Joe Rogan - Does Saturated Fat Cause Heart Disease?

We glossed over this very quickly in the beginning of this, but there was a dispute about cholesterol and a dispute about saturated fat. Nah. Seriously? You were saying that saturated fat, that there's recommendations to reduce saturated fat and reduce cholesterol. So let me get a real quick overview, and I'm gonna talk fast. So just talk normal. It was felt. We've got plenty of time. It was felt. So until the 40s, it was not common to have a heart attack. Heart attacks were described in 1916. Not to say they didn't happen, but the first medical article that used the word myocardial infarction, 1916. 1940, there were not many heart attacks seen in a modern American city. After World War II, where our economy went up, in the city of Minneapolis, executives started suffering heart attacks. It was also Franklin Delano Roosevelt died of high blood pressure. A few years later, Eisenhower had a massive heart attack. That's when our government, the National Institutes of Health, started funneling major money into studies like the Framingham study. You're from Newton, Framingham's a city outside of Boston, and they basically invaded this town in 1958 till today. So we're spending money. We're gonna figure this crap out. The idea had come up. Heart disease wasn't just aging. Heart disease could be explained by what's called risk factors. Smoking might not. You can smoke and live to 100, but it's gonna increase your risk. And then they got into blood pressure and cholesterol and family history. They identified what we call risk factors. So until that point, diet was not considered a factor in the development. I'm the number one killer, men and women. I want to point out, and Chris puts this on his website, I do too, during this interview, every 39 seconds an American dies of heart disease. Every 39 seconds, the most frequent cause of death. So there will be about 200 people perhaps that will die during this podcast of the number one killer. And 80% of it's preventable. Chris is gonna prevent some. I'm gonna prevent some, because the biggest enemy out there is smoking and crap diet. Calorie rich in processed foods, crap, sad diet, standard American diet. If it became apparent in the early 1950s, diet might play a role. And a notorious scientist and many others, his name, Dr. Ansel Keys, PhD, PhD, two of them, suggested dietary fat might be a factor. It was a hypothesis. It's this early stage, epidemiology doesn't prove anything. He went out and did studies, other people went out and did studies. And the idea transitioned. Actually, he was criticized for saying dietary fat. The conversation transitioned. There's some good fats, like omega-3 fatty acids are essential. You have to have them. And then maybe polyunsaturated fats from plants are more helpful. But the focus went on saturated fat in food, which is baking chicken, red meat, pizza. Those are the highest sources. And subsequently enough data accumulated that guidelines started to suggest we've got this huge problem with heart disease. We should limit saturated fat in the diet. It was never limit all fat. 35% of calories. That's not in anybody's word a low-fat diet. And that has now promulgated in 21 international statements. There is no opposite, whether it's the World Health Organization, the American Heart Association, the American College of Cardiology, whether it's the Institute of Medicine says eat as little saturated fat as possible. They couldn't be more clear. And these are highbrow. These are not associated with vegan movements or paleo movements or whatever. These are medical authorities. If there was half and half, you'd say controversy. 21 to 21 say the same thing. They might pick a different cutoff point. But we will enhance the health and cut down on the number one killer, whether it's in Asia, whether it's in Europe, whether it's Australia, whether it's in the United States. There's unanimity. Why did they come to the conclusion of saturated fat? Basic science, because there is basic science. And let me tell you, when you eat foods rich in saturated fat, which is called meat, cheese, eggs and such, receptors on your liver for cholesterol. I've got cholesterol in my blood. I'd like to get some of it out into the liver to be metabolized. I need a receptor. You eat saturated fats, receptors go down. Cholesterol has no place to go. Cholesterol stays in the blood, bumps into your artery while I'm putting a stent in your artery. That's the basic biochemistry. Then they had epidemiology studies, flawed, perfect. It doesn't matter. There was so many. It doesn't matter. Whoa, whoa, whoa, whoa, Chris, Chris, thank you very much. Then they did controlled trials. Everybody just go read Clark 1997, 395. It's called metabolic studies. Change the diet, see what happens. You add saturated fat, cholesterol skyrockets. On average, not in a single person. If I gave you a steak, Chris, a steak, and me a steak, our cholesterol would rise differently. It would rise. It would rise differently. It's our microbiome. It's our genetics. It would rise. So that's a problem in the studies when you average everything together. So they had