The Kevin Bass Show: Recent Episodes
Kevin Bass
On the Kevin Bass Show, I dig into the good, the bad, and the ugly in the world of health and wellness.
Link to WaPo opinion piece (no paywall) https://archive.ph/mR9iU
Link to Cochrane review on masking https://cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
Links to University of Minnesota commentaries https://cidrap.umn.edu/covid-19/commentary-wear-respirator-not-cloth-or-surgical-mask-protect-against-respiratory-viruses
https://cidrap.umn.edu/covid-19/commentary-what-can-masks-do-part-2-what-makes-good-mask-study-and-why-most-fail
Link to fatally flawed CDC study https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm
From Andres's show notes:
"Despite what we want to believe, cardiovascular disease does not only start once we are in our 50s and 60s. As we welcome Kevin Bass back to the Know Your Physio podcast, we hear his opinions on cholesterol, the medications to take, and opinions on collected long-term genetic studies. We don’t hold back on having a controversial conversation around starting the reduction of low-density lipoprotein (LDL) cholesterol in your mid to late 20s, the role of genetics in our predisposition to cardiovascular health issues, and how we need to look at things from an environmental, health, and nutrition perspective. Kevin tells us about his preferences and opinions on the different interventions for LDL cholesterol reduction and how he aims to (one day in the future) create a risk reduction calculator that will look at and create a risk-benefit profile. Plus, Kevin discusses his feelings toward Andrew Huberman, consulting medical professionals, and some signs of when it may be time to start looking at taking prescription cholesterol medication!
Key Points From This Episode:
- People in the fitness industry who are pissing Kevin off.
- Different calculations people can do to determine their risk of cardiovascular disease.
- Interventions for LDL cholesterol (including prescription medication) and their side effects.
- A look at how to reduce LDL cholesterol.
- Kevin’s opinions on Andrew Huberman.
- Unpacking cardiovascular disease considering your genetics and potential preventative measures.
- Why Kevin believes people 25 and older can start cholesterol medication.
- Where Kevin gets the long-term genetic studies data from.
- Analyzing and interpreting data on cardiovascular disease to create a relative risk reduction.
- Why Kevin wants to create his own risk reduction calculator and risk-benefit profile.
- Signs people should start looking for when deciding to take cholesterol medication.
- Questions to potentially ask your doctor to help you identify your cardiovascular risk (and why they may be unlikely to prescribe).
- A look at the purpose and benefits of statins, metformin, and rapamycin.
Links Mentioned in Today’s Episode:
The Diet Wars
Kevin Bass on Twitter
The Kevin Bass Show YouTube
Debunking Andrew Huberman
BiOptimizers
Andrés Preschel
Know Your Physio Podcast"
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From Andres's show notes:
"When it comes to nutritional science and social media it can be uniquely challenging to differentiate fact from hype. Here today, to help us unpack the topic of scientific influencers and misinformation is Kevin Bass, an MD and Ph.D. student, and founder of The Diet Wars, a site dedicated to upholding evidence-based nutritional research and exposing figures who spread nutritional and scientific misinformation online. We dig into how social media can incentivize the spread of misinformation, why these systems need to change, and take a closer look at the growing community of evidence-based nutritional science experts and influencers online. Tuning in, you’ll learn how to identify legitimate scientific influencers, and what red flags you should look out for when trying to avoid misinformation. Kevin also breaks down key areas of misinformation including how to combat sun damage, the so-called harms of seed oils, and how saunas can realistically benefit your health. Combating misinformation online is a huge challenge, but we can all find ways to better navigate the online space by thinking critically and by asking the right questions. Tune in for this important conversation on nutritional science, social media, and much more!
Key Points From This Episode:
- Learn about the power of Magnesium Breakthrough by BioOptimizers.
- Introducing today’s guest, Kevin Bass.
- Kevin’s early encounters with medicine, misdiagnoses, and how it informs his perspective.
- How current systems incentivize misinformation in the nutrition space.
- The growing evidence-based community in nutritional science and on social media.
- What sets evidence-based nutritionists apart from their counterparts.
- Tips on how to discern which experts to follow online.
- The benefits and harms of sunscreen use, and suggested alternatives for sun protection.
- Some of the advantages of early morning sun exposure.
- An overview of general attitudes toward seed oils and what is based on fact versus emotion.
- The role of anti-nutrients in certain foods and how they can work synergistically with other elements to produce positive outcomes.
- Examples of how influencers misrepresent information to sell their products on social media.
- What regular blood work can teach you about your physiology and your risk factors.
- How using steroids as a health professional affects your credibility.
- An overview of saunas, their potential benefits and harms, and how to utilize them appropriately.
- The science behind cold exposure, weight loss, and building resilience.
Links Mentioned in Today’s Episode:
BiOptimizers
The Diet Wars
Kevin Bass on Twitter
Public Health Initiative Against Misinformation
Magnesium Breakthrough
Red Pen Reviews
Layne Norton
Peter Attia
Dr. Mark Hyman
Rhonda Patrick
The Peter Attia Drive Podcast
Andrés Preschel
Know Your Physio Podcast
Support the show"
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For the past few months, thanks to @derek_barbellmedicine (and thanks to @austin_barbellmedicine for referring me to him), I have seen big improvements in my back pain and stiffness, and I'm able to train my sport and lift with less pain than I thought possible.
I have been struggling with lower back pain for more than a decade, and the idea that simply strengthening and progressively overloading my back using the very movements that cause it to hurt has been a welcome challenge to my belief system.
For that reason, I couldn't recommend the folks at Barbell Medicine enough.
However I still have serious reservations about the kinds of programming and the culture of weight lifting, powerlifting, resistance training, etc. that I believe led to my back problems--starting in my teens--in the first place. I believe that intelligent programming is not communicated and that the fitness industry systematically overstates the benefits and downplays the risks associated with misuse of powerful barbell exercises.
By misuse, I mean an excessive emphasis on intensity, high loads, etc., with little to no supervision and minimal education about intelligent programming. Without that supervision or education, injuries are inevitable.
What the fitness industry does at this point is what I call "outsourcing of risk". It takes credit for all of the benefits of resistance training, sometimes overhyping them out of proportion to what an impartial evaluation of the scientific literature really shows, but then, when risk is discussed, blaming all of that risk on the misapplication of resistance training by the user.
What this common response to discussions about risk misses is that, if marketing and overhype take center-stage, and education about risk-reduction and appropriate programming is given short shrift, then the responsibility for harm is not with the user, but with the fitness industry that overpromises and undereducates--elevating both sales and rates of injury.
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In this video, I talk with Kevin Folta about glyphosate, Roundup Ready, Monsanto, GMOs, biotech, and science communication. We talk about some of the current controversies in agricultural science and try to explain how they came to be.
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Does lifting weights automatically make someone healthier?
Not so fast.
One recent study showed that current and former power athletes (wrestlers, judo players, and powerlifters) have higher rates of metabolic dysfunction than non-athletes, despite a lower body fat percentage and, for active athletes, a smaller waist circumference (PMID 30148100). See figure in post.
Being big and strong does not automatically make someone healthy. In fact, the opposite might be true.
With our culture’s current obsession with muscularity, isn’t it important to know that muscularity might come at the price of health?
Enter studies of the mortality rates of former athletes. Consistently and internationally, they show that endurance athletes have a marked longevity advantage, mixed athletes have a slightly lower longevity advantage, and power athletes have a much lower advantage, even in some cases dying slightly earlier than the general population (PMIDs 33368029, 23241272, 26301178, 28149523).
One study published last year, meta-analyzing studies of more than 165,000 athletes showed that power athletes do not live any longer than the average person in the population. In contrast, former endurance athletes enjoyed a full 35% reduction in risk of death at all ages (PMID 33368029).
A new paper even showed that longevity benefits were maximized at 1-2 hours of weight training per week, after which they declined precipitously and even increased above the average population at 3-4 hours per week. That’s right. The average gym bro lifting 3-4 hours per week had a higher risk of death at all ages than the potato chip bro playing Xbox. This was despite lower metabolic and diabetes risk, probably due to increased amounts of muscle mass (PMID 35228201).
It’s true that weight training helps to stave off sarcopenia, an important cause of declining quality of life among the elderly. But the benefits of higher muscle mass can be gained without needing to become a bodybuilder. In fact, it might be more healthy to hit the treadmill more and the weights less.
Learn more at THE KEVIN BASS SHOW.
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Do seed oils cause inflammation? Are heated seed oils bad for you? Are seed oils part of a global conspiracy by agricultural and pharmaceutical companies to ruin our health and profit from it? Kevin confronts these questions head-on in this podcast.
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In this episode, I have more fun with Bart Kay talking about nutrition and health. My connection this time is better. We end by disagreeing about LDL cholesterol and cardiovascular disease, a subject we will take up further in the next discussion.
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In this podcast, I debunk Paul Mason's nutrition science book chapter in the book Clinical Sports Medicine by Brukner and Khan. Through a critique of just the introductory section, I show that it is not a work of science. If Paul would like to see further debunkings of the other sections (which in many cases are worse), please let me know and I would be happy to do further videos.
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In this discussion, Bart Kay and I talk about on the ethics, environmental effects, paleoanthropology, and nutrition science of meat consumption.
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In this episode, I talk about how Joe Rogan recently lashed out at the agricultural scientist Kevin Folta when Kevin discussed an alternative interpretation of the scientific data that was different than the one that Joe preferred and was familiar with.
Following lockstep with Chris Kresser, an alternative health guru that has been deeply influential on Joe, Jhee has been misled to believe that all exposures to glyphosate are harmful, no matter how low the dose, and expresses anger and outrage that legitimate scientists disagree with him about this topic.
I point out that Bruce Ames more than 30 years ago wrote a very influential paper called "Dietary pesticides (99.99% all natural)" (PMID: 2217210), where Ames pointed out that many natural pesticides present in plants already constitute a much higher exposure of "carcinogens" than synthetic pesticides.
I also point out that regulatory agencies are nearly unanimous in agreeing that glyphosate is not carcinogenic, that glyphosate is much less toxic than many natural pesticides, and that the exposures to which consumers are subjected at thousands of times lower than the doses required for even mild biological effects.
In other words:
THE DOSE MAKES THE POISON.
Finally, I defend Kevin Folta and point out that he defends glyphosate not because he is paid by corporations (he isn't), but because glyphosate has made agriculture more efficient and safer and has helped feed millions of people. I point out that misinformation about glyphosate and agriculture can lead to higher food prices and less ability for farmers to feed millions of people.
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Cult-like behavior among groups that promote various health interventions or lifestyle practices is the norm. Such groups NOT being cult-like is extremely rare. These groups, no matter what they promote, overhype benefits and underplay risks. They condescend to outsiders; they engage in dogmatic proclamations; and they are highly resistant to new information that might challenge their black-and-white narratives.
In fact, criticism will often be interpreted as immoral, as encouraging people not to undergo the lifestyle practice or health intervention, and critics can risk a kind of quasi-religious “excommunication” from groups that have taken a strong public position on behalf of the intervention.
This occurs for vitamin supplementation, cold exposure, sauna, diets, medicines, exercise regimens, sunscreens, psychedelics, and much more. It occurs for interventions with strong overall scientific consensus for their use, and for interventions with much weaker evidence.
Two papers published in 2015 and 2017 explain part of this bias. In the 2015 paper (PMID 25531451), after looking at 37 research studies involving 27,323 patients it was shown that patients systematically underestimated harms and overestimated benefits. The paper concluded that “clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.”
The problem, however, was with the 2017 paper by the same group (PMID 28097303). This paper showed that the same phenomenon existed among clinicians: the very group that was supposed to provide guidance to patients themselves overestimated benefits and underestimated risks, just like patients.
Cult-like behaviors reflect, to some degree, a systematic bias in the minds of most people when they think about health interventions. We should work hard to make people, both clinicians and patients, aware of this bias so that everyone can make and promote better decisions.
Find the full episode on THE KEVIN BASS SHOW.
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In this episode, I look at press releases, posters, scientific publications, and @peterattiamd’s recent review of PR Lotion.
