Heart Disease: An Overview Of Modern Research, Holistic Approaches, And Controversies

I understand that you already spoke about the heart disease.

What I would like to talk about today is modern research, holistic approaches, and controversies that are in scope for my holistic nutrition practice. To prepare, I had read and summarized quite a significant amount of research papers, about 80 of the most interesting are referenced in the Appendix. You can get your reading done as well!  So, without further due, let’s talk about heart disease.


Despite all the good and useful information today, I encourage you to see your doctors.  


In terms of agenda, we will talk about what heart disease is, holistic measures of prevention and treatment, and modern controversies. 

What is the #1 killer disease in the westernized world?

It is coronary artery disease, or CAD. And is a member of the Cardio-vascular disease group.

Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood vessels. It is also called heart disease. Heart disease includes numerous problems, many of which are related to a process called atherosclerosis.

Researchers confirmed the following risk factors for cardiovascular disease:

  • High Cholesterol
  • High Blood Pressure
  • Diabetes
    • Over time, high blood sugar from diabetes damages blood vessels in the heart and blocks blood vessels leading to the brain, causing high blood pressure leading to a stroke. More than 2 in 3 people with diabetes have high blood pressure.
  • Smoking and Second-hand Smoke Exposure cause the following damage:
    • Raising triglycerides in the blood and lowering high-density HDL cholesterol, also called “good” cholesterol; 
    • Making blood sticky and more likely to clot, which can block blood flow to the heart and brain; 
    • Damaging cells that line the blood vessels; 
    • Increasing the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels.)
  • Obesity, Unhealthy Diet, and Physical Inactivity

There are four main types of CVD:

  • coronary heart disease that occurs when heart muscle’s blood supply is blocked or interrupted by a build-up of fatty substances (atheroma, or plaque) in the coronary arteries.

When atherosclerosis affects the coronary arteries, which are the major blood vessels that carry blood to the heart muscle, it’s called coronary artery disease. That’s the No. 1 killer in Western world. Most of those deaths are from heart attacks caused by blood clots.

Restricted blood supply to your heart muscle can cause angina [an·jai·nuh] (chest pains). But sometimes heart disease may be “silent” and not diagnosed until a person experiences signs or symptoms of a heart attack, heart failure, or an arrhythmia. When these events happen, symptoms may include:

Heart attack: Chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, and shortness of breath.

Arrhythmia: Fluttering feelings in the chest (palpitations).

Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins.

  • stroke occurs when the blood supply to the brain is disturbed.

The main stroke symptoms can be remembered with the word FAST 

Face – the face may have drooped on one side, the person may not be able to smile or their mouth or eye may have drooped 

Arms – the person with suspected stroke may not be able to lift their arm and keep it raised due to weakness or numbness 

Speech – the person’s speech may be slurred or garbled, or they may not be able to talk at all despite appearing to be awake 

Time – it is time to dial 911 immediately if you see any of these signs or symptoms

  • peripheral arterial disease also known as peripheral vascular disease, occurs when there is a blockage in the arteries to your limbs (usually your legs).
  • aortic disease 

The aorta is the largest blood vessel in the body that carries blood from your heart to the rest of your body.

The most common type of aortic disease is aortic aneurysm, which is where the wall of the aorta becomes weakened and bulges outwards. 

Modern Research and Holistic Approaches

Heart Disease Risk 101

Let’s recall how the heart disease risk is calculated.

Doctors in Canada and US use the Framingham risk score. It is a traditional risk “inventory-based” scoring system that uses readily available data, such as gender, age, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, and cigarette use, to calculate the 10-year risk for cardiovascular events. It is based on the results of the Framingham Heart Study in 2008. It was validated in the US, both in men and women. When we are talking about risk reduction, we assume the risk is calculated using the Framingham risk model.

Catastrophic Event vs Prevention

As we see, a Heart disease episode may be a sudden catastrophic event that often has debilitating consequences or even results in death.