that. And then finally, finally, they looked at populations that live over 100. These are called the pillars of longevity. They don't eat foods rich in saturated fat. They have a little. They don't have a lot. They eat olive oil in Italy and Greece. They eat almost no dietary fat in Okinawa, Japan. They have the greatest longevity in the world in 1970. They eat almost no dietary fat, about 6%, 7%. So you put all that together. Well, it's actually that is the basis for a major push to say, cut back on animal products because that's largely with the exception of coconut and palm, where saturated fat comes from. And to negate that is to throw out every major health agency in the world. I don't believe Chris Kresser can do that. No disrespect. I don't think Chris can throw out 100 years of cholesterol research. Let's back up a little bit here. So first of all, every food that we consume has all of the fats in it. Polyunsaturated, monounsaturated, unsaturated fat. And in fact, two tablespoons of olive oil has more saturated fat than a seven ounce pork chop. That's a little known fact. The oily fish, mackerel, which all of these health agencies that Joel is talking about advises us to eat, has twice the total fat and one and a half times the saturated fat of the meat that we're told to avoid. Does it make sense that nature would include that you could eat mackerel and the polyunsaturated fats in it are good for you, but the saturated fat in it is bad for you? That's kind of nonsensical. But let's talk a little bit more about the research. So there never really was good evidence to suggest that dietary cholesterol and saturated fat are connected to heart disease. And Zoe Harkom, who has a PhD in nutritional researcher, she wrote her thesis, her PhD thesis, on the evidence back in the 70s that led to the restrictions on saturated fat and cholesterol. And then she also reviewed the evidence all the way up until 2016. And if I have this information on my website, if you go crecer.co.rogan, you can find it. And what you'll find is there never was really good evidence to support the limitations on saturated fat and cholesterol. And people have started to look at this more recently. For example, you have a meta-analysis of observational studies including about 350,000 participants recently that found no relationship between saturated fat intake and cardiovascular disease. You have an exhaustive review of studies, something like 25 randomized controlled trials, gold standard of clinical evidence, and almost 40 observational studies involving 650,000 participants. And I'll read you a quote from the conclusion. Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of saturated fatty acids. Now look, one of my favorite quotes is the philosopher Anatoly France. Even if 50 million people say a foolish thing, it's still a foolish thing. And the other thing to consider is that the history of science is really the history of most scientists being wrong about most things most of the time. And in science, we have to continually challenge our hypotheses and try to falsify them, and that's how the scientific process moves forward. And that's why in 2010, the US federal government removed restrictions on total fat, whereas before there was a restriction on total fat because they acknowledged that the research was showing that not all fat is the same and that we don't need to be restricting fat from avocados and things like that. And then in 2015, they removed the restriction on dietary cholesterol. Now they did that fairly quietly because how do you think it looks when people have been told to limit their fat and limit their cholesterol and then the federal agency goes back on that recommendation after so many years of telling people to do that. People lose faith in the agencies that are issuing these guidelines. And don't take it from me. I'm not expecting anyone to believe me, and that's why I've put all of the studies and the research supporting this at crecer.co.rogan. But how about Johnny Anidis, who's one of the most renowned epidemiologists in the world. He's a professor of medicine at Stanford, and he has written some scathing critiques of nutritional research recently that have been published in JAMA and British Medical Journal. So here's a quote from one of them. Some nutrition scientists and much of the public often consider epidemiological associations of nutritional factors to represent causal effects that can inform public health policy and guidelines. However, the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles. The field needs radical reform. And he goes on to point out that meta-analyses of observational studies have found that almost all foods are associated with the higher risk of death if you crunch the data in certain ways. So it's not enough to say that governments are recommending this or that. We have to look at the science and what the science is saying. And as I said, two recent meta-analyses covering over a million people are not showing a relationship between saturated fat and heart disease, and they're not showing any benefit from replacing saturated fat with polyunsaturated fats. So these organizations, Joel, that you were