll link in the description which let you calculate by how much. I think the answer is despite how much I wanted to believe that I follow the science, my intuition that nuts were just a fattening snack and oils were a refined food overpowered my ability to follow the science. Chris, what is wrong with you? You know, data is often not intuitive, yet it almost always trumps intuition. You say you have a decent background in epidemiology. It doesn't sound like it. — And that had me doing things I wasn't even aware I was doing, like the following. This is how I have repeatedly represented Austria's dietary guidelines, but in fact, they look like this. I wasn't even conscious I was removing oils from their guidelines. I guess I was thinking some people will watch this on a small screen. Better zoom in to the essentials. And that brings up something I think is absolutely critical. I think anyone dishing out nutritional advice should have at least a basic understanding of epidemiology. I would not have arrived at these blood test numbers without it. I think the greatest tragedy of America's health is simply that unlike healthy countries, we have allowed propheteers with no knowledge of epidemiology, instead of actual nutrition scientists who at least know the basics to misinform us on a grand scale with conflicting science denying advice. For example, two of the most popular propheteers are chiropractors selling supplements who are not involved in nutrition research but are acting as nutrition experts. Now, there's one last point I want to bring up doing a major deep dive into DNA and I've been looking at quite a few reports and out of all the things that show up as a common denominator, it's these polyunsaturated fatty acids. Okay? It keeps showing up as an alteration in our genes. Quite a few reports say seed oils are altering our genes. That sounds like a big story. Which reports? He's got 14 million subscribers, so surely he should say or list them in the description, but he didn't. But if you do want to mess with your jeans, Dr. Berg sells a polyunsaturated seed oil in his store. It's just $5 an ounce, but the benchmark price for premium extra virgin olive oil is around $1 per ounce. — And the number one misconception is that polyunsaturated fatty acids are healthy. — Dr. Eberg also sells a polyunsaturated fat-rich seed oil in his store, conveniently packaged in soft gels. That convenience makes the price $28 an ounce. Some doctors send me emails and say they cry inside when their patients believe some influencer who says seed oils alter their DNA. One sent us this hilarious skit from Studio C to try and laugh through the tears. I can only play very short clips without getting into copyright trouble, but I'll link it in the description. The setting is a man having a heart attack on a plane and a qualified physician responds to a flight attendant's request to help. But a chiropractor jumps in to help and hilarity ensues. — I'm also a doctor. Great chiropractor. — Unfortunately, the situation is just as bad in the American book market. There are at least 10 notable longevity books, but guess which one went viral? The one by a doctor who slams nutrition science and says nutrition guidelines are a joke. but he recommends you buy the ultrarocessed protein bar he designed and the processed red meat loaded with sodium from the company he funded. He's got a lot of brand deals. I know it's super popular in America to think nutrition scientists got it wrong and that's why Americans are so fat and sick. This book throws gasoline on that fire. For example, Peter writes that recent studies show no association between saturated fat and mortality. That is the opposite of the dramatic chart I showed earlier. So, who should an everyday American trust? A best-selling doctor who speaks with great confidence on Oprah or scientists whose name they don't recognize? The numbers show most people are picking the wellspoken doctor on Oprah. And this is where knowing just a little bit of simple to understand epidemiology makes all the difference. One paper Peter chose to make his point about saturated fat was called total dietary fat intake, fat quality, and health outcomes, a

scoping review of systematic reviews. To a consumer or even a doctor with no background in epidemiology, which very few doctors have, this looks like an awesome paper. It's a review of 59 systematic reviews and each systematic review has a whole bunch of papers in that review. That sounds so impressive. So many papers to compare to each other. But if you have even a wee knowledge of epidemiology, alarms go off and red flags pop up everywhere. For one thing, systematic reviews only require a laptop and internet connection. Industries whose profits are threatened by honest science love systematic reviews because they're cheap, quick to do, and they don't require many people to perform them. And they have a trick to play, which I'll get to. That was me pretending to be a magician. I need a rabbit out of a hat or something. There are a lot of journals published by companies like MDPI whose business models are all about a high volume of papers. They have low acceptance criteria, quick turnaround, and very light peer review. You can flood the zone with systematic reviews. That's why editors of MDPI quit and mass in 2018 because they were under pressure to accept lowquality studies. I don't even know how you do a peer review of a review of 59 reviews, each having a whole bunch of papers, many of them lowquality, from publishers like MDPI. nightmare. Compare that to primary research like Walter is doing where you actually do science, not just surf pubmed. We've collected