I show that the press releases announcing research do not link to any credible peer-reviewed research, despite Momentous-funded research apparently taking place at four separate research institutions. I show that the one peer-reviewed paper on PR Lotion (this one not funded by Momentous) showed no buffering capacity in the blood, no increase in bicarbonate in the blood, and no exercise performance improvement. Meanwhile, oral sodium bicarbonate (baking soda) showed robust changes in blood pH and bicarbonate, consistent with the experimental research.
The concept behind PR Lotion is that it would replicate the effects of oral sodium bicarbonate without the gastrointestinal effects, which prevent a minority of athletes from using sodium bicarbonate for the purpose of athlete performance. This would occur through direct absorption of bicarbonate through the skin.
The lack of pH buffering capacity in the blood or change in bicarbonate calls into question whether the proposed mechanism of PR Lotion—absorption of bicarbonate into the bloodstream—could even conceivably drive changes in exercise performance, even if they were ever demonstrated. And if such performance improvements were demonstrated, it would be unclear how these might be achieved without systemic absorption of the sodium bicarbonate, since PR Lotion is topical sodium bicarbonate.
I discuss Dr. Attia’s points, namely that positive findings were selectively highlighted, which may have been a statistical artifact. The rather harsh phrase characterizing this practice is called p-hacking. The fact that no peer-reviewed publications resulted from this research is suggestive that this is exactly what happened. After Dr. Attia’s critical post was published, many of the press releases and white papers were inexplicably removed from the Momentous website.
I conclude that there is no peer-reviewed evidence to show that Momentous’s PR Lotion works and some peer-reviewed evidence that strongly suggests that it does not.
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When it comes to promoting resistance training for health, lifting bros want it both ways.
They refuse to let anyone criticize any of their current lifting practices—despite an injury rate between 1-2 injuries per year for most strength sports [1]. They downplay increasing rates of body dysmorphia among men [2], eating disorders [3], and the psychological and physical risks associated with the lifestyles idolized by their communities [4-6].
In the same breath, they extol the health benefits of resistance training, comparing it to medicines, listing endless benefits.
Now imagine that there was a drug that produced 1-2 substantial injuries per year and did so for as long as the person took the drug.
Imagine that some of these acute injuries would eventually culminate in lifelong, chronic injuries. That’s 10-20 acute injuries per decade and some chronic injuries.
And that’s just on average.
And that’s just injuries.
Would many people forgo the drug, especially if it required a large amount of effort, every single week, to take? You bet ya.
So what explains the contradictions here:
Treating resistance training as if it were an extremely important tool for longevity, yet being extremely resistant to changing the culture around resistance training in order to reduce risk of harm and make it optimally healthy for the average person?
The answer is pretty simple: lifting bros simply enjoy resistance training and positive messages about it. But they don’t want to question what they are doing or promoting to make their messages fully coherent. They promote good news about resistance training, claiming that they want everyone to engage with it, but they don’t want to do the actual work of making it more accessible to the person who finds the toxic bro culture off-putting
This is not unlike the health communities that I have criticized in the past. In fact, it’s exactly the same phenomenon.
For making resistance training more popular, the resistance community is its own worst enemy.
PMIDs:
[1] 27328853
[2] 27930760
[3] 34712596
[4] 24494162
[5] 31818274
[6] 17506239
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Resistance training is frequently promoted online as if it has no risks or downsides.
But this is mainly because promoting resistance training like this advances the careers of those who use this kind of messaging.
It isn’t to benefit the their audiences. It’s to benefit the promoters.
And those of us who have been in the lifting game for a while know better.
Resistance training, while having important benefits to function especially later in life, increases the risks of a variety of health problems, including:
Body dysmorphia;
Disordered eating behaviors;
Psychological and physical harms due to disordered eating behaviors (e.g., aggressive bulking and cutting);
Joint damage and chronic injuries that undermine quality of life.
I argue that, in fact, the excess promotion of the benefits of resistance training, and especially more extreme, toxic, “macho” forms of it, increases the risks and harms associated with resistance training.
Indeed, the culture of machismo associated with resistance training online unnecessarily increases its health risks but makes it less accessible to the general population.
I love resistance training and I love lifting weights and being big.
But I would never promote something just because I love it.
I think glossing over the dark underbelly of resistance training does our audiences a disservice—and actually makes resistance training potentially more dangerous than it needs to be.
I believe that if we had a greater emphasis on promoting safe practices—rather than huge PRs, huge muscles, and the toxic ego-driven often associated with resistance training—we would benefit our audiences more.
Those of us who are interested in the health benefits of resistance training should also be interested in the harms. That’s the only way we will minimize the harms and maximize the benefits.
We need to put this goal above the goal of self-promotion.
Come at me, bros.
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In this episode, I ask the question: which diet would produce more nutrient deficiencies.
Using the nutrient calculator Chronometer, I am surprised to find that an all-whole wheat bagel diet actually produces fewer nutrient deficiencies than an all-ribeye diet.
If one was forced to choose between eating only wheat or meat, and one was aiming at the most nutritious diet, the answer is clearly to eat only wheat.
Even more surprisingly, a diet consisting of 43% calories from lentils, 43% from wheat, 9% from almonds and 5% from broccoli, carrots, and sardines produces an almost perfectly nutritious diet.
So why are Paleomyths about meat being more nutrient-rich than plants so widespread, despite the actual story being much more complicated (to say the least)?
My guess is that this is largely motivated by modernity anxiety. For all of human history, humans have idealized and romanticized simpler ways of life, as exemplified by our hunter-gatherer ancestors. We imagine our hunter-gatherer ancestors all ate large quantities of meat. It follows that we should eat meat. We therefore look for sciency-sounding reasons for this belief. Folks like Chris Kresser, Robb Wolf, and Mark Sisson all provide these sciency-sounding reasons. Because this is what we already believed anyway, and we are just looking for reasons to believe it, instead of critically evaluating what these bloggers write, immediately we think “ahhh so that’s why!” We are already primed to believe, not to question. And so we believe. Or at least, once upon a time, I did.
The reality is that the role of plant foods in our ancestors’ diets is substantially more complicated than these writers let on. For instance, near-universal presence of wild grain/legume residues have been documented over the course of the Paleolithic, >100K years, i.e. ubiquitous presence of these foods during human evolutionary history.
Suffice to say, every scientific field is more complicated and richer in controversy than we think at first. Often, we first access a scientific field via a popular writer who tells a good story and appeals to pre-existing beliefs to sell that story. Yet no matter if they are a New York Times bestseller or a famous columnist or respected by large popular audiences on the Internet, we should always be skeptical of the new things we learn, especially if they resonate with and make sense of what we already believe. Unless we are aware of and have critically assessed the relevant body of scientific literature, there is no way whether we are being sold a good yarn or something with strong basis in scientific fact. Until we know better, we need to proceed through life with the assumption that most of what we know is simply a “best guess” based upon “something that we heard that sounded credible”. Because that’s all it really is. My journey through nutrition science, especially with respect to grains, carbohydrates, meat, etc., has taught me that over and over again.
===
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This episode examines the purported connection between obesity and COVID outcomes.
While obesity does somewhat worsen COVID outcomes, the impact is modest and dramatically overstated.
These data have also been weaponized by antivaxxers and politicians for cynical ends.
Many COVID-obesity narratives create a false dichotomy between vaccination and obesity, suggesting that what we really need is to fight obesity, not vaccinate.
Let us look at the data.
First, mild obesity confers only a very modest, almost undetectable increased risk of death, and severe obesity gives a risk comparable to being male or black. Even severe obesity is outshined by simply having 2-5 medical conditions, or being an organ transplant recipient (PMIDs: 32640463, 34197283).
Now let's compare all of these to vaccination status. Obesity and vaccination are not even in the same ballpark. Obesity provides paltry additional risk compared to being unvaccinated (PMID 34529637).
For completeness, let us compare all of these to age. We can see that not only does age dominate, but it dominates overwhelmingly.
COVID deaths are driven by age first, unvaccinated status second, the presence of serious medical conditions third, and then by an equal mix of obesity and other risk factors like being black, being underweight, being male, etc.
A common statistic bandied about: "80% of deaths/complications/etc. are in people with obesity!!!"
Actually, the stat is: 78% of Americans hospitalized for COVID are overweight or obese.
But here’s another stat: 74% of American adults are overweight or obese.
In other words, the % of obese people in the hospital with serious Covid roughly matches the % of obese people in the US. Therefore you can’t point to the % of obese people and say it was caused by obesity, because the sick folks simply mirror the available population.
Media outlets have pushed this statistic, despite it actually showing that obesity doesn’t have much of an impact on COVID, because it drives clicks and advertising revenue.
Don’t let this trash colonize your mind.
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In this episode, I discuss facts and myths about Ancel Keys.
If carbs are the cause of obesity, as they are for many (non-scientist) diet book authors, then someone is responsible for making us eat so many carbs.
Ancel Keys provides a convenient enemy. He provides a unitary target, a sole cause, a single demon, one story.
But how TRUE is this story? Let us review.
First, it is claimed that Ancel Keys cherrypicked his Seven Country Study: he had access to the data for 22 countries but chose to include only 7.
This is wrong. Keys selected 6 countries from publicly available data to show a relationship between saturated fat and heart disease. Two of his critics plotted an additional 16 countries showing the relationship was in fact weaker if these new countries were included, but still valid (PMID 33496369).
In any case, this selection of 6 countries out of 22 predates the famous Seven Countries Study PMID (33496369).
The SCS included only seven countries because only investigators from seven countries agreed to collaborate with Keys.
Keys would have liked to have had more countries included. Indeed, it is claimed that Keys purposefully excluded France. However, France was invited: PMID 29121230.
Keys has been accused of misanalyzing the data from Greece during Lent. This is also false. PMID 29121230.
Indeed:
-
Keys's work had limitations of which he was aware;
-
We are right to be skeptical of the conclusions of that research in isolation;
-
Yet Keys's research was carefully conducted, and with integrity.
It is claimed that Keys ignored the relationship between sugar and heart disease, derailing Yudkin’s career.
It is true that Keys was not gentle to Yudkin, but the data at the time did not favor Yudkin's hypothesis. PMID 33496369
(It does not appear to us that the data favored either Keys or Yudkin's views.)
Keys would later promote a dietary approach that went beyond saturated fat and blood cholesterol: the Mediterranean diet. PMID 33496369
Finally, some of Keys’s major achievements (PMID 33496369).
Conspiracy theories about Keys are propagated by diet book authors to try to control weak-minded followers.
Don't fall for it.
===
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In this episode, I respond to the critical reviews on my podcast.
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It is now widely accepted that eggs have no meaningful impact on blood cholesterol levels. Dietary cholesterol is said not to impact blood cholesterol.
But is this true?
The impact of eggs on dietary cholesterol—and health—really depends on background diet and genetics.
Now, it’s true that the impact of dietary cholesterol on blood cholesterol is quite modest [1], and it only impacts about 20-30% of the population [2]. But, on the other hand, almost nobody knows whether they are in that 20-30%, so some caution might be warranted in those who are pursuing optimal health and find their LDL cholesterol levels a little high.
In the context of unhealthy diets, eggs actually seem to produce benefit, since they replace less healthy foods.
But in the context of healthier diets, eggs may be slightly harmful, by displacing healthier foods that have a lower impact on dietary cholesterol.
Overall, the impact of eggs on health seems heterogeneous and may depend on the baseline diet: more healthy diets may seem more harm if eggs are incorporated, and vice versa [3,4].
If LDL cholesterol is a little high, and diet quality is otherwise excellent, it might be advisable to try replacing the eggs with another source of protein that is lower in dietary cholesterol.
Ideally, this should be done using a lipid test to look at before and after values of blood LDL cholesterol.
PMIDs
[1] 30596814
[2] 24466502
[3] 32132002
[4] 35360933
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A study looking at people with genetic variants that mimic the effect of statins and PCSK9 inhibitors showed significantly worse cognition and brain area among those with the statin variants. This suggests that statins may negatively impact the brain (PMID 35953131).
This suggests that important benefits to cerebrovascular disease may be counterbalanced by other negative effects on the brain by statins through other mechanisms.
An important caveat to the study is that while these statin-mimicking variants are expressed everywhere in the body in people who have inherited them, different statins have a different degree of selectivity for the liver versus other tissues (such as the brain).