According to former chair of nutrition at Harvard, for most diseases contributing importantly to mortality in Western populations, we’ve long known that non-genetic factors often account for at least 80 to 90 percent of the risk that is preventable.

We know this because rates of the leading killers like cardiovascular diseases and major cancers vary up to 100-fold around the world. And when people migrate from low- to high-risk countries, their disease rates almost always change to that of the new environment. Risk factors I mentioned earlier account for over 70% of your risk of having a stroke or getting colon cancer, more than 80% of coronary heart disease risk, and more than 90% of risk for type 2 diabetes.   

Modern research shows that Prevention is a key. If you ignore the root causes of disease and neglect to prioritize lifestyle measures for prevention, your life is in danger. Unfortunately, even preventive strategies are now heavily biased towards pharmacology rather than supporting improvements in diet and lifestyle!

Worldwide: Ischemic Heart Disease per 100,000 (2017)

Can we do prevention holistically, treating of the whole person, taking into account mental and social factors, rather than just the symptoms of an illness? Certainly. Here is the data from CDC regarding Ischemic [uh·skee·muhk] Heart Disease prevalence. The highest incidence of coronary disease in the most urbanized areas. Canada is actually doing worse than the USA. Eating mostly plant-based diet, India also is doing great. Equatorial Africa has the lowest incidence of Ischemic disease. Why? Most likely because of the combination of plant-based diet, lots of walking and running, and moderate food consumption. 

Is there an exit from this trap? Of course! In 1990 landmark study, Dr. Dan Ornish proved you could not just slow heart disease—our #1 killer, not just stop heart disease in its tracks, but actually reverse heart disease, open up clogged arteries—and without drugs, without surgery. Only with a combination of plant-based diet and exercise. Very simple exercise, such as walking at least 30 minutes a day. Since then, millions upon millions have died totally unnecessary deaths. 

Commenting on this, I also would like to refer to 18-years of EPIC-Oxford study following-up almost 50,000 participants. The study confirmed that fish eaters and vegetarians had 13% lesser risk of ischemic heart disease compared to meat eaters, but vegetarians had a 20% higher risk of hemorrhagic stroke. That’s probably because vegetarians tend to have low intake of vitamin B12, and this could raise homocysteine, leading to an increase in risk of stroke.

Reduction of Risk

We used to think that heart disease was just an inevitable consequence of aging, or that cholesterol and blood pressure just naturally go up as we age, or many people have heart attacks with no risk factors; and not much you can do about it.

All these are now disproved by massive data.   

There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people (I have a friend like this, he’s a nutritionist himself!). This means that most persons with atherosclerosis acquire it by what they put in their mouth.

The INTERHEART study showed that for men and women, old and young, and in all areas of the world, potentially modifiable factors like diet, exercise, and smoking, accounted for 90 to 92% drop in risk of having a heart attack, and for 80% diabetes and stroke risk reduction.

What about drugs? Pharmacological therapies, including cholesterol-lowering statin drugs and blood pressure pills, typically only reduce cardiovascular disease risk only by 20% to 30%. So, even on drugs, 70% to 80% of heart attacks still occur.

The Harvard Health Professionals Follow-Up study looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol- and blood pressure-lowering drugs may be able to get a further 78% drop in risk by eating and living healthfully. So, the choice isn’t diet or drugs, but by scientific findings, cardiovascular medications should be used as an adjunct to, not just a replacement for, healthy lifestyle practices.

Cholesterol & Heart Disease

So why does medication drop risk just by 30%? Let’s try to understand.

Coronary atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before a catastrophic event.  Over a hundred prospective studies involving more than a million people have demonstrated that those with higher LDL levels are at higher risk for our #1 killer.

However, the average age in starting a cholesterol-lowering drug and conducting trials, is 63, for people exposed to a lifetime of circulating LDL-[cholesterol]. So, no wonder that trials show that drugs taken for a small period of life reduce risk by [only] 20% to 30%.

