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Low Carb or Low Fat (really important question to me because...)

low fat esselstyn ornish carbs

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#1 Rosanna

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Posted 23 February 2018 - 06:04 PM


Hi everyone...... a brief context to all this.....I lost my dad suddenly to a heart attack some years ago, he had abundant energy, he was 64, but to everyone around him he was still contributing a lot to the community, working probably 60 hours a week and just a dynamo...This isn't just me admiring my dad, a lot of the 20 year olds he worked with used to comment on his energy.  He was known for it, people even joked that he might run into himself one day because he was so speedy.

 

So you can imagine the shock when we just suddenly lost him, very little warning (athough there were some things looking back, which I can say if people want to know).

 

Anyway, that led to me trying to find the answers to what prevents coronary heart disease.  He didn't have a lot of it, but here's what I learn't (skip this paragraph if you want to get to the main question) - people can have very little heart disease in terms of calcification in the arteries, yet still, due to inflammation, have some very unstable plaque, even if it's relatively new and sparse, if it's 'bubbling' away with white blood cells and other stuff that makes up unstable plaque, it is likely to burst open.  When it does the blood clots around it, that clot blocks the artery (not the years and years of calcification, which we once thought) and causes the heart attack.

 

So anyway, I did my best to find out how to prevent it, and the best I could see was the work of Dr Caldwell Esselstyn, a doctor who actually reversed heart disease back in the 1970's using a very strict, low fat vegan diet.

 

This was good news to me as I'd been vegan for a number of years and I decided I would go back to veganism, just with the healthy adjustments to meet the standards of Esselstyn's approach.

 

Unfortunately, for whatever reason, i struggled this time around.  I was getting a lot of heart skips (ectopic heart beats) anyway, and the extra hunger feeling brought on by the strict diet just triggered my heart to skip more.  Due to how my dad died that caused a lot of anxiety.  The doctor believed the skips were stress related, but while I understand that, i think there's a tendency to call everything stress related that doesn't have an easy medical explanation.  

 

ANYWAY.....I'm now reading that low carb diets are healthier for the heart and longevity.....and I'm skeptical because I think it's a media thing largely.  First it was all 'no fat,' and now it's all 'no carb.'  But what is compelling is this idea that whereas carbs are immediately available, fat and protein are not, and so could trigger surtuin activity.

 

I suppose both could be right, the low fat diet of Esselystyn is convincing and as far as heart disease goes maybe it can reverse and prevent the disease.....but the other argument is less about heart disease directly and more about ageing and preventing that....and so both might be healthy in their own way.

 

thoughts?  Thanks for reading, this is quite a big issue for me as I have, up to now, tended to eat a very low fat diet, my main fat source coming from salmon and egg white (and dark chocolate)



#2 Nate-2004

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Posted 23 February 2018 - 06:41 PM

I'm doing the ketogenic diet. There is a lot of news rolling around about the fact that the sugar industry paid off researchers in the latter 20th century to pin the blame on fat. A lot of the conclusions from those studies have been called into question and the quality of those studies may have been very poor. There is a lot more blame to pin on sugar and simple carbs. Since the USDA based their recommendations on these flawed studies back in the 70's, we've seen a massive surge in diabetes and heart disease and obesity.  A lot of the low fat products marketed have way too many carbs.

 

That said, high fat can have its problems too. Ketogenic is high fat. Lipid peroxidation is a real problem with fats. If you're going high fat you need to go high fiber. That means loads of walnuts, almonds, flaxseeds, leafy greens like spinach, tomatoes and blueberries. A lot of seeds out there are high in net carbs so be careful if you're wanting to stay in ketosis. Also another problem with a lot of people on keto is they get way too much protein, which is also linked to issues. Keep the protein low. You're best sticking with plant based fat sources like avocado, flaxseed, walnuts, almonds. Salmon is also fantastic for animal sources. Just include plenty of nuts to counter that peroxidation with the tocopherols they contain. I mention walnuts and almonds in particular because they have the highest in gamma and alpha tocopherol, 25mg/100g respectively. Mix them together and they're balanced.

 

I honestly don't know the answer to your question right now though, all I do know is that adding more raw, plant based foods to your diet will improve things dramatically. Smoothies are my friend.