Statins that are selective for the liver are called hydrophilic, while those that are nonspecific and inhibit HMGCR in all tissues (including the brain) are called lipophilic.
This is because lipophilic statins freely travel across cell membranes, while hydrophilic statins need to be transported into liver cells using transporters (OATP1B1, OATP1B3, OATP2B1, BCRP, and MRP2) expressed only in the liver (PMID: 29051147).
Interestingly, another recent study found that statin users with mild cognitive impairment using lipophilic statins had an increased risk of converting to dementia compared to non-users and users of hydrophilic statins (https://jnm.snmjournals.org/content/62/supplement_1/102).
This same study found using FDG PET a decline in metabolism in several regions of the brain important for cognition in those using lipophilic statins but not non-users or users of hydrophilic statins.
While no strong, gold standard evidence implicates lipophilic statins as harmful for brain health, given the wide availability of similarly priced alternatives, these findings might suggest that hydrophilic statins should be preferred to lipophilic ones whenever possible.
The hydrophilic statins are pravastatin (Pravachol) and rosuvastatin (Crestor), while the lipophilic statins are fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), simvastatin (Zocor), atorvastatin (Lipitor), and pitavastatin (Livalo).
===
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In this episode, I provide critical, science-based answers to the following questions:
- Don’t traditional clinical tests miss the glucose variability that can only be detected by CGM?
- Doesn’t high blood glucose predict heart disease, cancer, Alzheimer’s disease, etc.? So, this is a reason for non-diabetics to use continuous glucose monitoring (CGM), right?
- Doesn’t high blood glucose variability predict heart disease, cancer, Alzheimer’s disease, etc.?
- OK, but although we don’t know exactly what the cutoffs should be for blood glucose spikes, doesn’t simply reducing blood glucose provide a benefit?
- Wait, I thought that CGM simply helped people to eat in a healthier way? Lowering carbohydrate is not necessary right?
- But don’t responses to each particular food differ from person to person?
- Doesn’t reducing glucose spikes reduce hunger?
- But I feel that CGM benefits me personally. Are you saying I cannot use CGM
- What harm could there be from using CGM as a nondiabetic?
I conclude that there is no evidence of benefit, no evidence for what CGM readings mean, and that the use of CGM to make nutritional choices could cause harm.
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In this episode, I explain why @drandygalpin's defense of the deadlift is actually a clear demonstration that it is a dangerous lift.
Specifically, he notes at least four conditions that must be met for the deadlift to be safe: appropriate positioning, volume, intensity, and complexity.
I note that it is difficult to meet those conditions consistently in the long-term while still progressing on the lift. More importantly, it is very difficult to know how to meet those conditions while still training hard enough to make progress: how much training is enough, and how much training is too much?
This becomes even more complex and difficult when adding outside stressors and other, often unpredictable training volume in the activities of athletes.
Doing this consistently weekly over the course of decades without making an error becomes even more difficult.
Additionally, I note how much training is too much may be individual, but more importantly, that the four conditions that Andy lays out are actually not the only conditions mentioned by many experts: there is a controversy in this area because the evidence about what causes injury from the deadlift is sparse.
This makes it even less clear whether safety can be ensured by controlling the variables that Andy mentions.
I draw an analogy with a gun—a gun is inherently dangerous but can be made safe with the proper stewardship. I point out that what proper stewardship for a deadlift is, is quite unclear.
Andy says that if someone gets injured from the deadlift, it is their or their coach’s fault. I note that most people do not have the knowledge that Andy has, nor a coach like Andy, and that even if he was right, in the real world many laypeople are ill-equipped to manage training in the way that Andy outlines.
I make the pragmatic argument: why not simply use less dangerous lifts that can produce the same benefit, without needing to manage half a dozen variables to avoid injury? The necessity of managing so many variables to avoid injury does not exonerate the deadlift: it clearly demonstrates its inherent danger.
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In this episode, I discuss why the evidence pyramid is a misleading and sometimes an unscientific way to interpret evidence; why anecdote is sometimes right; and why expert opinion is always the final word.
Specifically, sometimes systematic reviews and meta-analyses of randomized controlled trials are misleading, either designed improperly or using bad data. An excellent example of this is the Ivermectin systematic review and meta-analysis of randomized controlled trials that purported to show that Ivermectin was a useful treatment for COVID-19 in late 2021. This meta-analysis, published in a reputable journal (PMID 34145166) took the Internet by storm when it was used by Ivermectin promoters to show that Ivermectin was effective for COVID-19. It was later shown to have used fraudulent data (no fault of the paper authors), which biased the results and resulted in false conclusions. This gold standard study design spit out a false result which would have misled countless clinicians and resulted in harm if it had been implemented in clinical practice.
This demonstrates that such gold standard study designs cannot be taken at face value. Systematic reviews and meta-analyses are not "gold standard" but rather exist along a continuum of quality.
Similarly, anecdotes, such as the one used by Barry Marshall to establish that H. pylori caused gastric ulcers, are sometimes admissible when the rules of causal inference are followed cautiously. Other times they are not admissible, as with many nutrition anecdotes. It depends on the details of the anecdote. At the high-quality end of "anecdotes", we have N-of-1 trials, which are serious scientific tools.
What all of this establishes is that "high-quality" methods can sometimes be wrong, and "low-quality" methods can sometimes be preferred. All of these require expert methods to properly evaluate and arrive at appropriate conclusions. There is, in a word, no cookbook approach to science, and all good science ultimately depends on competent expert opinion.
In this part of an interview with Gavin Meenan, I cover the main research on the organic vs. non-organic produce debate.
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What I eat and why, part 2
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It is in vogue in resistance training circles to only publicly promote the benefits of resistance training while avoiding any mention of downsides. The rationale that mention of downsides and risks will discourage people from resistance training.
In this video, I talk about my journey in resistance training and how my overzealous application of training in my early training career led to or accelerated the development of lower back problems and other injuries. I talk about how I wish I had had more cautious minds in my corner when I first started training, and how I think the resistance training community could do a better job about this. I talk about the methodological problems in a commonly cited meta-analysis. I call for more public discussion of how common injuries are in resistance training, especially its more competitive forms.
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SHOW LESS
In this video I provide an update and explain what's next for the Youtube channel and podcast.
In this video, by looking at press releases, interviews, and scientific papers, I show very clearly that the FDA does not specifically endorse the use of chemical sunscreen nor does it call chemical sunscreen safe. Rather, FDA explicitly says that chemical sunscreens are NOT Generally Recognized As Safe and Effective (GRASE), allowing their use only as a kind of grandfathering until safety data has been obtained over the next few years, in light of recent data suggesting that blood concentrations exceed those at which automatic safety is granted to chemicals from sunscreens. Indeed, if companies do not submit adequate safety data in the coming years, FDA has threatened to remove approval of these sunscreens. FDA very strongly endorses the use of sunscreen but leaves it deliberately unclear whether this should be chemical or mineral sunscreen. Senior scientists at the FDA, press releases from FDA, editorials in JAMA, etc. all make it clear that titanium dioxide and zinc oxide sunscreens are a viable alternative to chemical sunscreens for those who are concerned about the current lack of data, until such data are forthcoming. Neutrality with respect to chemical sunscreens and a recognition that chemical sunscreens are of unclear safety is the current position of the FDA—not an endorsement of chemical sunscreens. Having the position that one might prefer to use mineral sunscreen rather than chemical sunscreen until better safety data are available is neither imprudent nor is it misinformation out of line with the position of regulatory agencies.
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In this clip from a discussion with @gavinmeenan, I talk about the research on the cognitive and emotional impact of intermittent fasting.
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In this clip of a discussion with @gavinmeenan, I talk about the use of intermittent fasting as a "beginner's" dieting strategy.
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In this clip of a discussion with @gavinmeenan, I talk about why the impact of sauna and cold exposure on growth hormone is meaningless.
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In this clip of a discussion with @gavinmeenan, I talk about what the research says about the relationship between intermittent fasting and testosterone levels.
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In this clip of a discussion with @gavinmeenan, I talk about what the research says about the relationship between sauna, testosterone, and (in)fertility.
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In this clip of a discussion with @gavinmeenan, I discuss the most common cause of low testosterone in men.
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In this clip from a discussion with Gavin Meenan, I discuss the relationship between testosterone and blood cholesterol levels in men.
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In this clip with @gavinmeenan, I talk about human chorionic gonadotropin (HCG), a potential alternative to testosterone for the purpose of hormone replacement therapy in men.
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In this clip from a discussion with Gavin Meenan, I give an overview of the risks and benefits of vitamin D supplementation.
===
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In this clip from a discussion with Gavin Meenan, I give an overview of the risks and benefits of creatine supplementation.
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In this clip of a discussion with Gavin Meenan, I discuss the role of dietary protein in weight loss and in the optimization of body composition. Specifically, I note that dietary protein enhances nutrient partitioning between fat and muscle but plays only a minor role in the regulation of body weight.
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In this clip with Gavin Meenan, I go over the basic facts about the causes of obesity as well as some of the major myths propagated online by self-proclaimed experts.
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From original description:
"When it comes to nutritional science and social media it can be uniquely challenging to differentiate fact from hype. Here today, to help us unpack the topic of scientific influencers and misinformation is Kevin Bass, an MD and Ph.D. student, and founder of The Diet Wars, a site dedicated to upholding evidence-based nutritional research and exposing figures who spread nutritional and scientific misinformation online. We dig into how social media can incentivize the spread of misinformation, why these systems need to change, and take a closer look at the growing community of evidence-based nutritional science experts and influencers online. Tuning in, you’ll learn how to identify legitimate scientific influencers, and what red flags you should look out for when trying to avoid misinformation. Kevin also breaks down key areas of misinformation including how to combat sun damage, the so-called harms of seed oils, and how saunas can realistically benefit your health. Combating misinformation online is a huge challenge, but we can all find ways to better navigate the online space by thinking critically and by asking the right questions. Tune in for this important conversation on nutritional science, social media, and much more!"
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In this clip from a live IGTV I did with @muscle__master. He asked what I thought about TRT after the age of 40, especially from a muscle-building perspective. This was my response.
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In this clip taken from a live IGTV with @muscle__master, I discuss how frequent testosterone injections for testosterone replacement therapy should be, as well as how "physiological" the typical TRT dosages are. I note that wide fluctuations in testosterone can produce side effects that may be mitigated by more frequent injections. However, more frequent injections are also inconvenient, so therefore represent a tradeoff.
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In this podcast clip that I did with @muscle__master on IGTV, I break down how Rhonda Patrick is getting--and got--things so wrong with vitamin D.
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There are many widespread myths about metformin as a longevity or performance-enhancing agent. In this podcast clip for a live IGTV that I did with @muscle__master on Instagram, I break down some of the science around the alleged performance-enhancing benefits for athletes--and why taking metformin might not be such a great idea if you are an athlete or bodybuilder and do not have diabetes.
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In this episode, I summarize my points about Huberman's dangerous and ignorant salt recommendations, pointing out his motivations, how he misuses the evidence, and what the evidence actually says
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In this podcast clip that I did with @muscle__master on IGTV, I break down various ways in which Paul Saladino is wrong about saturated fat, polyphenols, and so-called plant toxins according to the best evidence.
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In this episode, I cover all of the major randomized controlled trials looking at sodium reduction. I show a consistent pattern between these trials--that sodium reduction and potassium enrichment reduces cardiovascular mortality, including heart attack and stroke. I explain some ways to leverage this knowledge to reduce your risk of death, extend your life, and enhance your mental and physical longevity.
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In this episode, I discuss Inclisiran, an injectable PCSK9 inhibitor that produces dramatic LDL cholesterol reductions with just two intramuscular injections per year. I spell out the implications of such a dramatic reduction in LDL cholesterol and point out the massive potential impact that this might have on the future of cardiovascular disease prevention.
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In this episode, I cover a 2021 study (PMID: 34531021) that shows that most statin-related muscle side effects are actually caused by the placebo effect. When participants in this crossover trial were assigned to placebo, they experienced nearly as many muscle-related side effects as they did when they were assigned to received a statin. The side effects were also of the same intensity. There may be a small increase in the incidence of side effects on statins versus placebo, but the large majority of muscle-related side effects are due to expectation bias—they’re not real. This has important implications for patients and clinicians using statin therapy.