A study looked at young men, aged 18 through 39, and followed them for up to 34 years. Their cholesterol levels in a young age predicted long-term risk of heart disease and death. Men in their 20s and 30s who have a total cholesterol even just under 200, have a “substantially longer estimated life expectancy”—around 4 to 9 years longer—than those over 240.

In terms of feasibility of treatment with satins, a study was considered unethical—just like you couldn’t ethically set up a study in which half the kids are made to start smoking, to see if smoking really does cause lung cancer. 

But you can conduct an observational study and follow people with rare genetic mutations that result in unusually high cholesterol or unusually low cholesterol—providing you can segregate confounding diet and lifestyle factors.

About 1 in 40 African Americans have a mutation that drops their LDL cholesterol even from about normal 130 down. The study group didn’t eat healthy for starters and still ended up with low coronary heart disease risk. It’s just in their genes. More than half had high blood pressure; there were lots of smokers and diabetics, yet those with genetically low LDL levels still had a “significant reduction in the incidence of [coronary heart disease]…even in the presence of [all these other] risk factors, like about 88% of heart disease gone.

The astonishing finding was that the heart disease risk in these individuals was reduced by more than 80%; whereas, the same 20- to 40-point decrease in LDL from drugs only reduces risk like 30%. It makes perfect sense, as the guys with the mutation had low levels during their whole lives; they didn’t just start taking some pill when they were 60 years old.

Therefore, a primary prevention strategy is to promote keeping LDL-cholesterol levels as low as possible, beginning as early in life as possible, and sustaining those low levels of LDL-cholesterol throughout the whole lifetime. And, that’s just what a healthy diet can do.

Canada Food Guide

Elevated LDL cholesterol levels are also caused by the lack of consumption of fiber, found in all whole plant foods. Since we evolved to eat enormous quantities of fiber, when we don’t, our LDL ends up much higher than it’s supposed to be.

Since all plants have fiber, and all animals have saturated fat and cholesterol, in general, all whole plant foods tend to lower our risk of dying from our #1 killer, and all whole animal foods tend to raise our risk, and that’s where Canada Food Guide recommendations stem from. 

There are, however, processed plant foods that do raise cholesterol: hydrogenated vegetable oil, for example—and animal foods that don’t: skim milk and egg whites.

In animal models, animal proteins alone increase cholesterol, but in people, it’s more the animal fat and cholesterol. Or at least in adults. There was a study of one- to three-year-olds that found that replacing the milk protein by the wheat protein dramatically lowered cholesterol, and then when they went back to milk protein, it rose back up again.

Mediterranean diet

Actually, Canada Food Guide Recommendations seem very much like the Mediterranean diet. It is a primarily plant-based eating plan that includes daily intake of whole grains, olive oil, fruits, vegetables, beans and other legumes, nuts, herbs, and spices. Other foods like animal proteins are eaten in smaller quantities, with the preferred animal protein being fish and seafood. Although the pyramid shape suggests the proportion of foods to eat (e.g., eat more fruits and vegetables and less dairy foods), it does not specify portion sizes or specific amounts depending on physical activity and body size. 

This eating plan features:

  • An emphasis on healthy fats. Olive oil is recommended as the primary added fat, replacing other oils and fats (butter, margarine). Other foods naturally containing healthful fats are highlighted, such as avocados, nuts, and oily fish like salmon and sardines. Among these, walnuts and fish are high in omega-3 fatty acids.
  • Choosing fish as the preferred animal protein at least twice weekly, and other animal proteins like poultry, eggs, and dairy (cheese or yogurt) in smaller portions either daily or a few times a week. Red meat is limited to a few times per month.
  • Choosing water as the main daily beverage
  • Stressing daily physical activity through enjoyable activities.

This year alone, there were more than 17,000 papers published about Mediterranean diet. 70 papers a day! So, Where did it come from? Why is it good?

