The skeptical cardiologist was asked to give a lecture in July on diet to the cardiology fellows in our training program at Saint Louis University.

Needless to say, I didn’t hew to current recommendations from the American Heart Association or the Dietary Guidelines for Americans.

For example, these recommendations are still promoting the narrative that everyone should minimize the consumption of all forms of saturated fat. This makes for a nice simple message but is clearly not science-based.
I’ll be posting soon on some specific areas where I differ from mainstream dietary dogma in the near future.


In the meantime, you can feast your eyes on this 53 minute recording of the entire Zoom-aided conference.


This streams from my Vimeo site and is totally free of annoying ads. It can be watched without an account or log in.

A summary of what I’ve written on diet and lifestyle on this website can be found at this link.

Skeptically Yours,

-ACP

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8 thoughts on “<a>What is the Optimal Diet for the Prevention of Atherosclerotic Cardiovascular Disease?</a>”

  1. I’d like to thank you for making this lecture available to me. I find your thoughts compelling as I navigate my heart health in my mid-50’s. A hearty thank you!

    Reply
  2. Thanks for sharing this presentation. It was full of fascinating information! I have one question, and it is of personal relevance. Is it possible to have HDL levels that are too high? Mine are 2.6 mmol/L, and there are some papers that suggest levels above 2 mmol/L may actually be harmful. Thanks again!

    Reply
  3. Hah! I’d say you know your patient population well. This MI surviving, stented, KETO practicing, 61 year old male is indeed a COVID vax and statin (20mg daily) skeptic.

    Enjoyed your presentation and I’ll have to watch it again. I did not pick up much of a distinction between the KETO and Med. diet. Would you care to amplify the differences?

    Best regards.

    Reply
  4. Thank you so much for helping your patients and the public sort through so much information that is available on cardiovascular health. There seems to be contradictory studies concerning the impact of saturated fat on CHD, particularly with respect to what nutrients are consumed to replace them in the diet. A Harvard 2015 study by Yanping Li et al., indicated the impact of saturated fat was relative to the alternative, with substitution of whole grains and polyunsaturated fats conferring a lower CHD risk. A 2010 meta-analysis published in 2010 by Dariush Mozaffarian et al. in PLOS Medicine (I’ve never heard of that journal) showed the same thing. From my understanding, although the PURE study showed lower risk of death with increased consumption of saturated fats, it was through reducing carbohydrates and the study did not adequately differentiate between simple, low glycemic index carbohydrates and complex, high fiber carbohydrates. Your thoughts?

    Reply
    • Dwight,
      An excellent observation and question. These “studies” and meta-analyses are generally lumping together observational studies to make the case for substituting PUFA for Sat fat. Observational studies are inherently flawed in the nutrition space no matter what statistical gymnastics are applied to them. I mention that in the talk.
      I’ve spent some time recently looking at the randomized controlled trials in this area and I do not find that they support this theory either.
      I do think if you are consuming red meat at double the average in the US , especially if this was causing high LDL/apo B,
      you would see a drop in the LDL/apo B if you switched to EVOO/avocado oil/nuts as a substitute source of fat for the red meat. This might translate to lower CV disease risk over time (PREDIMED).
      I have respect for Mozzafarian in this space and my last slide was a summary of his dietary recommendations from Up To Date which align very closely with mine. I have spoken with him and he agrees with me that there is no evidence that lowering dairy fat consumption lowers CV risk.
      Dr P

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  5. I’m lucky enough to know very well what an orchard tree-ripened peach tastes like. Ambrosia! The best produce stores can’t do it. I had a “victory” garden during the energy crisis. I know about bright red succulent tomatoes. Beets, any of the coles, eggplant, and of course Spring asparagus. Yesterday I bought supermarket asparagus from Peru. It was tiny, but tasted rather like it should. Was it worth it to buy out of local season, thousands of miles away? What was it like when harvested? Like the hard green bananas were that we buy still slightly green? What is a ripe banana just-off-the-tree like? Ambrosia, I wonder? Whatever it is that must be shipped, trucked, or flown in (and bred for that purpose!) at expense to wallet and to environment – can these be ambrosial?
    Eat Local! Sounds like me? But the admonition can become zealous, and can local, seasonal, nutritious produce fulfill our health needs though the year? Here in New England? LA? NE? NV? FL? Did my ambrosial peach actually provide more health benefit than the wooden/mushy things available now? Less? My tomatoes VS the truck-proof ones? . . . .
    Health. Gustatory aesthetics. Environment. Sustainability. Agribusiness vs local small farms. Beef. $.
    This isn’t going to be easy.

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  6. Interesting presentation – just one correction. Michael Pollen said “Eat food. Not too much. Mostly plants.”

    That’s the advice journalist and author Michael Pollan offers in his book, In Defense of Food.

    You wrote that he said, “Eat food. Mostly plants. Not too much.”
    Expressing the same sentiment, but Pollan said it slightly differently.

    Reply

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