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In this episode, part 3 of the Huberman salt episode debunking, we dive deeper into the sources that Huberman uses and why they are not considered legitimate by scientists. As we saw in parts 1 and 2 (and will see in subsequent parts in more detail), Huberman seems to draw from the LMNT website to make his scientific case. In this part, we examine his previous invocation of Gary Taubes and why Taubes’s case is no longer plausible or legitimate in the wake of new scientific evidence. We also examine James DiNicolantonio, DiNicolantonio recent co-authorship of a book with Joseph Mercola (who recently received serious legal threats from the Biden administration), and the comprehensive, systematic, scathing dissection of DiNicolantonio’s book by Red Pen Reviews. We conclude with a brief overview of the latest randomized controlled evidence supporting the causal link between high sodium intake, high blood pressure, and cardiovascular disease, as well as the clear and demonstrated benefit of substituting potassium for sodium for preventing cardiovascular disease and death.
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This video, part 2 of the video series on Huberman’s episode #63, will focus on a few of Huberman’s broad claims. Here is a rough outline of what will be discussed in this series, of which part 2 will be the beginning of the remainder (which will ultimately be 6 to 10 parts):
- First, I will introduce the podcast.
- Second, I will talk about the sodium paradox, which Huberman bases his claims about the healthfulness of sodium on. I will talk about the health paradoxes more generally. I will explain why they are not reliable pieces of evidence.
- Third, I will discuss the designs, strengths, and weaknesses of randomized controlled trials versus observational studies. I will show that randomized controlled trials indicate that these health paradoxes are fallacious. I will dive into the details of the sodium paradox studies in particular, and explain how Huberman gets things wrong here.
- Fourth, I will discuss the arguments made by Huberman that because animal models show anxiety on low-sodium diets, therefore humans could benefit from higher sodium in their diets. I will show that Huberman misuses these studies.
- Fifth, I will examine the claim made by Huberman that because Andy Galpin recommends a high electrolyte intake during physical activity, such an intake is justified at all times. I point out that Huberman provides no evidence that electrolyte replacement is required to optimize cognitive performance; and that Galpin’s claim pertains only to physical performance.
- Finally, I address Huberman’s discussion about the importance of sodium in neurons. I simply point out that the evidence indicates that Americans dramatically overconsume sodium, and again, I provide evidence that this is the case.
First, I will introduce this podcast. Specifically, I want to extend upon the connection between Dr. Huberman’s claims and those on the LMNT website. LMNT is one of Huberman’s main sponsors and provides 15% commission on each sale using Huberman’s link. Huberman recommends that people should buy and consume LMNT salt-containing products. Now this podcast by Huberman covers all of LMNT’s ingredients and only LMNT’s ingredients: sodium, potassium, and magnesium, suggesting that this Huberman podcast was made for the purpose of selling LMNT supplements, as I discussed in part 1. What’s more interesting however is that the pivotal study on which Huberman hangs his hat is precisely the same one as the one featured prominently on the LMNT website. This suggests that Huberman decided to directly make use of LMNT’s marketing materials.
Interestingly, there is a good deal of misinformation on the LMNT website, which is also reflected in the details given in Huberman’s podcast: Huberman makes the same interpretative errors. For example, the LMNT website misreports that the average American salt intake is just 2.3 grams daily. This is wrong on several levels. First, the 2.3 gram per day intake is the recommended intake of sodium for Americans. It is neither the average intake of salt, nor is it even the recommended intake of salt. It is the recommended intake of sodium. This recommended intake of salt is actually 5.75 grams of salt, not 2.3 grams of salt. Interestingly, Huberman at 54 minutes into his podcast repeats this error made by LMNT, claiming that the salt recommended by the guidelines is equal to half a teaspoon. This is incorrect. The basis of Huberman’s mistake is probably LMNT marketing materials. At 5.75 grams of salt, the recommended intake is more than na full teaspoon. And indeed, the amount of salt that Americans eat is actually 8.5 grams, or nearly 2 teaspoons, corresponding to about 3500 milligrams of sodium. It is not, as Huberman says, half a teaspoon.
Strikingly, however, this two teaspoons this is exactly how much Huberman recommends consuming on his episode, at 1 hour, 34 minutes, 37 seconds, i.e. the amount of salt already consumed by Americans. Despite this, Huberman claims that “for most people, a moderate increase in salt intake is not going to be detrimental provided that you consume enough fluids, in particular, water” at 1 hour, 2 minutes, 21 seconds.
Which is it? Should Americans consume more salt? Or are they consuming enough? Indeed, Huberman seems a little confused on this point. He starts the podcast by warning about high salt intakes repeatedly. Then he mentions that people in certain disease states benefit from higher salt intakes. Then he points out that Andy Galpin recommends additional salt for serious, exercising athletes. Then he extrapolates from that to say that everyone would benefit from more salt for cognition. There is a lot going on here. We discuss some of that here. We will discuss more in the future parts of this series.
===
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In this episode of The Modern Warrior Podcast, Gavin Meenan interviews Kevin Bass.
In less than an hour, we talk about creatine, vitamin D, testosterone boosters, TRT, cholesterol, organic, protein sources and body comp and weight loss, intermittent fasting and cognition, eggs, etc.
Listen in for a feast of densely packed information.
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In this episode, I lay out the basic rhetorical and scientific structure of the podcast episode "Using Salt to Optimize Mental & Physical Performance | Huberman Lab Podcast #63", Dr. Huberman's conflicts of interest (he earns 15% for each purchase from his affiliate LMNT), and explain the context of the different pieces of content presented in this podcast.
This serves as an introduction for part 2, where I will continue explaining how the rhetorical structure of the podcast unfolds as I also begin analyzing what is in my view Huberman's misuse of studies used to support the dangerous recommendations he makes.
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In this episode, I dissect a 2013 study showing that soy protein blunts increases in post-resistance training testosterone in men (PMID 24015701). I discuss the implications of this finding in the context of a meta-analysis that suggests that soy does not affect testosterone in men (PMID 33383165), as well as the debate about the role of post-exercise hormonal changes in exercise adaptation to resistance exercise (PMID 24136137). Finally, I discuss a recent study showing no difference between plant and animal protein in exercise-induced muscle hypertrophy (PMID 33599941), namely its having been conducted in untrained individuals in whom the magnitude of "newbie gains" will tend to overwhelm and negate small effects that might the differences in protein quality (i.e. whey versus soy) may have on muscle hypertrophy. I argue that for intermediate and advanced trainees, an evidence gap continues to exist that requires mechanistic considerations to "fill" until appropriate randomized controlled trial data becomes available to better inform our decisions.
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In this episode, I show that all dietary guidelines in all countries of the world are essentially the same and are in many cases identical. Nonetheless, there is a massive variability in the prevalence of obesity, from 1.4% to 42%, despite these nearly identical guidelines. I show furthermore that the time elapsed since the implementation of the guidelines also has no impact on the rate of obesity in any given country. It follows therefore that the dietary guidelines have no impact on obesity in any country, and that other factors govern the prevalence of obesity. Changing the dietary guidelines will not materially impact the obesity epidemic.
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In this episode, I analyze 12 figures to show that the Chinese obesity epidemic is largely attributable to increases in dietary fat, specifically from pork. I follow this up by commenting on the work of Barry Popkin, suggesting that the Chinese dietary changes are part of a broader, nearly universal trend known as the nutrition transition.
Sources:
https://www.fao.org/faostat/en/
jstor.org/stable/2938388
PMID: 28802307, 27295015, 24341757
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In this episode, in contrast with a widespread conspiracy theory, I show that the dietary guidelines do not promote junk food and that Americans have ignored the dietary guidelines by eating refined grains and sugar far in excess of them.
Sources:
https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/
https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
https://health.gov/dietaryguidelines/1980thin.pdf
https://www.ers.usda.gov/amber-waves/2017/july/us-diets-still-out-of-balance-with-dietary-recommendations/
PMIDs: 20702750
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In this episode, I show that Americans do not care about or follow the dietary guidelines. Therefore the dietary guidelines could not have caused the obesity epidemic. The belief that the dietary guidelines contributed to the obesity epidemic is contradicted by the available evidence and is a conspiracy theory.
References cited (in the order mentioned):
https://ers.usda.gov/data-products/food-availability-per-capita-data-system
http://www.nber.org/papers/w16252.pdf
https://www.fao.org/faostat/en/
https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/
https://www.ers.usda.gov/amber-waves/2017/july/us-diets-still-out-of-balance-with-dietary-recommendations/
https://blog.aicr.org/2017/06/13/processed-foods-calories-and-nutrients-americans-alarming-diet/
https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
PMIDs (in the order mentioned0: 23426032, 24130784, 20702750, 23363999
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In this episode, I show how sugar intake has declined dramatically for two decades. I explain what this means for the belief that sugar intake is the cause of the obesity pandemic (it isn't).
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In this episode, we look at the USDA food availability data and show that most of the added calories in the American diet over these years have been from soybean oil. I discuss the implications.
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This episode goes over the myths and science behind the causes of diabetes and how it is reversed. By dissecting a recent paper written by physician Dr. Tro Kalayjian, it shows how one can easily be misled by the idea that carbohydrate is the cause of diabetes and thereby choose suboptimal management strategies—and it discusses what the latest science actually says and how to best manage diabetes--and its reversal--using that science.
Reversal occurs via weight loss. Liver and pancreatic fat are preferentially lost. This loss in liver and pancreatic fat drives the reversal of diabetes.
Dr. Tro Kalayjian claims to have demonstrated, using case studies, that carbohydrate intake, independent of weight loss, causes diabetes (PMID: 34262925). This is a widespread myth. But do his case studies show that carbohydrate restriction can produce comparable effects to weight loss for diabetes?
They do not. Indeed, the weight lost by his patients is similar to the weight lost in other studies showing similar improvement in diabetes. In other words, Dr. Tro is showing what the science already knows: modest weight loss in diabetes causes big drops in blood glucose (PMID: 21656330).
Moreover, if Dr. Tro had encouraged his patients to lose more weight, they might have completely reversed their diabetes: magnitude of weight loss is directly related to the odds of reversing the disease (PMID: 31097391).
We hope that this podcast can encourage viewers and listeners to consider the latest science in determining the best course of action in the management of diabetes. Type 2 diabetes is reversible—but only if one understands what causes the disease and what specifically will best reverse it.
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In this episode, I explore the links between sun exposure, skin aging, skin cancer, and seed oils. Paul Saladino, the Carnivore MD himself, makes a special cameo, as he denies the role entirely of sun exposure in accelerated skin aging.
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This was the question that Dr. Mike Hart asked me during our recent interview.
This was my answer.
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Dozens of papers have shown an association between low LDL cholesterol levels and an increased risk of death (for example, PMID: 33293274), now for over half a century. Yet we are told that lower LDL cholesterol is good for us. Which is it? Why do doctors and scientists advise the reduction of cholesterol if lower cholesterol causes a higher risk of death?
In this podcast, I explain the association between low LDL cholesterol and an increased risk of mortality. Specifically, it is probably due to confounding by age-related chronic illnesses, which in turn causes a reduction in eat, and therefore calorie restriction and malnutrition (PMID 33293274) and therefore reduced cholesterol (PMID 4828569, 15096581). I explain that weight loss near the end of life is a normal part of age-related disease, probably universal in mammals, and that weight loss indeed does indicate the end of life (PMID 24941891). In other words, chronic illness causes death, but it also causes malnutrition weight loss which causes low cholesterol. The lower cholesterol levels and the higher risk of death are each independently caused by chronic illness, rather than the higher risk of death being caused by the lower cholesterol.
We know this especially by meta-analysis of randomized controlled trials looking at the effect of cholesterol-lowering medications on the risk of death. These trials very conclusively show that cholesterol-lowering medications directly reduce the cause of death (PMID 28444290, 29677301).
So while chronic illness may reduce cholesterol levels, chronic illness has a much more deleterious effect on risk of death than the reduction of cholesterol has. Direct reduction of cholesterol is beneficial. Cardiovascular disease is the leading cause of death in the United States (as well as erectile dysfunction). Therefore, all else equal, when one can reduce cholesterol, one should do so to optimize cardiovascular disease risk.