After World War II, the government of Greece asked the Rockefeller Foundation to come in and assess the situation. Impressed by the low rates of heart disease in Greece, nutrition scientist Ancel Keys, after whom K-rations were named, initiated his famous 7 Countries Study, in which he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. 

So, the heart of the Mediterranean diet is mainly vegetarian, much lower in meat and dairy–which Keys considered the major culprits in the diet because of their saturated fat content.

Unfortunately, no one is really eating the traditional Mediterranean diet anymore–even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods.

Mediterranean diet strengths

Why it is protective? Some studies show that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients and Magnesium found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains are all associated with a significantly lower risk of dying. 

Mediterranean diet is low on Heme iron found in blood and muscle– that acts as a pro-oxidant and appears to increase the risk of coronary heart disease, whereas plant-based, non-heme iron appeared safe

Further on, I would address benefits of some foods and nutrients, but first let’s have a glance at how your daily food may look. I think it is good!

Which nutrients give strength to Mediterranean diet?


First, let’s talk about magnesium. High blood levels of magnesium were associated “with an almost 40% reduced risk” of sudden cardiac death.

Magnesium is a mineral that plays an essential cofactor role in over 300 enzymatic reactions in the body. It’s also 4th most common mineral in the body. However, around 2 in 3 people in the western world don’t get the recommended for optimal health daily amount of magnesium.

Magnesium is contained in whole grains, leafy green vegetables, legumes—meaning beans, peas, lentils and soy—and nuts [as well as seeds], major components of Mediterranean diet. A considerable body of evidence indicates that a higher intake of dietary magnesium may favorably affect metabolic and inflammatory disorders”, including many of our top killers, like diabetes and heart disease.

There have been 2 studies prospectively examining Magnesium supplementation, Harvard Nurses’ Study, published in 2011 and “The Atherosclerosis Risk in Communities” in 2010, covering a multiethnic population of thousands of men and women taking magnesium pill. 

The magnesium requirement to reduce cardiovascular risks is 420 mg/day for adult men and 320 mg/day for adult women, which is contained in about 2 ½  cups of cooked spinach (1 cup is 160 mg of Magnesium). Unfortunately, the average person consumes only about 0.1 cups of greens a day.

Magnesium supplementation is a good thing, and the best to protect your heart are  Magnesium taurate and glycinate. Glycinate, diglycinate, and bis-glycinate are actually the same magnesium atom bonded to two glycine molecules and are good to protect your heart. 


Garlic, Hippocrates wrote, was a medicinal food, but that was to treat a nonexistent entity called “displacement of the womb.” So, was he wrong?

Those who eat more than a clove a day do seem to have better artery function than those who eat less. 

Heart disease patients were randomized to receive either garlic powder or placebo tablets twice daily for three months. And, those in the garlic group got a significant boost in their artery function: a 50 % increase taking only 800 mg of garlic powder a day. That’s just a quarter-teaspoon of garlic powder; less than a penny a day!

Fancy Garlic extract supplements do not exert this kind of power though.  

Dozens of studies on garlic also show that garlic can reduce cholesterol levels by more than 16 points measured in mg/dL (twice as much measured in mmol/L in Canada). In a randomized control trial, the progression of the cardio-vascular disease appeared to slow and stall with the garlic pill. A quarter-teaspoon of a simple spice available everywhere may be considered as an adjunct treatment for atherosclerosis, the number one killer.

Also, a systematic review and meta-analysis of randomized controlled trials demonstrated garlic has “a statistically significant and clinically meaningful effect” on both systolic and diastolic blood pressure, reducing the top number by nearly 7 and the bottom number by about 5. That may not sound like a lot, but reducing diastolic blood pressure—the bottom number—by 5 points can reduce the risk of stroke by about a third, and heart disease by 25 percent.