 

Get plenty of cruciferous veggies, especially those high in glucoraphanin and myrosinase (sulforaphane) like broccoli and broccoli sprouts, or take Broccomax. Huge impacts on heart health.


Edited by Nate-2004, 23 February 2018 - 06:45 PM.

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#3 Rosanna

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Posted 23 February 2018 - 07:19 PM

Thanks Nate-2004.  I've heard a lot of the current arguments and they are very interesting but for the work of Dr Esselstyn.  He's the only doctor I know of, apart form Dr Dean Ornish, who actually demonstrated reversal of atherosclerotic plaques.  His argument is also very compelling and he remains adamant about the strict low fat approach despite the current views.

 

It looks like I'll be going back to the drawing board, and reviewing all research again before deciding.

 

Meanwhile I will continue with high doses of veggies, if there's one thing that's common to both approaches, it's to have plenty of vegetables.

 

I have a terrible chocolate addiction atm, which I've justified as it's the only 'bad' food I eat...but if sugar is that bad, then I've got to cut it out.

 

(I should add, Dr Esselstyn is against refined sugar also, but he didn't research that.......He believes complex carbs are safe)

 

 


Edited by Rosanna, 23 February 2018 - 07:21 PM.


#4 matrix83

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Posted 24 February 2018 - 12:41 AM

One of the best nutrition studies to date came out earlier this week regarding low fat vs low carb:

https://jamanetwork....0?redirect=true

You could say both were winners which is to the disappointment of the low carb crowd. But certainly, low carb has more to prove and it should become more widely accepted following this study. Interestingly, you could make a good argument that the advice given to all participants was right out of the paleo playbook but it is consistently rated as the "unhealthiest diet".   


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#5 tunt01

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Posted 24 February 2018 - 11:38 AM

If you are doing a HFD and not in ketosis, then you will probably not be activating sirtuins very much because NAD+ is destroyed in a HFD.


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#6 Rosanna

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Posted 24 February 2018 - 05:49 PM

Thanks for the references.  I just purchased a ready meal, apparently it's two portions, but everyone I know eats the whole thing because it's the size of a normal sized plate!  I just looked at the saturated fat content for one portion and it's 17 grams!  So for the whole thing it's 34 grams!!  I won't be buying that again, I have enough fat in the chocolate I eat!

 

Re the paleo approach, I thought I'd be against it, but actually what I read advocates lean meat, etc, and vegetables....

 

It seems to me if you're going to have fat, it's about getting it from the right sources, natural foods like avocados, etc, rather than from donuts.  (or chocolate, but at least I'm getting the cocoa there).

 

I'm suspecting there's a middle ground that both the anti carb and the anti fat groups are stumbling on in their research.

 

(off out to buy some vegetables to eat with HALF of this fatty meal!)


Edited by Rosanna, 24 February 2018 - 05:52 PM.


#7 mccoy

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Posted 11 March 2018 - 07:29 AM

Sorry to chime in late, but I believe here are a few points to make clear on the issue:

 

  • The vegan, very lof fat (VLF) diet proposed by Dr esseltsyn and the other vegan cardiologists (Barnard, Kahn, Ornish in part) is the only one which has been shown to actually reverse cardiac coronary disease. That's evidence and no other dietary intervention had such an effect
  • You may prevent caridac disease by a combined strategy which does not necessarily implies a very strict, VLF diet. If I already had a coronary obstruction, though, I would have no doubts to follow a VLF diet, as much as I would hate it, since I eat 45% fats and love'em
  • An healthy, plant based diet has been shown to reduce death hazards by hearth ischemic stroke. 
  • Some foods are known to be cardioprotective. Among them, hi-polyphenols EVOO (secoiridoids), undutched cacao powder (flavanols), green tea (flavanols).
  • Dr. Michael Greger in his excellent book 'how not to die' has a specific chapter on CVD prevention

Also, please consult this very recent  'neutral' article on CVD prevention (it's not affiliated to any dietary religion)

 

 

Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition

 

That's a very recent matanalysis where some of the results:

 

Dairy products (low-nonfat) seem to lower stroke risk

Fish seems to lower stroke risk

Meat seems to increase stroke risk

Dark chocolate, tea, alcohol within limits (1 drink/d ladies, 2 drinks/d gents), all are confirmed to lower stroke risk

Salt seems to increase stroke risk (suggested max threshold 5 grams/d)


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#8 Rosanna

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Posted 13 March 2018 - 12:20 AM

Thanks mccoy

 

That Esselstyn and other vegan doctors actually demonstrated reversal of heart disease I take as very strong evidence that the vegan diet may be safe - and also agree with your point that prevention (as opposed to reversal) may not require a low fat vegan diet. 