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In this clip, I talk with Dr. Mike Hart about some of the research about lifespan and heat shock proteins that puts some of the hype about sauna and heat shock proteins into perspective.
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I did this podcast with Zach Bitter last week, for his podcast's 300th episode.
\We talked a lot about diet and health anecdotes, diet adherence, placebo, n-of-1, protein and performance, iron and heart disease risk, a bit about seed oils, and the insane hype buzzing around semaglutide.
Check it out.
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Dr. Mike Hart interviewed me on his podcast last Friday. We did an insane amount of content in less than an hour on: sauna, heart disease, blood tests, why I think everyone who can should take a statin, optimal salt intake, and more. This is that podcast in full.
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The Game Changers, a best-selling documentary from iTunes and Netflix, promotes ethical veganism under the guise of health. In this review, I break down the narrative approach that the film uses to achieve this deception.
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In this episode, I talk about why I take a statin even though I am in my 30s and have no major risk factors or short-term risk of cardiovascular disease, and why I believe everyone should do the same. The main reason is this: cardiovascular disease is the number one cause of death in the United States. It remains a major cause of death and disability even in my demographic. In one paper published in the Journal of the American Medical Association, one of the most important medical journals in the world, in 2012, men at age 45 who had risk factors that were all optimal (systolic and diastolic blood pressure <120 and <80 respectively, total cholesterol <180 mg/dL, no diabetes, and no tobacco smoking), still had a risk of having a cardiovascular event of 15% by age 80. Men with just one risk factor that was not optimal had a risk of a full 35% by age 85 (PMID 23117780). Subclinical atherosclerosis, which affects quality of life, sexual, and physical functioning, is even more prevalent than these figures indicate. Why should anyone take any chances? Take a statin.
We know that statins reduce cardiovascular risk regardless of whether or not lipids are elevated. This is because LDL cholesterol is necessary for atherosclerosis. The lower LDL cholesterol goes, the more risk is reduced in a log-linear relationship, regardless of baseline risk, with larger risk reductions the longer one’s lipids are lower (PMID 28444290). The benefits of LDL reduction are cumulative. This is because impact of LDL cholesterol on cardiovascular disease risk is itself cumulative, similar to pack-years in tobacco smoking. Although there is scant evidence for the prevention of cardiovascular disease in people younger than 40, such an approach is supported by a convergence of evidence. Indeed, as an article called “Time to Relax the 40-Year Age Threshold for Pharmacologic Cholesterol Lowering” published in the Journal of the American College of Cardiology points out: “LDL-C exposure in early adulthood may pose greater risk than the same level of exposure later in life” (PMID 34763773). Current guidelines on statin treatment are excessively conservative and at odds with the currently available body of evidence.
What’s more, the side effects of statins are minimal and dramatically overstated in the popular media. As a classic meta-analysis by Feingold and colleagues of 29 randomized controlled trials involving more than 83,000 patients showed, “only a small minority of symptoms reported on statins are genuinely due to statins” (PMID 24623264). And a paper published this month showed very clearly that even intensive lipid lowering of LDL cholesterol levels below 40 mg/dL due to statins produced benefits that far exceeded risks. The risks are even smaller in those treated with the newer classes of lipid-lowering agents such as ezetimibe and the PCSK9 inhibitors (https://doi.org/10.1093/ehjopen/oeac038). Indeed, the injectable PCSK9 inhibitor inclisiran, which requires treatment only twice per year, halves LDL cholesterol and is a candidate for universal lipid reduction such as I am proposing.
In my case, I take 2.5 mg of rosuvastatin and 5 mg of ezetimibe, a combination therapy that produces most of the LDL-lowering effects of higher doses while minimizing side effects. I experience no side effects whatsoever, despite a highly active lifestyle as a combat sports athlete. To me it only seems obvious. For people who experience a similarly non-existent side effect profile of lipid lowering, I think the decision to use these drugs to minimize long-term cardiovascular disease risk is cut-and-dry. Everyone should try it and do it if they can tolerate it.
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In this episode, I demolish core arguments underlying Paul Saladino’s belief system.
Summing up his argument:
Plants contain compounds that produce some benefits. However, they have some downsides as well. Therefore, get nutrition from animal foods that do not have these downsides and obtain health benefits from heat, sauna, cold, exercise, sunlight, fasting. Forgo eating plants.
This argument is fallacious for two main reasons:
-
Plant food toxicity is dose-dependent. The body maintains homeostasis in response to small perturbations.
-
All modalities recommended by Paul also have potential downsides.
a. Animal foods. Birth defects due to vitamin A (PMIDs 7477116, 22516730), copper toxicity (PMID 31832729), iron toxicity (PMID 8943168), excess B vitamins (PMIDs 16531613, 16531614), and the heart disease-promoting properties of saturated fat (PMID 28444290).
b. Animals housed at higher temperatures have a shortened livespan (PMID 35288719).
c. Overexpression of heat shock proteins in rats reduce lifespan (PMID 19072255). Sauna undermines male fertility (PMID 23411620).
d. Cold exposure does not reduce inflammatory markers (PMID 27991663). And it increases heart attack risk (PMID 1483767).
e. Excess body size due to exercise can cause cardiomegaly (PMID 31287235). There are other health risks from excessive exercise.
f. Sunlight poses risks of both cancer and accelerated skin aging. Sunlight is a risk factor for skin cancer (PMID 28478931).
g. Fasting increases anger (PMID 28025637), and impairs cognition (PMID 24583414).
All modalities that improve health have downsides. These downsides are dose-dependent. Health experts advocate for a balanced diet and lifestyle.
Do not be fearmongered into one way of thinking—and especially if this means buying someone’s supplement line.
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In this episode, I criticize the use by the Diaz brothers of a raw vegan diet that was likely very low in protein. Citing the research, I argue that this factor was responsible for the highly variable quality of the Diaz brothers' physiques (often poor) over the course of their career. This factor contributed to the Diaz brothers not reaching their maximum potential. The choice to be vegan was mainly ideological but rationalized as a performance decision. Meanwhile, this claimed performance decision--which was strongly at odds with the available evidence--clearly failed.
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Using the work of Michael Ristow, I again dismantle the oxidative stress concept. I acknowledge that oxidative stress exists but I point out that it is simply not a reliable biomarker of health and that sometimes oxidative stress improves health via hormesis.
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In this episode, I discuss the claims made by a defender of Paul Saladino in response to my debunking. I show, again, that seed oils were not originally engine lubricants, while acknowledging that rapeseed oil (a predecessor of canola oil) might have been. I continue pointing out that lard has a much longer history as a machine lubricant than do seed oils. I also point out that many fats and oils are used as machine lubricants. It's not something unique about vegetable oils. I comment that this story has emerged as a kind of rhetorical strategy to trick people into disliking seed oils.
Using the work of Michael Ristow, I again dismantle the oxidative stress concept. I acknowledge that oxidative stress exists but I point out that it is simply not a reliable biomarker of health and that sometimes oxidative stress improves health via hormesis.
I acknowledge that the research conducted on stearic acid is interesting while also pointing out that mechanistic plausibility does not constitute evidence. I again introduce the idea of mechanistic speculation to shoot down this idea. I point out that Paul constantly uses mechanistic speculation while dramatically overselling it to market himself and his products.
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A number of studies have shown that statins increase the risk of diabetes (PMID 27277934, 24623264, 27616593). Although some, more recent studies including more data have suggested that such earlier studies might have been mistaken (PMID 34261627), and although some statins actually reduce the risk of diabetes (pitavastatin; PMID 34261627), this podcast explores the question: what if statins do increase the risk of being diagnosed with diabetes?
Again we are confronted with a recurring theme on this podcast: although statins may increase fasting blood glucose and increase the risk of being diagnosed with diabetes according to one blood marker (glucose), this does not necessarily mean that statins are harmful. This is because glucose is only one marker of health and other markers might be more important for health. In other words, one cannot infer from one plausible mechanism (elevated glucose) that disease is more probable without actual health outcome evidence.
The major chronic complications of type 2 diabetes--indeed, the major reasons we are concerned about the development of type 2 diabetes--is cardiovascular disease and microvascular disease. People with type 2 diabetes are at 2-3 times higher risk of cardiovascular disease. One of the principal risk factors for cardiovascular disease is elevated blood lipids. This is why people with diabetes are often aggressively treated with statins according to official treatment guidelines: while the statins might modestly increase blood glucose, they help to reduce the major complications of that elevated blood glucose far more effectively than the small rise increases it. Although statins may increase the risk of diabetes, they are so effective at treating cardiovascular disease by lowering lipids that they are used in people with diabetes despite this fact.
There is also no evidence that statins increase the rate of microvascular disease associated with diabetes; in fact, they may reduce it.
There may be some reason to reduce dosage, change medication, or start combination therapy with a lower dose of statin if there are excessive increases in blood glucose. If one is at elevated risk of cardiovascular disease, statins are an excellent option. Talk to your doctor before considering switching or discontinuing medications.
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In this episode, I discuss the facts and myths behind Gwyneth Paltrow's 7-Day Detox Kit, highlighting where the kit can be helpful and some of the scientific principles underlying its design and use. I talk about which components of the kit are and are not scientifically supported. I discuss some of the underlying principles that make it work and how to make sense and leverage these both while the kit is being used and after it is being used. I analyze the foods selected for use in the kit, dissecting the science supporting the inclusion of each, and I dissect each supplement included in the kit, showing which supplements make sense, which don't, and which are somewhere in between. I discuss some of the general principles of healthy eating, weight loss, and weight maintenance, including dietary protein intake to optimize body composition, energy density and satiety, and the primacy of mindfulness (the what, when, and why) during dieting. I talk about how to create a supportive eating environment at home during use of the kit and after, how to leverage relationships to help achieve your health goals, and how to maintain psychological balance while pursuing healthy eating and weight loss and maintenance. I talk food preparation and recipes. Finally, I explain how you can leverage the kit's main components without purchasing the kit, achieving what the kit was built to achieve at a fraction of the cost.
I use the paper PMID 26094889 for this episode. The detox kit website can be found at https://goop.com/wellness/detox/gwyneth-paltrow-detox-kit/.
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This episode runs through four studies evaluating the impact of dietary protein % on energy intake. While some studies find that dietary protein reduces energy intake, there is no dose-response relationship, the effect occurs over different ranges of protein intake depending on the study, and it is unclear if other aspects of study design might have confounded causal inference. Likewise, one of the most well-conducted and carefully controlled studies find no impact of dietary protein % on energy intake.
Higher dietary protein intakes are of unambiguous importance for body composition and nutrient partitioning, especially when in an energy deficit (i.e. during weight loss) and when undergoing physical training. However, what these studies show is that the impact of dietary protein on energy intake per se is quite unclear, and the effect relative to other effects of food on satiety, if it does exist is quite modest.
While replacing ultra-processed foods with higher protein foods may reduce energy intake, this may be unrelated to protein's special satiating characteristics and more related to the fact that ultra-processed foods disproportionately encourage excess intake of energy/calories. In minimally processed diets, modifying protein % may produce little additional impact on satiety. To induce an energy deficit, it is usually not enough to add additional protein or attempt to replace food with protein shakes unless dietary quality is already poor. Other strategies are needed, and attempts should be made not merely to increase protein % but to actively reduce absolute energy intake. In other words, the protein:energy ratio (P/E ratio) as popularized by Ted Naiman's P:E diet is by no means magical and does not by itself necessarily have any substantial impact on weight loss.
Part 2 will look at meta-analyses of the effects on weight loss of dietary protein % in long-term randomized controlled trials.
The following studies were referenced in this episode:
PMID: 21272705, 22022472, 23221572, 24760974, 25183991 (search for each of these numbers on PubMed to find the appropriate study)
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This episode is for the vegans who say that plant-based diets provide enough protein. Not only do they provide less protein than omnivorous diets. But in old age, even omnivorous diets could benefit from a much higher protein intake. I discuss a large randomized controlled trial published in the British Medical Journal that clearly demonstrates this.
Vegans would have you believe that there are no benefits whatsoever to consuming animal products.
And believe me, I sympathize with the vegans. I have eaten very little meat for the past 15 years. For 3, I was a vegan. And for the past several years, I have been a pescatarian.