describing, why do you think that they recommend, based on what Chris has just said, why do you think that they recommend reducing your saturated fat, reducing your cholesterol? Okay. And thank you. And you know, the importance here, which we are technical in the weeds, but I want to bring it back. This discussion is, do you have a stroke, heart attack, erectile dysfunction, lose a leg? Or do you not? Because at least one factor in development of these horrible medical problems that are 80% preventable, at least one of it is your nutrition and the continent of nutrition. I mean, there's no doubt. It's the single most important factor. It's never been the only factor. Okay, but why do you think these organizations are saying this if he's saying that the studies don't support that? Well, I disagree that the science, and I want to be very specific. Let's talk about cholesterol and let's talk about saturated fat. But stay with saturated fat because there is differences there. They're both, you know, contents of food, fatty contents of food, but they're chemically different and the volume weight is very, very different. Cholesterol only comes from animals, saturated fat is in animals and plants, depending on the food source. So when this rise in heart attacks developed, research began, 1948, 1950, 1958. There were observations made that carefully done dietary logs suggested, these were hypotheses, there might be a connection between what you eat in heart attacks and then it's centered on, you know, is it foods high in protein, foods high in sugar, foods high in fatty sources? Ultimately, they got sophisticated foods high in plant fat sources, foods high in animal fat sources. So by the late 1950s, there was a very strong consensus already that foods high in animal products with saturated fat, they go together. We're talking meat, egg, and cheese may be a role. Let me give you a great example. 1959, you grew up in Japan, you have a cholesterol of 120, you almost never see a heart attack. You move to Hawaii because there's migration. Your cholesterol rises to 180, welcome to America, your heart attack risk triples. You moved to this great city, Los Angeles, this was published in 1959, your cholesterol is now 210, you have 10 times the heart attack risk that you had when you lived in Japan. Genetics don't change that quick, this is within one generation. They're called Nisei, people that leave Japan to move to California, the Nisei, and there's the Nisei Han study that tracked these people. Now, is it the air, is it that they adopted other bad habits? Sure it could be, but within a very short time, they had 10 times the risk of heart attack. So public research and dollars, this stuff matters. Why is this correlated with animal fats and proteins and why isn't it correlated with sugar and refined carbohydrates? So carefully done studies say, and I think we all agree, more so now because we're overweight and now we're more insulin resistant and added sugars in the diet are more important in 2018 than they were when the country was thin in 1960. They weren't good then, they aren't good now, but when you parse it out, multivariate analysis, there's a stronger relationship between the number one food and studies like this is usually butter, more than red meat, it's actually butter, that's just at our value, it's called statistic. I don't want to go so deep into statistics, it is. Somewhere there is sugar, I'll give you a classic study, if you could hold sugar the same and increase dietary saturated fat heart disease rockets. If you could hold saturated fat the same and increase sugar in these manipulations, coronary heart disease doesn't increase. Let's point something out. I've been inside of hearts 15,000 times, I've never scooped sugar out of a blocked artery, I've scooped cholesterol out of blocked arteries. 20% of every blockage in a heart is cholesterol. So a fact that was discovered in 1910, it's never varied. Then we fed animal. Let's pause for a second, Chris, do you have something to say about that? That doesn't mean that the cholesterol is there because people were eating it, Joel, you know that. It could be though. Hold on. Let's look at what the research says again here. They've done controlled feeding studies where they've fed people two to four eggs a day and those show that in 75% of cases that has zero impact on blood cholesterol levels. For the other 25% of people they're termed hyper responders and in that group dietary cholesterol does modestly increase LDL cholesterol but also increases HDL cholesterol and it does not increase the risk of heart disease. This is why the guidelines were changed on dietary cholesterol. There is no evidence that consuming dietary cholesterol increases the risk of blood cholesterol on most people and even when it does there's no evidence that it increases the risk of a heart attack which is again why the dietary guidelines change. For saturated fat, again, most of the studies that showed harm were short-term studies. These longer-term studies have shown that on average eating saturated fat does not increase saturated fat levels in the blood and of all of the long-term studies that looked