 

The one thing I'm curious on though is that Esselstyn never really talked about inflammation in his book.  Atherosclerosis can be stable or non stable, and how much of Esselstyn's demonstrated reversal was for the stable kind that wouldn't have done any harm?  I know its still better to be rid of it, but my own father had a heart attack despite having relatively clear arteries, there was just a tiny patch of unstable plaque.

 

I know Esselystyn talks about certain nutrients taking down the inflammatory process that makes plaque unstable, and that is by increasing the progenitor cells in the endothelium.  A handful of beets or greens such as kale with every meal is suggested as a way to do this.  So he addresses inflammation there, but he is totally against use of oil, including olive oil......and whilst I understand his argument, I have a suspicion that there is something in olive oil that is good, that may take down inflammation.  And even if not, I'm just a little concerned about the lack of fat in the Esselstyn diet (for brain health, etc, and a lot of fats control appetite too).  Also with such a low fat vegan diet, one would have to have complex carbs, and those, without much fat would surely encourage inflammation?

 

I sound like I'm not into the Esselstyn approach, but I actually am, but I think fish is protective, so I'm not sticking to it entirely.



#9 Darryl

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Posted 13 March 2018 - 08:50 AM

Additionally, several of the VLF studies had very low cardiovascular event rates, although the lack of controls or randomization means these studies aren't highly regarded.

 

Kappagoda et al, 2006. Cardiac event rate in a lifestyle modification program for patients with chronic coronary artery diseaseClin cardiol29(7), pp.317-321.

Esselstyn et al, 2014. A way to reverse CAD?J Fam Practice63(7), pp.356-364.

 

Complex carbs have relatively little inflammatory impact compared to dietary fats. I suspect gut-derived endotoxins account for much of this.

 

Wallace et al, 2010. Postprandial lipaemia, oxidative stress and endothelial function: a reviewInt J clin practice64(3), pp.389-403.

Vafeiadou et al, 2012. A review of the evidence for the effects of total dietary fat, saturated, monounsaturated and n-6 polyunsaturated fatty acids on vascular function, endothelial progenitor cells and microparticlesBriti J Nut107(3), pp.303-324.

Herieka and Erridge., 2014. High‐fat meal induced postprandial inflammationMolecular nut food res58(1), pp.136-146.

Erridge et al, 2007. A high-fat meal induces low-grade endotoxemia: evidence of a novel mechanism of postprandial inflammationAm J clin nut86(5), pp.1286-1292.

Pendyala et al, 2012. A high-fat diet is associated with endotoxemia that originates from the gutGastroenterology142(5), pp.1100-1101.

Lyte et al, 2016. Postprandial serum endotoxin in healthy humans is modulated by dietary fat in a randomized, controlled, cross-over studyLipids in health and disease15(1), p.186.

 

 


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#10 Benko

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Posted 13 March 2018 - 11:43 AM

I don't think it has been mentioned but there are genetic variations (apoE being one) that make at least some people do less well with saturated fats and genetic variations that make some people do less well with keto diets (don't remember what the genetic variation was for that).  Dr. Green talks about saturated fat and APoE4 on his website (think it was the website related to alzheimers).  The genetic variation related to keto I think was on a Q & A session a few days ago by Rhonda patrick and I believe had to do with one's PPAR related genes.  Not sure when it will be posted.

 

The other issue is that the amounts of carbs e.g. grains in the vegan diets I don't think work for everyone.  I"m 58 years old and started at 42"'waist.    By increasing fats, mostly avocado, nuts and olive oil but also salmon and some animal protein and decreasing grains (but still eating a reasonable amount of carbs including berries/legumes) my fasting insulin dropped from like 15 (insulin resistant)  to 2, my lipids especially triglycerides improved and weight loss was much easier.  I did add some exercise as well, but I don't think that was that major factor since it was only mild exercise..