So I want for it to be true that eating animal products is not healthy for anyone. That would be awfully convenient because it would make the story of health and my personal belief system line up perfectly!
Unfortunately, that is not how reality works. And if we want to make the best decisions, we have to acknowledge REALITY.
In this video I talk about an important study published last year. In a randomized controlled trial, 7195 nursing home residents (average age 86 years old) were randomized to receive supplemental yogurt, milk, and cheese, or their usual menu.
What happened?
Daily intake of calcium doubled. Protein intake increased by 20%.
And those receiving supplemental dairy reduced their rate of:
-
Hip fracture by HALF;
-
All bone fractures by a THIRD; and
-
Falls by 11%.
This effect may have been mediated in part by favorable differences in bone characteristics in the group receiving supplemental dairy versus the control group.
The bones of the group receiving supplements were much denser at the end of the study.
Likewise, the group receiving protein supplements saw a slight increase in muscle mass, while the control group lost almost 2 kilograms, or 5 pounds, of muscle.
And this was from a protein intake supplemented on top of an intake already in excess of the intake recommended by official government dietary guidelines!
This may have impacted the risk of falling.
Impressively, the impact of the intervention was seen within 6 months!
It is possible that plant protein with calcium rather than dairy protein could have achieved the same effects. But what is for sure is that supplemental dairy has been shown to play an important role in preventing debilitating bone fractures in the elderly.
Vegans, pay attention! It is better to accept these findings and try to build something out of them than to wave your hands and try to deny them.
Link to the study: https://www.bmj.com/content/375/bmj.n236
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In this episode, I cover what I eat and some of the reasons why.
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In this podcast, I dissect a recent Paul Saladino video about seed oils posted on Instagram. I discuss how he uses a rapid-fire presentation strategy that, because it is impossible to check in real-time, allows him to make claims that have little relationship with the citations that he provides. In this case, I show that he misrepresents the research on oxidative stress, does not properly evaluate study design, and has missed the past 20 years of research on free radicals and health, among a great number of other issues. I correct the record by providing what the latest evidence actually says.
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In this episode, I discuss the observational evidence showing that vegans and vegetarians are more likely to have depression (PMID 34375207), more likely to have an inadequate iron intake (PMID 27101764), and more likely to have low body iron stores (PMID 30783404). I show that iron deficiency without anemia is a real clinical phenomenon with symptoms resembling depression (PMID 33762368, 31933400, 29881569, 28634965), and that treating with iron supplementation it results in the remission of depression (PMID 26715522). I argue that vegans should be especially careful about becoming deficient in iron and that they should be screened for iron deficiency, especially if they are premenopausal females and experiencing psychological challenges.
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In this podcast, I discuss a paper that shows profound reductions in sperm concentration (nearly 75%), total sperm count (2/3), and sperm motility (half) after just two 15-minute sauna sessions per week for three months (PMID 23411620). These changes were not reversed after three months cessation of sauna use; a full six months were required for these changes to reverse. It is unknown how the sauna may impact spermatogenesis among those who already have impaired testicular function or during development.
It is important to fully explain the risks and harms of interventions that are massively hyped on social media. This podcast offers itself as a corrective to overhyping by the most popular and well-known American health influencers.
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In this episode, I discuss the research and recommendations on a link between excess vitamin A intake and neural tube birth defects (PMIDs 7477116, 22516730). I show that eating beef liver supplements--and especially beef liver itself--as directed by Liver King (Brian Johnson) and Paul Saladino--increases the risk of birth defects in the offspring of women taking them, especially in the context of a vitamin A-rich diet. Liver is extremely high in vitamin A--excessively high if consumed regularly as part of a vitamin A-rich diet--and caution should be employed by women who consume these supplements and might become pregnant.
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In this episode, I evaluate Saladino's claim (formulated years before by Mark Sisson and others) that because plants are rooted in the ground and cannot defend themselves, they defend themselves with plant poisons and are therefore toxic and shouldn't be eaten by humans. I employ several counterarguments:
- Plants are domesticated. Like domesticated animals, this makes them more amenable to human consumption.
- Animals have also evolved toxins to avoid consumption. Indeed there are dozens of extremely poisonous animal species and there is no reason to believe that animals have not evolved less poisonous toxins that we might consume from their flesh everyday.
- If we take Saladino's argument to its logical conclusion, we must conclude that all animals should only consume other animals, including herbivores like rabbits and turtles. However, if rabbits and turtles consumed a carnivore diet, they would develop disease and die. It follows that the argument from "plants are toxic" cannot be applied to all species. Therefore this is an empirical question: we must study in actual scientific studies the impact of plant consumption on health. We cannot resolve it with a priori arguments.
- Furthermore, even if plants are toxic, disruption of normal biological function can be beneficial in some cases. Indeed, genetic knockouts of important inflammatory genes actually increase longevity in laboratory animals. It follows that even if a plant is "toxic", it might still produce benefit--as longevity drugs do.
- Finally, I present evidence from COSMOS that, indeed, some plant toxins work in exactly this way. Cocoa flavanols in particular reduce death from cardiovascular disease and from all causes, according to gold standard randomized controlled trial research. Cocoa flavanols are unquestionably "plant toxins", yet they enhance cardiovascular health and cognition.
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Vitamin D supplements have been widely touted as a cure-all based on weak observational evidence and animal data. Unfortunately, these data have not been well-supported by the randomized controlled trial data. In this episode, we examine a potential harm of vitamin D supplements within the normal range of supplementation: bone mineral density loss. In a study published in the Journal of the American Medical Association, there was a dose-response relationship between vitamin D supplementation and bone mineral density loss, with increasing loss seen at 4,000 IU and 10,000 IU (PMID 31454046). If you are at risk for osteoporosis and want to take vitamin D supplements, please talk with you doctor, as these data indicate that high-dose vitamin D supplements may enhance risk for the disease.
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In this episode, I go through the evidence that seed oils cause oxidative stress. In short, there isn't any, even when the oils are heated to extremely high temperatures for long periods of time (PMID 17406809). Evidence strongly demonstrates that seed oils are not inflammatory in humans (PMID 29043006), indicating that they do not cause the cellular or tissue injuries often claimed that they do. Finally, the observational evidence shows a strong relationship between vegetable oil intake and better health outcomes (PMID 26148920). I place all of these findings in context and explain them. I also explain: the point is not to recommend higher vegetable oil intake but to debunk the paranoid and poorly supported view that they are the cause of the West's obesity and chronic disease woes.
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In this podcast, I review the human and animal data and show that soy isoflavones (estrogens) have no impact on hormone levels in men (PMID 33383165) or women (PMID 1929944). Likewise, the effects of soy estrogens in rodents are inconsistent and seemingly random, with some studies showing benefits and others the opposite, with no clear pattern (https://doi.org/10.1016/j.mambio.2014.11.006). I explain and contextualize these findings.
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Vitamin K, specifically vitamin K2, has been almost universally hyped by social media's health influencers for the past 10 years as a cheap, risk-free, alternative preventive therapy for cardiovascular disease. But what evidence is there that it actually works?
Many highly plausible preventive therapies for cardiovascular disease have been shown not to work over the past 50 years. In many cases they have been shown to be harmful. Starting with anti-arrythmics, which were shown in the CAST trial to dramatically increase mortality in heart attack survivors despite having been used for over a decade prior (likely the cause of tens of thousands of deaths), the history of plausible mechanisms for cardiovascular disease prevention is grim indeed. Among these can be included homocysteine-lowering therapies (which may increase rates of some cardiovascular events), HDL-lowering therapies like CETP inhibitors (which in some trials also increased cardiovascular events), and antioxidant therapies (which in some cases, such as with beta-carotene, increased rates of cancer). One thing can be said for certain: what seemed promising according to observational and mechanistic research has often proved deadly when tested in actual clinical trials.
Could this also be true for vitamin K2 supplements?
According to some of the prevailing theories of cardiovascular disease among researchers, the mechanism of action of vitamin K2 for preventing cardiovascular disease is nonsensical. After all, simply reducing arterial calcification does not address the primary cause of calcification: the existence--and healing--of atherosclerotic plaques. Indeed, formation of non-calcified plaques occurs prior to the presence of calcifications. Calcifications are part of the healing process--indeed, part of a healing process that is universal across many different types of injuries in mammalian biology. Calcifications may in fact stabilize atherosclerotic plaques. Correspondingly, statins are thought to act in part by acceleration the formation of calcified plaques, thereby protecting atherosclerotic lesions from destabilization and breaking off to form thromboembolism, a blood clot which blocks the artery--the cause of most cardiovascular events, including heart attacks. People who exercise also have a dose-response increase in calcified plaques--despite having lower rates of heart attacks.
Vitamin K2 may reverse the formation of calcifications that are protecting the arterial vessels from the formation of thrombi due to atherosclerotic plaques. Vitamin K2 may convert dense calcifications--good--into spiculated, patchy calcifications--bad. In other words, vitamin K2 may increase the risk of cardiovascular events--and death.
Or it may not. Without the actual hard outcomes evidence of randomized controlled trials, we simply do not know whether vitamin K2 is helpful or harmful. One thing is for sure: on the basis of a long history of failed treatments, unproven mechanistic speculations should never be the basis for the prevention of cardiovascular disease. Even more dangerous is in the more extreme parts of the alternative health industry, where vitamin K2 supplements are often promoted as alternatives to conventional treatment like statins, such as by influencer Ivor Cummins.
This practice among health influencers must stop, and we must be more circumspect about the kind of evidence that we deem adequate to overhype a recommendation. The lives of actual human beings depend on this.
(I will add references when I get the chance--needed to get this out. If you would like to find them before I have that opportunity, please watch the video on Youtube. Thank you for your patience.)
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Popular health celebrities and online influencers systematically misuse scientific evidence. Most of their scientific claims are wrong. Being wrong is what makes them famous. This podcast explains how and in what way the most popular health influencers are constantly wrong.
References
https://academic.oup.com/biostatistics/article/20/2/273/4817524
https://pubmed.ncbi.nlm.nih.gov/12731504/
https://www.annalsofoncology.org/article/S0923-7534(20)42987-4/fulltext
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1105961
https://www.mayoclinicproceedings.org/article/S0025-6196(13)00405-9/fulltext
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In this episode I cover a recent news report of a death during "cold water therapy" in the United Kingdom. Cold exposure is currently dramatically overhyped online, and misinformation on the topic is rampant among the top health influencers. This misinformation misrepresented the balance of harms and risks from cold exposure therapy, undermined this woman's ability to rationally judge whether the intervention might produce more benefit than harm (or vice versa), undermined her decisionmaking autonomy, and ultimately resulted in her death. Health misinformation needs to be curtailed to empower individuals to make free decisions and reduce harm to both individuals and society.
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In this podcast, I go through the latest research on the sexual function-enhancing properties of statins.
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In this episode, I review the risks and benefits of statin therapy using the definitive review paper "Interpretation of the evidence for the efficacy and safety of statin therapy" (PMID 27616593).
This will be the first in a series of podcasts on statins.
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In this episode, I systematically dismantle Huberman's sauna health claims that he makes on the Lex Fridman podcast. In particular, I show that he overstates the strength of the epidemiological evidence and show that nobody has really been able to address the criticisms made of it in the scientific literature. I question whether heat shock proteins really confer a longevity phenotype. In fact, I show that they might actually undermine longevity. I then question the relationship between dynorphin and heat shock proteins and whether what has been claimed has ever been shown. I then provide several pieces of evidence that suggest that animals living in higher temperatures actually have reduced lifespan. On every relevant point, I cannot see how Huberman makes the claims that he does--even as he makes them with an absolute confidence.
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In this episode, I cover the latest research on statins and their link to dementia risk, see: https://jnm.snmjournals.org/content/62/supplement_1/102
In a nutshell, there is some reason to be cautious about the lipophilic statins: atorvastatin, simvastatin, lovastatin, fluvastatin, cerivastatin and pitavastatin.
The hydrophilic statins rosuvastatin and pravastatin pose less concern.
See the podcast episodes on statins for a clear idea about the risks and benefits of statins.
Always consult with your doctor before changing medications.