at this only one showed any association between saturated fat intake and cholesterol levels in the blood. Then we have a meta-analyses, lots of meta-analyses actually but one of the best-known meta-analyses was of 17 randomized controlled trials of low-carb diets that were high in saturated fats and published in the journal obesity reviews and they found that low-carb diets neither increased nor decreased LDL cholesterol but what they did find was that low-carb diets were associated with decrease in body weight, improvements in several cardiovascular risk factors including triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, C-reactive protein as well as an increase in HDL cholesterol. Now there have now been 10 meta-analyses of randomized controlled trials looking at low-carb diets for weight loss. All 10 showed that the low-carb diet either outperformed in most cases or was at the same level as low-fat diets. There have been several meta-analyses now, you can see them all at crecer.co.rogan that have looked at low-carb diets for diabetes and even cardiovascular risk markers and all of these meta-analyses have found that low-carb diets are superior for glycemic control, for reducing insulin, for reducing triglycerides and have beneficial effects across the board without increasing cardiovascular risk markers. So we're now talking about randomized controlled trials which is the best form of evidence that we have and we're not seeing any harm from increased consumption of saturated fat. So is the problem that you're citing epidemiology studies from the 1940s and the 1950s? I would definitely, I think we need to prefer randomized controlled trials over that kind of evidence for sure. Why do you continue to go back to these studies from the 1940s and 1950s? Well, they're just the beginning, the beginning but Chris just like took 14 topics and put them into one from meta-analysis to randomized controls to low-carb to low-fat. I mean they're all different topics and I don't know how you put that all together. You need clarity and laser focus. So we were talking saturated fat. So hypothesis is generated, saturated fat in the diet, butter, eggs and cheese may be bad for heart disease, something killing Americans left and right in 1940 and 1950s. Let's go into countries with widely different diets, let's see what they're eating, let's actually take their friggin diet back to Minneapolis, let's analyze it so it's not guessing, not food frequency questionnaires. We're taking their meals back to the United States to analyze them. But boom, there's a relationship between dietary saturated fat and your risk 50 year follow-up. There's no short-term follow-up. The study I'm referring to has 50 year follow-up, 1958 to now. And that strongly suggested that dietary saturated fat and heart disease, that's not what's called the ultimate randomized clinical study but it's one high quality. Second study done in China at the same time with years of follow-up. So these are right up to date. There's publications right now from studies starting at then but the publications are now. But then you get the best kind of study. Okay, I'm still in saturated fat, I'm not talking any other topic. You put people in a metabolic ward at the National Institute of Health. 395 of these studies published in 1979. You change their diet. This is the ultimate careful experiment. You might be for four weeks or six weeks. You up their saturated fat, their cholesterol rises, assures can be. We're all different. The change in cholesterol is consistent. You're going to go up 20%, 20%, 20%. We start at different points. You have to track the change in cholesterol. Chris referred to, actually, can I go off on a tangent? It's really interesting. This will fascinate your listeners. But it's right on the topic. 2008, this is published data. I don't bullshit on this. 2008, Mexico City, the International Dairy Council meet. And they published their notes, which is why we know this. And they said, we are losing the battle. People are eating less dairy around the world and we are losing sales. What we can do is influence researchers, influence acametitions, influence speakers. This is in Mexico, though. Well, it's every dairy council in the world just happens to meet in Mexico City that year. Then they go meet in Portugal. Then they go meet in New York, whatever. 2008, we're going to put dollars into changing research and influencing people. Doesn't mean it's all bad. They published those notes that our global initiative for the next year, they looked for sympathetic researchers that would change public opinion. And that was right before the Milk Mustache campaign. They find a guy, I actually respect now, but I'm going to beat him up a little. Dr. Ronald Krause, MD, in Berkeley, California, right by him, runs at a lipid center. He's had beef funding for 10 years. He's had dairy funding. All of a sudden, he's speaking to dairy industries all over. In 2010, two years later, he publishes, we call it a meta-analysis. That's not new research. That's statistical playing with previous studies that can be fair, can be unfair, whatever. Whatever it is, their conclusion is they could not