Edited by Benko, 13 March 2018 - 12:04 PM.

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#11 Nate-2004

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Posted 13 March 2018 - 12:48 PM

Basically it all comes down to this. If you're going high fat, try to keep it mostly plant based, which is possible, just hugely limiting in terms of what you can eat. Fish being what's left. The soluble and insoluble fibers you get from a plant based diet may be the biggest key elements to the improved health (mostly because of the microbiome) aside from the micronutrients and plant hormetic compounds.  I'm not a vegan by any means but I do try to aim for 2/3 of what I eat to be plant based. I do think a key ingredient missing from most people who only do plant based is fish, or at least fish oil. It's basically a hunter gatherer diet that's good for you, that's what we're adapted to. Pescetarian isn't a bad alternative.

 

I'm also trying to limit wheat gluten. Not gonna be gluten free but I do avoid it as much as I can, which is actually surprisingly easy to do these days. Corn is a good alternative if you're craving breads, crackers and chips.


Edited by Nate-2004, 13 March 2018 - 12:51 PM.

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#12 Rosanna

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Posted 15 March 2018 - 01:56 AM

I'll reply properly soon, but appreciate the clarity from all your thoughts and references.  It seems plants are protective, fat is needed but how much is debatable, and is healthier in natural states like in fish and avocado, and plant based, etc. 

 

I've just learned about ApoE.....and it concerns me because there seems to be a pattern of cardiovascular disease on my dad's maternal side.  I realise that doesn't necessarily mean anything though.



#13 matrix83

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Posted 15 March 2018 - 04:09 AM

 

Meat seems to increase stroke risk
 

 

https://www.scienced...3?via=ihub#sec1

 

Interestingly, the PURE study found SFA to be inversely associated with stroke, among other things. 


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#14 Telo

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Posted 15 March 2018 - 01:18 PM

Having several relatives with heart disease, I had the fortune a few years ago in my mid forties to discover the Ornish and Esselstyn studies before getting any problems myself. Since then I’ve thought a lot about this ”an ounce of prevention…” issue i.e. what can I add to the Esselstyn diet without worsening my arteries. Or maybe you can make the diet even better, for example eating intact grains and minimizing flour products like bread and pasta.

 

Wouldn’t it be neat if we could do a well controlled clinical study over at least one year with the following groups: 1:Esselstyn diet  2:Esselstyn + a handful of nuts  3:Esselstyn + a couple of tbsp EV olive oil. 4: Esselstyn + fish. And maybe another group with some kind of standard mediterranean diet. Of course with before and after angiograms of the arteries.

 

Without these studies I guess we can only look at the totality of the different types of research; epidemiological, clinical etc. and weigh the evidence for and against different foods. After doing this, my personal decision is to eat a handful of nuts every day(I think the evidence is rather strong for this), some fish maybe once a week (based mostly on epidemiological and centenarian studies) and I occationally add some EVOO in a salad dressing for taste (small amounts). Otherwise I eat mostly a whole food plant based diet. 

 

In his book The end of heart disease, Joel Fuhrman does an interesting comparison with different diets like Ornish  Esselstyn, mediterranean, with pro’s and cons and suggests what he thinks could be improved.

 

I recently read The Longevity Diet by Valter Longo (I highly recommend it) and in the heart disease chapter he discusses Ornish and Esselstyn and similarities and differences to what he, based on the ”five pillars of longevity”, recommends for your everyday diet. He also discusses the research behind his 5-day fasting mimicking diet which I think also could be a useful addition for heart disease prevention even for those strictly following the Esselstyn diet.  


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#15 mccoy

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Posted 18 March 2018 - 09:35 AM

 

 

Meat seems to increase stroke risk
 

 

https://www.scienced...3?via=ihub#sec1

 

Interestingly, the PURE study found SFA to be inversely associated with stroke, among other things. 