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High homocysteine levels are associated with cardiovascular disease and dementia. A series of studies have shown that the relationship with cardiovascular disease is not causal [1,2]. However, yet another series of randomized controlled trials have shown that reducing homocysteine levels reduces brain atrophy and cognitive decline [3,4,5], as well as risk of stroke [6] and symptom severity in schizophrenia [7,8]. Yet other studies suggest still other benefits for psychiatric disorders such as bipolar disorder [9]. This podcast explores the risks and benefits of homocysteine reduction by the use of three vitamins: B12, B6, and folate, as well as what might be the recommended dose for this purpose [10].
References (PMIDs):
[1] 16450017
[2] 16531614
[3] 20838622
[4] 23690582
[5] 25877495
[6] 19228852
[7] 23467813
[8] 16412989
[9] 35386526
[10] 31677936
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As part of the Interventions Testing Program run by the National Institutes of Health, five agents—resveratrol, green tea extract, medium chain triglycerides, curcumin, and oxaloacetic acid—were tested at three independent testing sites in over 1000 mice per agent tested. The testing found no benefit to any of the agents. I interpret these findings to mean that we can reasonably conclude that there will be no benefit in humans. I explain why and when we can use animal studies to inform human recommendations, as I believe we can here.
Study PMID: 22451473
For more about the resveratrol story, check out Brad Stanfield’s summary here: https://www.youtube.com/watch?v=JAFnD27ffqE
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In this video I expand upon the first video where I discussed the epidemiological findings linking sauna to improved health outcomes. I cover the criticism I made in the first video in detail. This does not mean that these epidemiological studies are “wrong”. Rather, they are flawed and constitute weak evidence.
I also cover the much-bandied-about specialness of “heat shock proteins”, something that Joe Rogan has often been fascinated by. I show that the mammalian studies looking at overexpression of heat shock proteins actually show earlier death in those models. While heat shock proteins might play a role in the purported health benefits of sauna, there is little evidence that this is actually true. Indeed, the opposite might be true: more heat shock proteins might actually cause an earlier death.
Enjoy.
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Random Acts of Wrongness is a catalog of a certain kind of social media misinformation: egregiously wrong statements by prominent online experts.
Here I cover Nina Teicholz's claim that Americans ate low-carb diets (just 28% of total calories as carbohydrates!) before the dietary guidelines ruined everything and caused people to start eating carbohydrates for the first time.
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Cold exposure kills muscle and strength gains and may worsen inflammation. It “improves” recovery by improving the mental and emotional state—mainly by activating the sympathetic nervous system. While it does help mental recovery, it does not help—indeed, it impairs—physical recovery. The improvement in mental state caused by ice baths tricks the body into feeling more recovered than it is, even while it harms the recovery of the body.
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Modern, domesticated meat is nothing like what our hunter-gatherer ancestors consumed. It contains several times more times more fat, much more saturated fat, and much less polyunsaturated fat. In this podcast, I argue that people who are interested in eating an evolutionarily consistent diet should not consume much fatty modern meat, or should consume seed oils to balance the fatty acid profile. Alternatively, they should reject the idea that a modern diet has to be evolutionarily consistent to be healthy, a concept that I dismantle using several examples and pieces of research.
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In this podcast, I cut through the pseudoscience on the sauna use promoted by Rhonda Patrick and Andrew Huberman. I show that Rhonda and Andrew misrepresent what the scientific literature says in order to hype their public image and accumulate clicks and money. The epidemiological studies that they cite are heavily confounded, and even if they are not, they show no benefit of sauna use in healthy people. The benefit of sauna use in people with chronic disease may be driven by reverse causation. Therefore, there is substantial risk of sauna use, and there may be no benefit. But this side of the story is not told on social media by these two influencers, because it is inconvenient to the Huberman-Patrick hype machine and not profitable.
Enjoy.
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In this video, I try to debunk five Ted Naiman false claims or misrepresentations in five minutes.
I spend an hour.
Enjoy.
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In a study from China, use of a salt substitute containing 75% sodium chloride and 25% potassium chloride by adults reduced the rate of stroke, major cardiovascular events, and death by 10-15% over just 5 years. Reference: https://nejm.org/doi/full/10.1056/nejmoa2105675
The adults in this study had a history of stroke or who were older than 60 years with a history of uncontrolled blood pressure. There may be less benefit in adults without a history of stroke or uncontrolled blood pressure. I suspect there will still be some benefit.
You can replicate the salt formula used in this study by mixing Morton Lite with normal Morton salt, in 50/50 proportions. Morton Lite has 50% potassium chloride. Morton Lite is very similar to regular salt in taste in foods, but with a subtle difference. However, 25% potassium chloride salt is indistinguishable (or superior) according to most people.
A recent randomized controlled trial, for instance, shows that subjects prefer 25% potassium chloride salt to regular salt. (The same is not true of 50% potassium chloride salt, according to other studies.) Reference: https://clinicalhypertension.biomedcentral.com/articles/10.1186/s40885-016-0054-9
If you have a history of kidney disease or are on blood pressure lowering medications, please consult your physician before starting to use 25% potassium chloride salt.
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Three new studies show that time-restricted eating does not produce weight loss benefits greater than simply paying attention to what one is eating or how much one is eating. In this video, I will be covering these three studies, how to interpret them when combined together, what potential benefits there are to time-restricted eating (if not weight loss), and various false claims about each study. Diving into the details will help us grasp what the latest science says and does not say about time-restricted eating/intermittent fasting.
Links to studies:
https://tos.planion.com/Web.User/AbstractDet?ACCOUNT=TOS&ABSID=23138&CONF=OW2020&ssoOverride=OFF&CKEY=
https://pubmed.ncbi.nlm.nih.gov/35443107/
https://pubmed.ncbi.nlm.nih.gov/32986097/
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A new cohort of obesity drugs, called GLP1 receptor agonists, are so effective and safe that they will likely be put into widespread use for the treatment of obesity and achieve unparalleled success in the treatment of this disease—on par with bariatric surgery, but without the surgery. In this video I discuss the latest science and the promise of these drugs—as well as two other new classes of drugs that show similar (and synergistic) promise.
Links to references, in the order that they were discussed:
STEP1, semaglutide:
https://www.nejm.org/doi/10.1056/NEJMoa2032183
STEP4, semaglutide:
https://jamanetwork.com/journals/jama/fullarticle/2777886
Semaglutide plus cagrilintide:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00845-X/fulltext
Meta-analysis of long-term outcomes:
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2213858719302499
Tirzepatide clinical trial registration:
https://clinicaltrials.gov/ct2/show/NCT04184622
Bimagrumab:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774903
Small molecule GLP1 receptor agonist:
https://diabetesjournals.org/diabetes/article/69/Supplement_1/353-OR/56321/353-OR-Oral-Small-Molecule-GLP-1R-Agonist-PF
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Due to compensation (more eating drive and/or lower energy expenditure outside of cold exposed periods), cold exposure has been shown in several studies not to result in weight loss. It might even result in weight gain in some situations. This is in direct contradiction to some of the claims made by some of the biggest health influencers like Rhonda Patrick and Andrew Huberman. They need to start telling the truth and stop misrepresenting the science on everything.
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Andrew Huberman claims that he eats sticks of butter to increase his testosterone production. This does not make any sense, since Huberman injects testosterone as part of testosterone replacement therapy. TRT suppresses all endogenous testosterone production. Huberman knows this, so it is difficult to understand why he said this to his audience. I talk about this and why Huberman’s explanation is nonsensical for many other reasons as well.
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Time-restricted eating is one of the biggest fads of the past 5-10 years in the alternative health space online. Dozens of studies have been conducted looking at time-restricted eating and intermittent fasting for health. However, only recently have rigorous, large randomized controlled trials controlling for key variables been conducted. These large trials have found no effect of time-restricted eating. See: https://pubmed.ncbi.nlm.nih.gov/32986097/, https://www.nejm.org/doi/full/10.1056/NEJMoa2114833, and https://www.nytimes.com/2022/04/20/health/time-restricted-diets.html. A large number of people online who have strongly promoted TRE are now up in arms about these studies, trying to find any way possible to suggest that they show an advantage to TRE, when they do not. In this video, following up on my last one critiquing Satchin Panda and Rhonda Patrick (https://www.youtube.com/watch?v=k_NDUsNyi-Q), I dismantle the bad takes of five more of these people. Enjoy.
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A new randomized controlled trial shows a strong dose-response relationship between increases in atherogenic (heart attack-causing) blood lipids and soda consumption. The bottom line: don’t drink sugar-sweetened beverages, even if you are lean.
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A new randomized controlled trial, the largest and most rigorous of its kind, clearly shows that vitamin K2 does not reduce aortic calcification. This suggests that the much vaunted mechanism of vitamin K2, its ability to take calcium from the blood stream and deposit it in bone, does not affect the rate of calcification or heart disease risk. Save your money on vitamin K2 supplements. They don't work.
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In this video, I discuss the latest New England Journal of Medicine study on time-restricted feeding and some exceptionally bad takes on it. In particular, I detail how Andrew Huberman appears not to have read the study and mischaracterizes it on Twitter. Then, I talk about how Satchin Panda and Rhonda Patrick each mis-state important facts about and misinterpret the study’s significance. I use these examples as a sounding board to explain what we can in fact take away from the study—and indeed, from the research on time-restricted feeding to date.
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In this video, I cover the factors that drive variation in response to different diets and lifestyles. I argue that we are not as different as we think and that factors such as values, lifestyle, life circumstances, etc. account for differences in response to diet, more than differences in biology do. I cover the latest and greatest studies in intermittent fasting and carbohydrate restriction.
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Does dietary cholesterol impact muscle gain? Does blood cholesterol affect testosterone production? In this video/podcast, I will be giving you the cutting-edge answers to these questions.
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One of the largest, most rigorous randomized controlled trials in nutrition was published last month. Called COSMOS, it evaluated whether a supplement containing 500 milligrams of cocoa flavanols reduced cardiovascular events and/or death. It did. With more than 20,000 participants and a full 15% reduction in cardiovascular events and 39% reduction in cardiovascular deaths, this is one of the most successful nutrition intervention studies of all time. Mechanisms of cocoa flavanols include reduced blood pressure, increased blood vessel elasticity, and reduced inflammation. To match the doses given in the trial, about half a pound of dark chocolate would be required—or a handful of cacao nibs, or a supplement (as used in the study). Milk chocolate not recommended because of the large quantities required and likely bad health effects due to excess calories and refined sugar. Sorry.
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Carnivore Aurelius is a nutrition science charlatan. In this video, I will be using his example to demonstrate the dangers of what has been termed “mechanistic speculation”, a form of pseudoscience that is highly prevalent on social media and of which Carnivore Aurelius is an expert. I will be debunking several of his claims made about seed oils in particular. This is part one or a two-part series.
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In the past decade, archaeologists have applied new techniques to analyzing teeth of prehistoric humans. Finding: Near-universal presence of wild grain/legume residues, >100K years, i.e. ubiquitous presence of these foods during human evolutionary history. https://www.sciencedirect.com/science/article/pii/S0047248414000189
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Intermittent fasting is a fad that has been exploding over the past 5-10 years. What most of the influencers promoting this fad won't tell you is that intermittent fasting does not produce better results than continuous calorie restriction, while it also causes more muscle mass loss. We saw this in the recent study published in JAMA Internal Medicine by Lowe et al. (PMID 32986097), but we also saw this in a meta-analysis published in 2019 (PMID 30206335). Indeed, the length of the fasting window seems to correlate with the muscle mass loss: the longer the fasting window, the more muscle mass loss. This makes intuitive sense: when the body is not being fed energy and protein, it will break down its muscle mass to meet its energy and protein needs.
We need to stop mindlessly jumping on fads promoted by charismatic online voices. It harms our health. Please share this podcast if it was useful to you.
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Andrew Huberman has exploded onto the health influencer scene over the past 1-2 years. While an accomplished neuroscientist, his nutrition information leaves much to be desired. In many cases it is misleading, false, and sometimes even harmful. This is because he is not an expert in nutrition and often extrapolates from his own personal (and limited) experience without being aware of the scientific literature. Huberman should not be regarded as an expert in nutrition. In this podcast, I show, using over 50 years of extremely consistent scientific literature, that Huberman's unhealthy fasting habits are probably contributing to his obesity, which appears to be getting worse as he ages. If you want to learn how the circadian rhythm affects feeding windows and optimal meal timing for metabolic health, listen to this podcast.