blood samples, urine samples, toenail samples, and we've collected many of these uh samples repeatedly over time. — The number cataloged here is in the millions. Since 1976, more than 280,000 nurses of different ages, and backgrounds donating their own biological specimens, then recording detailed information about their health, lifestyle, and medications for researchers like Dr. Walter Willlet. We have dozens of big nitrogen freezers that almost as tall as I am loaded with thousands of samples and that takes actually about $300,000 a year just to provide the liquid nitrogen to keep those samples cold. It's funded by the National Institutes of Health, not the food or pharma industries. Quality studies like that get published in top journals like Nature where it's a long process with very deep peer review. I don't know if Peter read the paper he referenced. It's behind a payw wall, but the systematic reviews they collected were designed around a mindblowing number of conditions. He was seeking an answer to saturated fat and heart disease, but most of these studies were designed to look at cancers and many of them were focused on other fats like omega-3s, dietary cholesterol, etc., not unsaturated fat. It's like wanting to know what makes a great NFL player. wide open and a flick into the END ZONE BY JEROME SIMPSON. OH GOODNESS. — Is it size, speed? To find out, you decide to take a broad look at sports science. So you mash together 59 studies of sprinters, basketball players, marathoners, ice skaters, football players, etc. And at the end, you conclude the science isn't clear. Studies conflict because some of the top athletes don't have explosive speed. and they aren't very big. Walter is co-author of a paper about how bad these papers can be. It's an easy read, just two pages, and I'll link it in the description. Psychologists have used more colorful language than Walter about these studies. Hans Eiseneck famously wrote a paper calling one an exercise in mega silliness, comparing apples to oranges. The statistician Jean Glass, who coined the term metaanalysis, which is closely related to systematic reviews, defends them if they're done well. He famously claims you can even compare apples to elephants. My bottom line is they're like soccer games, easy to organize. They're everywhere in your neighborhood. But if you want to see great soccer, watch the World Cup. There are way fewer of those games, but the players are 100 times better. Important. And it's simple. Peter quoted the paper as concluding mainly no association of the amount of saturated fat with chronic diseases. So how in the world were Harvard's results completely different? The answer is very simple. It's that slight of hand thing. The golden rule of nutrition science is if you reduce calories from one thing, you have to know exactly what you're replacing them with. We all know one reason the low-fat craze of the 80s failed. When you ask

Americans to cut back on saturated fat, they replace those calories with white flour and sugar. — Excuse me. Do you make these delicious fat-free snack double food cookies? — Why, yes, I do. — You want to tell us why we can't find them in the stores anymore? — What is this? — You got some explaining to do, Cookie Man? — Yeah, a little more popular than we expected. Yeah, — this guy's quick. — We're making more as fast as we can. — Oh, you're breaking my heart. — Hey, I just make the cookies. You want the big boys upstairs? The makers of fat-free snackwells devil's food cookies apologize for the short supply. — Harvard showed white flour and sugar is about as bad as saturated fat. There is a critically important quote from the big systematic review Peter referenced but did not include in his book. Substitution analyses indicate that saturated fat replacement with polyunsaturated fat and/or monounsaturated fat improves cholesterol and blood sugar across bodies of evidence from randomized control trials. Overall current recommendations to replace saturated fat with monounsaturated fat and polyunsaturated fat and avoid the consumption of industrial trans fats seems reasonable. So, when you see a study claiming that reducing the total amount of saturated fat does not change health outcomes, it's a pretty solid bet that they haven't carefully replaced it with something healthy. That's the trick, and that's the reason the beef industry or one of their front groups loves to fund those kinds of studies. You may ask, what does total mortality actually mean on the Harvard charts? That is a great question. Not every review paper is weak, and this is a strong one. Why do I think so? Because I recognize most of the authors and the work they do is solid. Just like you probably recognize Tom Hanks and Meil Stre and think their acting is solid. That's not an appeal to authority, but to talent. — You're Sully Zelenburgger. — This paper had a fascinating chart. Just like Harvard's chart, this one is all about what happens if you reduce your calories of saturated fat by just 5% and replace those calories with another fat. That's monossaturated fat, meaning nuts or olive oil. That's polyunsaturated, meaning salmon or an oil like canola. And that's trans fats. Credit to Walter and epidemiology for uncovering how harmful trans fats are. The bottom scale is hazard ratio. That means the rate at which people die. 1. 