 

 

I couldn't read it extensively but that's a substitution study, that is, it studies how the hazard ratios varied in different individuals who consumed more fats than carbs, that is, where energy from carbs is replaced by energy from fats. Also, the source of carbs are declaredly junk foods:

 

Moreover, in our study most participants from low-income and middle-income countries consumed a very high carbohydrate diet (at least 60% of energy), especially from refined sources (such as white rice and white bread), which have been shown to be associated with increased risk of total mortality and cardiovascular events.42

 

 

So there is no wonder that replacing refined sources of carbs with food which contains SAFAs may have an overall beneficial effect in some people.

 

So far, only a very low fat diet has been shown, in controlled trials complete with arteries scans, to reverse the obstruction of coronary arteries. The studies are classical, from dr Ornish and Dr Esseltsyn. I want to be clear that in general I absolutely do not support such a VLF diet, but the evidence is just that, people with potentially high CVD hazard may very much benefit from it.

 

The above being said, some individuals may be able to handle cholesterol very well, but that's not the general rule.

 

There are dangers in wanting to defy at all costs conventional wisdom, and that's what apparently the paleo community and low-carb communities are doing. In the same PURE article, the authors in the text underline that the strongest decreas in hazard is given by amount of PUFAs, and this agrees with conventional wisdom.

 

 

In our replacement analyses, the strongest association on total mortality was observed when carbohydrate was replaced with polyunsaturated fatty acids, which is consistent with the pooled analyses of the Health Professionals Follow up and the Nurses’ Health Study.46 We found a lower risk of stroke when carbohydrate was replaced with saturated fatty acids, which is consistent with previous work showing that refined carbohydrate intake is associated with increased risk of stroke.7,47

 


Edited by mccoy, 18 March 2018 - 10:21 AM.


#16 misterE

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Posted 20 March 2018 - 09:23 PM

Just remember who has the results. The diet recommended by Ornish and Esselstyn is the only safe and logical choice.


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#17 mccoy

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Posted 21 March 2018 - 01:25 PM

Just remember who has the results. The diet recommended by Ornish and Esselstyn is the only safe and logical choice.

 

You mean, for those who already have a condition of coronary disease or are at high risk of it.

 

For healthy people there are sure other safe and logical choices according to requirements and individual genetic makeup.

 

Also, a regimen which is too low in fats can have its hazards, although it's probably nearly impossible or requires a determined effort to get lower than 5% fat in energy.



#18 misterE

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Posted 21 March 2018 - 04:10 PM

No, what I mean is: follow the diet recommended by the men who have proven results. I've never seen a ketogenic-diet or any other kinda diet reverse atherosclerosis... have you? 



#19 Rosanna

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Posted 21 March 2018 - 04:52 PM

misterE - I get your point, at the same time I don't think we have any research to go on.  As in, I don't think anyone has attempted to reverse atherosclerosis in a controlled study using the ketogenic or the paleo diet.

 

If anyone knows of such research I'm interested to see it. 

 

Personally I'm inclined to follow a low fat, mainly vegan diet, particularly I find Ornish easy to follow as his approach is a little more flexible.  That said, I do think genetics plays a big part and it might be that different diets suit different people, I don't think it's going to be black and white.


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#20 pamojja

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Posted 21 March 2018 - 05:49 PM

No, what I mean is: follow the diet recommended by the men who have proven results. I've never seen a ketogenic-diet or any other kinda diet reverse atherosclerosis... have you?

 
Myself, as detailed in this post.
 

If anyone knows of such research I'm interested to see it.

 

One of the approaches I followed was the diet recommended by Dr. William Davis, who did a small non-controlled study on it. For me there were no alternatives, since I've been vegan and very low fat since 10 years of age. And despite at 41 got a 80% blockage at my abdominal aorta (PAD) along with a 60% walking-disability. Changing lifestyle and starting supplementation could reverse that disability.

 

Actually am still mainly vegetarian (old habits die hard, also because organic meat is so bloody expensive), but increase my fat intake to about 68%, added eggs and fish back in. All the details in above link.


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#21 misterE

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Posted 22 March 2018 - 12:21 AM

 

 

Personally I'm inclined to follow a low fat, mainly vegan diet, particularly I find Ornish easy to follow as his approach is a little more flexible. 

 

Smart choice!
 


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