Blueberries and cardiovascular health

Blueberries were shown to help control bad cholesterol, blood pressure, blood sugars, body weight, diabetes, and inflammation in more than 20 randomized, controlled trials on a 1,000 people. That happens because of their brightly colored pigments, called anthocyanins.

In some recent studies of berries, it was shown that an increased intake is significantly associated with a reduction in risk of coronary heart disease by between 12 and 32%.

That lower range is from studies of older individuals, and the greater reduction of risk was noted in younger populations. So, the earlier we start eating berries, the better? Even blueberry tea can lower cholesterol  in kids genetically predisposed to high cholesterol. 30% drop from powdered blueberries in a tea bag dipped in hot water for five minutes. Comparable to statin! But effect is not permanent. In a study, it took 3 months for the tea to start having a significant effect, and then, of course, 6 months after they stopped drinking the tea, they were back to where they started.

For every 15 mg increase of anthocyanins a day, scientists found a 17 percent drop in risk. 100 mg a day reduce the cardio-vascular risk almost 100%, and this is less than a half-cup of blueberries.

Even fatty, sweet blueberry muffins give some boost in artery function. 

A randomized, controlled trial of cooked blueberries, raw blueberries, or no blueberries at all was conducted. If you feed people buns made out of white flour, eggs, butter, and salt, you get a gradual drop in artery function over the next 6 hours. But add the equivalent of a cup of wild blueberries to that same bun, and instead, you get a big boost in artery function––almost as if you had just mixed the blueberries with water. In comparison, about the same amount of strawberries failed to rescue artery function from the likes of two cheese pancakes, with whipped cream, a sugary syrup, egg, and bacon. But that is quite the heavy load to bear. And rather than relying on blueberry magic, maybe it’s safer to avoid this type of meal altogether?

From this slide, you can compare anthocyanins content in different berries.


If you ask advice from doctor Google, almost everything seems “beneficial” for heart disease. And any medication carries a heavy load of side effects. But is it really so?

Absolute vs Relative risk reduction

Let’s first consider relative vs absolute risk reduction. Say, the risk of a certain event is 5%, and lifestyle changes and behaviours reduce it to 4%. The absolute risk reduction is 1%, almost statistically negligible, but the relative risk reduction is a 20%. That can be used to visibly inflate the benefits.


Based on the metanalysis of a bunch of statin trials, it looks like the relative risk reduction with statins is 25%. For simplicity, let’s consider these events independent; then with can multiple probabilities.

For those at average risk, say about 10%, let’s consider a statin over the next 10 years. Of 100 people, 10 may have a heart attack doing nothing. If all 100 took a statin every day for those 10 years though, 8 would still have a heart attack, but 2 (or 2.5, to be precise) will have been spared, so there’s like a 1 in 40 (2.5/100) chance taking the drug would help you avert a heart attack over the next decade. 

And if your personal 10-year risk of a heart attack or stroke is 5 percent, then taking a statin could take that down from 5 percent to 3.75 percent, for an absolute risk reduction of 1.25 percent, meaning there’s like a 1 in 80 chance that you would avoid a heart attack or stroke taking the drug over the next 10 years. But if your baseline risk gets higher and higher, even though you have that same 25 percent risk reduction, your absolute risk reduction gets bigger and bigger. 

In case of a high, 20 percent baseline risk, you have a 1 in 20 chance of avoiding a heart attack or stroke over the subsequent decade if you take the drug, as 0.25 multiplied by 20 is 5; 5 to 100 is 1 to 20.

And a spilled benefit of Statin therapy also that it had shown some promise for fighting viral infections!

The downsides are some gastrointestinal side effects, muscle aching and stiffness in maybe 5 percent, reversible liver inflammation in 2 percent, and very rarely, life-threatening muscle damage called rhabdomyolysis (rab-doe-my-OL-ih-sis). Rhabdomyolysis can cause extreme muscle pain, liver damage, kidney failure and death. But the risk of very serious side effects is extremely low perhaps 1 in 20,000 patients.