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Andrew Huberman is the biggest and most rapidly growing health influencer in North America. The problem is that he frequently completely invents the "science" that he communicates. In this video, I will be demolishing a recent tweet of his about intermittent fasting, where he completely fabricated the information that he communicated about intermittent fasting and is wildly at odds with the current science. In this video and podcast, I also argue that Huberman consistently pushes pseudoscience.
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A great deal of misinformation has been put out about the dietary guidelines by online diet influencers who seek to market themselves by posing themselves as an "alternative" to official recommendations. Usually this misinformation tries to suggest that the dietary guidelines say something that is radically unhealthy or unwholesome. They also try to conceal a very inconvenient fact: often the guidelines are 100% consistent with their own recommendations. Here I break down some misinformation put out by health influencer Max Lugavere. I like Max, but this misinformation needs to stop.
Max wrote:
Current U.S. nutrition guidelines call for:
- vegetable oil dressings and spreads
- 10 slices of bread a day (5 white)
- up to 70 grams of added sugar daily
- minimal meat
If we followed these guidelines, would we be healthier? Or sicker?
In this video/podcast, I go through each of these claims in turn, using the actual official document of the U.S. Dietary Guidelines for Americans, found here: https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
For reference, the pages of the document with the relevant content are here:
oils- page 48
grains- page 45
sugars- page 50
meat- page 46
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In this podcast, I break down some claims about "regenerative" beef
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It is almost a dogma on social media that vegetable oils are iNfLaMmAtOrY aNd ToXiC. However, this is a dogma that has been tested many times and consistently shown not to be true. But what about hexane? Does hexane in vegetable oils pose some kind of health risk?
Key facts:
-
You would need to drink more than 100 swimming pools worth of vegetable oils in one sitting to have a 50% chance of dying from the hexane;
-
Hexane in food accounts for only about 2% of total daily exposure to hexane, making vegetable oils the least of our worries.
Next time, ask whether it is toxic to drive.
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Are vegetable oils “toxic” or “inflammatory”?
Evidence strongly shows the very opposite of this widespread myth.
Yet despite the constant drumbeat of science showing the healthfulness of “industrial seed oils”, an equally persistent drumbeat from the likes of Mark Hyman and others maligns them.
What is the truth?
Well, one paper published in the European Journal of Clinical Nutrition in fact showed that olive oil, soy oil, and cod liver oil all decreased some markers of inflammation. PMID 21326271
A recent article reviewing all currently available evidence concluded human trials consistently show that omega-6 fatty acids, a constituent in “seed oils” blamed for their supposed ill effects, do not cause inflammation. PMID 29610056
And some of the highest quality observational evidence shows a dose-response relationship between degree of unsaturation of fatty acids consumed and reduction in heart disease risk. PMID 22583051
Where do these myths about vegetable oils come from? Well, a few places:
-
The naturalistic fallacy- vegetable oils are “unnatural” and therefore they cannot be healthy, right? But this is a fallacy. Cooking is unnatural. Shoes are unnatural. Toothbrushes are unnatural.
-
Mechanisms governing inflammation- omega-6 fatty acids might to “feed” inflammatory biochemical pathways. However, the clinical trial evidence does not bear these mechanisms out.
-
Other mechanisms such as endothelial dysfunction and oxidation. However, again, these mechanisms are contradicted by the available clinical trial evidence.
What the case of seed oils teaches us is that coming to conclusions based on mechanisms is inappropriate: we need to pay attention to the human evidence.
Now, vegetable oils may increase the calorie density of foods and make it easier to overconsume calories. However, compared to the alternative, such as butter, vegetable oils are much healthier. PMID 33853582
My recommendation: use oils to the degree that you can keep overall calorie intake low (for many people that's none at all!), but whenever possible, substitute them for butter or lard. Moreover, whenever possible, substitute nuts, seeds, or fish for fatty meat. When you do eat fatty meat, if you are not eating fish, make sure it is as lean as possible! The science supporting this recommendation to prevent disease is among the strongest we have in nutrition.
About 20% of blood LDL cholesterol (the cholesterol fraction that your doctor worries about) is from dietary cholesterol. We know this because when we block cholesterol transport in the intestine with the drug ezetimibe, blood LDL cholesterol declines by an average of 20%. (PMID 11558859)
However, most of that blood LDL cholesterol comes from the first few hundred milligrams of dietary cholesterol. Additional increases in dietary cholesterol above this amount have less impact on LDL cholesterol. In other words, the impact of dietary cholesterol on blood LDL cholesterol “plateaus” Caveat: in the average person! In a substantial proportion of the population, this plateau is much less flat and dietary cholesterol continues to raise blood LDL cholesterol! (PMID 30596814)
You can see this in a paper showing that simply blocking the cholesterol receptor in a “hyperresponder” to the ketogenic diet (with a sky-high LDL cholesterol) caused a reduction of 65% in LDL cholesterol. This person continued to absorb every bit of dietary cholesterol that they consumed. This is unusual but reflects the widely varying absorption of dietary cholesterol in the population. (PMID 33191194)
This can also be seen in ezetimibe clinical trials: there are some people who strongly respond to cholesterol absorption blockers, while others respond very modestly. (PMID 24725763)
Take home:
-
20% of blood LDL cholesterol comes from dietary cholesterol. Completely blocking cholesterol absorption or becoming a vegan all else equal reduces blood cholesterol by 20%.
-
However, there is a plateau in how much dietary cholesterol is absorbed as the cholesterol transported becomes saturated. Thus, for omnivores, increasing or decreasing dietary cholesterol will not affect blood cholesterol by much.
-
Caveat: There are some people who respond very strongly to dietary cholesterol and continue absorbing it. There is little to no plateau! These are called hyperresponders.
-
Hyperresponders are clearly seen among people who see exceptional rises in LDL cholesterol on a ketogenic diet, as well in the ezetimibe clinical trials.
Find this useful? Like, follow, share!
Here I debunk a recent viral thread by Anthony Gustin where he claims that Hadza eat almost no plants. This is not consistent with any of the evidence. The Hadza consume a predominantly plant-based diet. In this video I present the evidence and explain how Anthony Gustin, Paul Saladino, Brian Sanders, and their peers consistently get things so wrong about the Hadza.
Follow me at @kevinnbass on all social media platforms. Check out my website at www.thedietwars.com. And please donate at www.thedietwars.com/support-me if you like my content.
Dave Feldman has made a number of claims about the relationship between LDL cholesterol and the risk of cardiovascular disease and death that are not supported by evidence. He has recently flamboyantly taken to offering money to anyone who could show that LDL cholesterol increases the risk of death in people who were otherwise healthy: who have high LDL but low triglycerides and high HDL. The so-called lipid triad. Deirdre Tobias, a professor at Harvard, took him up on this challenge using the latest methods. Watch this video to see how Dr. Tobias put Dave's claims to rest--once and for all.
Follow Dr. Tobias on Twitter: @deirdre_tobias
Find her original thread here: https://twitter.com/deirdre_tobias/status/1473622014107820035
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Taurine has promise for athletic performance, the prevention of cardiovascular disease, and possibly for psychiatric disorders such as anxiety, depression, and psychosis. In this video, I review some of the evidence supporting these applications of taurine supplementation.
Taurine is found only in meat, with vegans and vegetarians having lower concentrations of taurine in their blood, urine, and breast milk [1-3].
Taurine was shown in a 2018 meta-analysis of 10 randomized controlled trials to improve endurance exercise performance [4].
A 2020 meta-analysis of 12 randomized controlled trials showed a reduction in blood pressure, blood triglycerides, and blood cholesterol [5].
Improvements in lipids have been shown in rats, mice, hamsters, guinea pigs, and rabbits. This is strong evidence (in my opinion, almost conclusive) that the improvements in lipids seen in meta-analyses are real [6].
Yet another meta-analysis including 188 subjects showed an improvement in both systolic and diastolic blood pressures after taurine supplementation compared to placebo [7].
And at least one randomized controlled trial showed clear evidence for improvement of vascular function [8].
Two small trials in humans suggest that the effect on the vasculature, including blood pressure, may be mediated by a reduction in circulating catecholamines ("stress" hormones) [6]. This is supported by animal studies that report very, very large reductions in circulating epinephrine and norepinephrine [6].
One study in rats, published in 2017, suggested an anti-anxiety or anti-depressive effect of taurine. Again, norepinephrine was reduced [9].
All of these findings suggest that, in addition to the anti-hypertensive effects, which might benefit cardiovascular disease, there might be some benefit of taurine supplementation for psychiatric disorders.
Indeed, a recent albeit small RCT in patients with first-episode psychosis showed a substantial improvement in taurine-treated patients [10].
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PMIDs
[1] 31197570
[2] 3354491
[3] 3676193
[4] 29546641
[5] 32871172
[6] 19592001
[7] 30006901
[8] 26781281
[9] 28694433
[10] 27835719
A lot of misinformation is promoted about seed oils on social media. In a recent post, Benjamin Bikman, a professor, claims that seed oils cause weight gain. He lists several mechanisms and links them together in a story that expresses the reasons why this should be the case. However, he does not provide any evidence for his story; he just provides the story. Science requires evidence for a story to be true. This is known as testing the hypothesis. Bikman provides no indication that the hypothesis he is presenting has been tested.
Only thing, it has been tested. And studies overwhelmingly and consistently show that the opposite is true: seed oils actually promote fat loss and a higher metabolic rate. This was found in one comprehensive review looking at dozens of studies published in 2014 [1], a long-term clinical trial of 83 subjects looking at the impact of soybean oil (versus cocoa butter and palm oil) on liver and body fat in 2021 [2], and a meta-analysis of 25 randomized controlled trials comparing canola oil-containing diets to other diets, including saturated fat-containing diets [3]. All of these studies are remarkably consistent. Not only do diets containing seed oils outperform other diets in terms of metrics like fat oxidation, diet-induced thermogenesis, and energy expenditure—increasing all of these relative to diets high in saturated fat—they also outperform these diets in the ways that matter: fat and weight loss. That’s right, replacing butter with seed oils produces not only better blood lipids and cardiovascular disease risk [4], but lower body weight and body fat.
It is critical for us to actually test our hypotheses and not promote misinformation at odds with the available evidence.
PMIDs [1] 24363161 [2] 33381795 [3] 30809634 [4] 33853582
In this question and answer session, we cover all things on the cutting edge of the science of keto. These include:
Do ketogenic diets have a weight loss or metabolic advantage? Do ketosis and fasting improve cognition? Can we improve Alzheimer's with ketogenic diets? What trials have been conducted? What are the mechanisms? What trials are coming up? What can the trial literature tell us about fasting and mental clarity? Why might the trial evidence miss an effect, while subjectively, the benefits seem so obvious? What are some underrated aspects of keto research? Overrated? (Underrated- cancer, cognition. Overrated- everything, especially weight loss.) Science and cults both challenge conventional beliefs. What is the difference between science and cults? Why the popular keto movement is largely a cult. What is the difference between a scientifically rigorous n-of-1 study and an anecdote? Why we cannot conclude anything about causality from anecdotes. What is the biological purpose of ketosis? Why I would have a beer with Ivor Cummins or Shawn Baker any day of the week. Relationship between ketogenic diets and hunger hormones leptin and ghrelin. Obesity, brain inflammation, sickness syndrome, and depressed mood. Ketones, GPR109A, and cancer prevention. Saturated fat and breast cancer risk. How to follow a healthier, lower risk ketogenic diet pattern.
And much more.
Enjoy.
In the second episode of Diet Wars, we talk with two clinical COVID19 experts on the front line. We address personal protective equipment (PPE), factors that may increase risk to healthcare workers, risk factors for mortality, clinical presentation, laboratory testing including non-specific markers of disease, and the current science on treatment. In our Q&A, we cover NSAIDs, supplements, severe lockdown, ACE2 expression, length of immunity after infection, and the extent of undetected cases.
This 1st episode of Diet Wars features Kevin Bass together with Ethan Weiss, Avi Bitterman and Cyrus Khambatta, discussing insulin resistance and how the ketogenic diet fares against type 2 diabetes.
@Kevinnbass
@ethanjweiss
@AviBittMD
@CyrusKPhD