Comments on the Fat Summit, Day 7

Published 2.11.2016
These are notes and commentary from presentations given on day 7 of Dr Mark Hyman's Fat Summit. In my view, the primary reason for the summit was to promote Hyman's new book, Eat Fat, Get Thin.

Still, a number of the conversations were interesting to listen to. What follows isn't a detailed recap of the conversation, but rather some of the notes and observations I made while listening. This piece and the summary I intend to publish following it are much delayed, but life is like that sometimes. Onward.

Ron Krauss, MD

• Krauss is the guy who found that particle size and density of low density lipoproteins (LDL) matter. Small, sense LDL particles are poorly cleared by the liver and can damage artery walls. This fact has been exploited by some in the low cab/"paleo" blogosphere as meaning that super high LDL counts don't matter if the particles are "fluffy." Doctors (at least those with medical degrees who treat people are MUCH less definitive. At some point, it's a traffic situation. Doesn't matter what size particles are present, blood flow is constricted if there are too many of them.)
• Much to Krauss's chagrin, his gizmo to measure particle size has not been widely adopted, though he has convinced Quest Diagnostics to buy it and begin to push it on patients.
• Hyman quotes a study of 500,00 heart attack sufferers that showed 75% had normal cholesterol levels; 60-70% had HDL under 40 and triglycerides over 150.
• The American Heart Association gets slammed for recommending replacing fat with carbs (breads, pastas and other grain based food— that was actually true in the food pyramid. Fruits and vegetables should have been the base, not bread. In that sense, people who complain about lobbyist influence have a point.
• Krauss's study on LDL size and low fat high carb (high bread I'm assuming) found that the diet made people with normal cholesterol profiles shift to the smaller, deadly LDL pattern. But this was NOT caused by the low fat level of the diet, but rather the high REFINED carbohydrate (carb) content of the diet.
• The problem when you cut fat calories is that you have to replace them with something. Since people won't (and doctors don't tell them to) eat large quantities of LEGUMES… they eat grains to make up the calorie difference. And along with those grains comes a big dose of sugar (in any form).
• It's REFINED carbs and sugar driving heart disease per Krauss, not the fat. However, high fat dairy in his own studies raised LDL. What can these people who are downing sticks of butter with their coffee be thinking?
• Krauss is not anti-statin. For people who respond (and who already have heart disease) there's a 20-50% reduction in risk. It's an individual thing as to how people respond to drugs OR saturated fat.
• Krauss says the issue is more complicated than saturated fat = good. Now he says saturated fat in dairy might be okay, but saturated fat in meat might not be. People should not take one piece of information and blow it out of proportion. Dr Krauss, have you never been on the internet?
• Then Hyman asks him about poly unsaturated fats (the omegas — O3 and O6) versus saturated fat. Krauss thinks the the carb/ saturated fat questions is easy to answer. Sugar and REFINED carbs cause problems, saturated fat is less harmful (but he does NOT say it’s healthy, even there. Hyman pushed him a number of times to say that unlimited saturated fat intake was healthy and Krauss would not)
• The O6 vs O3 question is much more complicated, and he's trying to get funding to look at that. He notes that O6 acids have protective properties, so he agrees with Willett. You get less plaque with more O6. He thinks that polyunsaturated fats are protective. If you’re going to replace sat fat, then use poly unsaturated fats for it. So much for slurping down a wad of coconut oil with your coffee every morning, which Hyman claims that he does.
• O3 also appears to be good— if you get it from fatty fish. Here supplements or separated O3 oil has not shown benefits if other risk factors are controlled. Eat real food, fish is real food. Sardines, anchovies and salmon are mentioned.
• Krauss is also studying trimethylamine N-oxide (TMAO) which is found in meat and could be an important mechanism for red meat causing heart disease BUT this did not happen when the fed a vegan a steak. So it might just be that if you eat a lot of vegetables then eating meat is okay.
• Statins affect mitochondria, and mitochondria have a life span, so they fail as we age. No reason to hasten the pace.

Neil Barnard MD

• This talk is actually the one I registered to hear. Not because I'm a vegan— I'm not. I was impressed that Hyman would invite someone who very clearly disagrees with him— and Barnard definitely does and did.
• Barnard it turns out is older than Hyman who is 55, but he truly does not look it. Barnard is also extremely thin. All the vegan doctors are actually, but Barnard may be the thinnest.
• About Atkins, claims no one loses weight unless they cut calories— but that’s the case on all diets, not just low carb. Also claims that for a third their cholesterol rises.
• David Jenkins is an inspiration for Barnard. Jenkins has shown there are two types of low carb diets, the Atkins meat based and one that replaces refined carbs and grains with plants. So get rid of the refined carbs, but replace them with plants such as legumes etc. Barnard says that’s better than Atkins.
• Barnard is very anti-meat and dairy. Ornish is also vegan, but recognizes that not everyone will eat that way and hence created his "spectrum". Barnard makes not such allowance. He was only interested in talking about and advocating veganism.
• Barnard pushed low glycemic plant foods because on a plant based diet triglycerides can go up.
• Barnard uses a low carb vegan diet to reverse type two diabetes. Barnard is also firm on the low fat need. Hyman tries to assert that really all that's needed is a whole food diet, but Barnard doesn't care if the fat comes from plants.
• Barnard is a good example of why vegans are often summarily dismissed. No one (well outside the low carb blogosphere) argues against eating vegetables, but the assertion that meat is unhealthy in any form or amount is simply not supported by the evidence. I wish that Hyman had asked him about vitamin B12. B12 is essential for brain and heart health and it is NOT found in plants.
• Barnard bases is vegan stance on ethics, which means there is no reasoning with him, but to eat animals you must either kill them or in some way harm them.
• This was the final talk that I listened to. It was one of my least favorite.

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