There were also some studies showing increases in breast cancer rate from 0.3% to 4.1% (1260%) but that appears to be a fluke.  

Vitamin D

Scientists assumed that a possible reason for lower coronary disease incidents in some areas is sun exposure and resulting abundance of vitamin D in the body. 

But when vitamin D supplements are actually put to the test in randomized controlled trials, they often fail to support a direct vitamin D benefit for cardiovascular disease (like heart attacks and strokes). Maybe higher levels of vitamin D are just in People who exercise outside?

There were more than 20 randomized controlled trials to put vitamin D for heart disease… They found no benefit for heart attacks, strokes, or overall mortality. 

Actually, maybe low vitamin D levels are a result of cardiovascular disease, rather than the cause. If you have chest pain, you’re probably not out in the sun running around. The good news, of course, is that heart disease is preventable, is reversible, but requires a significant cleaning up of your diet.

Vitamin K

Vitamin K… its name stands for coagulation in German, that is the fundamental role vitamin K plays in helping the blood to clot. 

There are actually several forms of vitamin K. The most important are phylloquinone (K1) and menaquinones (K2). The difference is in absorption rates, tissue distribution, and bioavailability. 

Vitamin K1 is present in leafy greens and fruits, and its absorption is increased by oils. In human body, the most concentration of K1 is in liver. K2 is present in fermented food, meat, and dairy produce and distributed all over the body, except liver. In terms of absorption, vitamin K2 has a longer half-life in the circulation and absorption rate than vitamin K1.

Researchers studied vitamin K supplementation for the prevention of cardiovascular disease, because there is a vitamin K-activated protein in the blood that binds up excess calcium, and helps prevent calcium from being deposited into the walls of your arteries and stiffening them. So, if you give people extra vitamin K, will that protect people’s arteries from calcification? 

Unfortunately, Vitamin K supplementation did not improve vascular stiffness or other measures of artery health. In fact, one study on patients with diabetes found that calcification tended to increase after supplementation with a type of vitamin K found in a fermented soy food called natto.

Iron supplements

Iron is a double-edged sword. If we don’t absorb enough, we risk anemia. But if we absorb too much, we may be increasing our risk of colorectal cancer, heart disease, infection, neurodegenerative disorders, and inflammatory conditions. Other conditions that have been associated with high iron intake include Alzheimer’s, Parkinson’s, arthritis, and diabetes.

Not all iron is created equally. Heme [h-ei-m] iron is the type of iron found in blood and muscle, in animal foods like red meats, fish, and poultry. It has superior absorption rates. Heme iron gets its name from the heme protein attached to a lone iron atom. The “heme” in the blood protein hemoglobin refers to this protein-bound form of iron.

Nonheme iron is iron found in plant foods like green leafy vegetables, beans, and nuts. Nonheme iron is not combined with a heme protein, and this difference is the reason for the body’s reduced ability to absorb nonheme iron. Slower absorption allows you to eat more iron-rich plants without worrying about iron toxicity.

The detrimental effects of heme iron are thought to be because it oxidizes cholesterol with free radicals and thus can act as a pro-oxidant contributing to the development of atherosclerosis. The risk has been quantified as a 27% increase in coronary heart disease risk for every one milligram of heme iron consumed daily – and a broiled steak contains 9.2 milligrams of heme iron…

The same has been found for stroke risk. Higher heme iron (animal iron)–but not non-heme iron–was associated with an increased risk of stroke and diabetes type 2, 16% increase in risk for every daily milligram of heme iron consumed.  And the same for cancer, with up to 12% increased risk for every milligram of daily heme iron exposure.

Intermittent fasting

Intermittent fasting is a dietary approach that has become increasingly popular in recent years, a collective term for various meal timing schedules that cycle between voluntary fasting and non-fasting over a given period, at least 12 hours. There are several methods of intermittent fasting including alternate-day fasting, periodic fasting, and daily time-restricted feeding.