find and verify that saturated fand the diet, butter, eggs, and cheese raises the risk of heart disease. They never said eat butter, eggs, and cheese. They just couldn't verify it. What's amazing, it's in the American Journal of Clinical Nutrition. That same journal is an editorial that destroys the study. This is 15 reasons this is horrible epidemiology by a guy named Jeremiah Stanla. I've never seen a medical journal destroy a piece that they accepted for publication. Okay, so everything's stirred up. And in 2014, a guy named Choudhury publishes a similar analysis that is the reason that Time Magazine put on the cover, Butter is Back, because it was not new research. It's a meta-analysis. It's all following this Mexico City effort to fund dairy positive publications. A study so bad that both the journal required them to adjust and republish the data because of mistakes. The Harvard School of Public Health said, take this thing away. Statistically, this is nonsense. Since those two times, and that's just the bottom line, we have had confusion in the public. We've got experts like Chris, experts like me, experts like Dr. Mark Hyman, experts like Dr. Walter. There is a quote from the tobacco industry that our product is confusion. They didn't care about winning the battle when the public's confused, they're just going to keep on doing habits they have. I've got to stop because now we're in the weeds with conspiracy theories. I'd like to go back to saturated fat. But that's when the pendulum of 1950, 1960, 1997, 395 of the best done studies in the world say, you eat more saturated fat, your cholesterol goes up. You eat more saturated fat, coronary heart disease goes up. It was crystal clear and the guidelines set it. The guidelines still say it. The guidelines still say limit saturated fat. Are you suggesting that the same science from the 1950s and the 1940s is applicable today? If it's in retrospect valid, let's point out one that's not ... But is it? Yeah, absolutely. Do you think it is? Absolutely. No. Why do you think it's not? What's changed? Because we keep bringing this up. Why do you think it's not? We're going back to observational studies done 50, 60 years ago that suffer from all the problems that I mentioned to begin with and several more that we didn't have time to go into. We have randomized controlled trials now. Observational studies were never meant to prove a hypothesis. They're meant to generate a hypothesis. It's true that in some cases it's not possible to do a randomized controlled trial like with cigarette smoking. You'd have to have the trial last for so long and you'd have to isolate people and award so they weren't exposed to air pollution and other factors that could affect the result. You can't do that. But in that case, the risk was 1,000 to 3,000% higher. So there are criteria called the Bradford Hill criteria, which you can use and apply to observational studies to assess the chance that there's a causal relationship. And in the case of smoking, which actually was when the Bradford Hill criteria were created, that meets many of those criteria. In the case of nutrition research, very seldom did they meet more than a couple of the Bradford Hill criteria. Now observational research, in order to be valuable, needs to be confirmed. The results need to be replicated in a randomized controlled trial. That's how science is supposed to work. But there was one analysis that found that zero of 52 claims that were made in observational nutrition studies were replicated when they were tested later. And in fact, five were replicated in the opposite direction. In other words, when they did an experiment, they found the opposite result to what the observational studies suggested. So good examples of this are observational studies originally suggested that beta-carotene, an antioxidant, that people with the highest intake of beta-carotene had something like a 30% reduced risk of death, which is not really plausible anyways. But then when they started doing trials where they were giving people beta-carotene supplements, not only did it not improve their lifespan, they got more cancer. It increased the risk of cancer. So this is why it's so important not to rely just on observational data and to do these experiments. Now going back to saturated fat, as I said, we've got a 2013 meta-analysis of 20 randomized controlled trials that found that low-carb, high-protein diets led to greater improvements in glycemic control compared to low-fat American Heart Association, American Diabetic Association diets. We've got a 2014 meta-analysis of 10 randomized controlled trials that showed that low-carb diets are more effective than high-carb diets for patients with type 2 diabetes. And we've got another meta-analysis of 25 randomized controlled trials just published in 2018 that found the same thing. So you know, science marches on. We learn more, we change, and now we've got randomized controlled trials that are replacing some of the observational evidence from the 50s and 60s and 70s, which by the way, in Dr. Harkholm's paper, you see that that evidence was never strong to begin with. And this is what we should be looking at.