0 represents the zero effect line. For respiratory disease, people who reduce saturated fat and replace it with monossaturated die at half the rate. That is absolutely bonkers. I would never have believed that if we didn't have lots of other primary research to back that up. Moving up to neurodeenerative diseases. They also have a big effect size, just not as crazy big. The impact on cancer deaths was much lower, but it was still a mildly positive move away from saturated fat. I was surprised to see that for cardiovascular disease, this paper did not report a large effect for monossaturated fats, and the bar representing uncertainty was fairly broad, but the effect was big for polyunsaturated fats. What had very little uncertainty, however, was total mortality. their numbers fell right in line with Harvard's. I mentioned that there are a lot of great longevity books. Here are 10 that I think are among the best. Two of them were written by winners of the Nobel Prize. There is no controversy among them about the enormous effect of substituting healthy calories for saturated fat. Eric Toppel put the Harvard graph in his book. So if the effect on mortality is that huge, why would the most popular longevity book be silent about it? In my years in tech, we had a saying, engineers are not very good at science and scientists engineering. But if they work together, they can put a man on the moon or build an AI. I think tragically the same is true between doctors and epidemiologists. Doctors like Peter are hopeless with epidemiology and epidemiologists can't even begin to doctor. But big long-term studies get them working together. Also, tragically, I laugh through the tears as I think adding an epidemiologist as co-author of Peter's book would wreck sales. And that's because I have never heard one of them say, "Saturated fat is back, baby. Eat butter. " No. They put on their thick glasses. They look at the data and they say, "Well, it looks like nuts are really healthy and maybe you should eat some salmon. " By the way, in his own life, Peter is not concerned about saturated fat. — I don't go out of my way to eat saturated fat, but I'm also not like restricting it either. I would say I probably am in line with sort of where

the average person is, but he also takes a cocktail of three cholesterol-lowering drugs. But what about my fear that nuts were going to make me fat? I did gain a few pounds over the last few years. Was it the nuts? There were some great papers over the last few years that also defied my intuition. And I'll let Walter explain. — What do we understand about nuts and body weight? — As the studies came out and the epidemiologic studies, nuts did not uh were not related to more weight gain. If anything, less weight gain. And then there were short-term studies looking at satiety and those showed that nuts were had really strong effects inducing satiety that was more durable. But again, do have to be reasonable about everything and you can't overdo that. A couple of years ago, my cardiologist told me in no uncertain terms that I needed to cut way back on my extreme exercise habits because of having rheumatic fever as a child, also a congenital abnormality in my heart, and because extreme endurance exercise increases the risk of aphib. I made an episode about that. I think it's more likely that the pounds I've gained came from not getting to eat as much now that I don't burn off as many calories. But my body composition was just measured at 6. 8% fat, which seems decent for a 72-year-old who has been persuaded to do less exercise. I hired a trainer who is mean, so perhaps he's restoring a little bit of the muscle mass I had before I got into endurance events. That body composition scan came from a day four of us spent at a company called Human Longevity, Inc. Are you nervous about what they're going to find? — I am nervous. Oh, — I had my cameras rolling as we did full body MRI scans, CT scans, getting our DNA sequenced, you name it. Once our DNA is fully sequenced, we'll publish an episode about what we found. We'll be very transparent about our results, even some concerning ones. On the good news front, my liver fat was just 2. 7%. So, the oils and nuts don't seem to be giving me visceral fat. Check to make sure you're subscribed if you're interested in that episode. And finally, the people who initially discovered that nuts were so healthy have continued to study them and they discovered that a contributing reason for their health is the quality of proteins they bring. We made an episode with Valter Longo about that. Something simple I learned in my time in environmental epidemiology is good scientists rarely use emotionally charged culture war language like politicians do. If you ever do see a scientist cross over and use culture war language, it's a good bet they're selling something. — A government issues a mandate telling its people what to eat and boy they got it wrong. — Government issues a mandate on what you can eat. That is some culture war language. But if you have a side hustle to sell highly refined liquid calories to replace whole food meals like cell biologist Ben Bickman has, you better go full culture war to jin up social media views to discredit every dietary guideline in the world because they all encourage but don't mandate real whole food and at least some type of oil. And that in my opinion is the tragedy of America's health. As every author and film director knows, you can't get attention without emotion and conflict. Since epidemiologists never go there, they get no attention. But if you are willing to use emotionally charged language, as Peter and Ben Bickman do, you can get big rich. The winning message is science got it wrong, but I can make you healthy if you just pay up for what I'm selling. His stark diagnosis and advice on what to do about it have attracted millions of followers and billionaire patients who pay hundreds of thousands of dollars to hear the words, "Dr. Aia will see you