However, this method of eating has actually been practiced by humans for centuries in hunter-gatherer societies. Fasting was also used historically for medicinal purposes by ancient Roman, Greek, and Chinese civilizations.

Intermittent fasting results in changes to hormonal patterns and energy metabolism in the body. With prolonged fasting after a meal, the supply of glucose is reduced. To meet energy needs, the body will break down glycoGen, the form of glucose stored in the liver and skeletal muscles. The body also uses gluconeogenesis, a process in which the liver produces glucose from non-carbohydrate sources.

Improvements in blood pressure and triglycerides have been noted on intermittent fasting regimens, though this is probably due to the reduction in body fat, since the effect appears to be weight-loss dependent. Alternate-day fasting can improve artery function too, but it does depend on what you’re eating on the non-fasting day. In the study of an alternate-day diet high in saturated fat, artery function worsened, despite a 15-pound weight loss. It improved, as expected, in the lower-fat group. The decline in artery function was presumed to be because of the pro-inflammatory nature of saturated fat.

A concern has been raised about the effects of alternate-day fasting on cholesterol. After 24 hours without food, LDL cholesterol may temporarily bump up, but this is presumably just because so much fat is being released into the system by the fasting. An immediate negative effect on carbohydrate tolerance (point where you don’t gain of lose any weight)  may stem from the same phenomenon: the repeated elevations of free fat floating around in the blood stream. After a few weeks, though, LDL levels start to drop as the weight comes off. 

In the largest and longest trial of alternate-day fasting, A hundred obese men and women were randomized into one of three groups: 

2 weight loss groups; one is alternate-day modified fasting, another is continuous daily calorie restriction; 

and a control group that was instructed to maintain their regular diet, say of 2,000 calories a day. 

The calorie restriction group would have started at 1,500 a day every day, and the intermittent-restriction group would alternate between 500 calories a day and 2,500 calories a day.

With the same overall average prescribed calorie cutting in both weight-loss groups, they both lost about the same amount of weight, but, surprisingly, the cholesterol effects were different. In the continuous calorie-restriction group, the LDL dropped as expected compared to the control group as the weight dropped. But in the alternate-day modified fasting group, the LDL levels didn’t drop. At the end of the year, the LDL cholesterol in the intermittent fasting group ended up 10 percent higher than the constant calorie-restriction group despite the exact same loss of body fat. Given that LDL cholesterol is a prime causal risk factor for heart disease, this is a significant blow against alternate-day fasting. 

Are potatoes deadly?

In the U.S., potato consumption was associated with increased mortality: 65% increased risk of dying from heart disease, a 26 %  increased fatal stroke risk, a 50 % increased risk of dying from cancer, and also increased risk of dying from all causes put together. However, this all disappeared after adjustment for confounding factors. In other words, it wasn’t the potatoes at all. Potato eaters must just smoke more, or drunk more, or ate more saturated fat, or something. Once you control for all these other factors, the link between potatoes and death disappears. 

One word of caution – chill, reheat, and enjoy low-glycemic index delicious food if you like it!

Is Fish Oil a Snake oil?

Fish oil is one of the most used supplements marketed as a health cure-all, so no wonder there are multiple trials to prove it. The benefits of Fish Oil for general brain health, like cognitive function,  are proven scientifically in multiple studies, most likely due to increased blood flow to the brain. 

An extensive trial suggested that regular exercise coupled with a moderate dose of high DHA fish oil improves high-density lipoprotein (HDL) cholesterol but not the major risk factor, LDL-cholesterol, total cholesterol, or systolic or diastolic blood pressure.

As we already mentioned, a higher stroke risk in vegetarians was found in a longitudinal 18-year EPIC-Oxford study. So it would be beneficial to check if fish oil supplementation can reduce it. Unfortunately, 28 controlled trials did not find any benefit for stroke either.


That’ all I was going to talk about today. Any questions?