The Winter of Their Discontent

I realize it’s currently summer. But someone forwarded to me the post of yet another ex-vegan food blogger who divulged to the world this past winter that she was giving up the vegan diet. This time it was Kristen of KristenRaw.com in her post of March 17, 2013, My Vegan Diet Caused Health Problems. Would Primal, Paleo, Or “Real Food” Be Better?

A few paragraphs in, Kristen lists a couple of common threads that she has noticed among the meat-curious vegans:

“We were vegan, some quite smugly, thinking it was the human ideal of a smart-n-healthy diet, but then, only after several years, started to experience health problems, and then switched back to omnivore, and the health problems disappeared….What we also have in common — made somewhat easy no doubt due to having adapted to a strict (vegan) diet for many years — are the strict kinds of omnivore foods we eat now vs what we were eating pre-vegan….Even more so for former raw fooders, whose restrictions (such as avoiding grains) make some vegans’ diets look like junk food.”

Kristen’s story is the typical one – she became vegan for animal rights reasons and at first she did great on the vegan diet and got into raw foodism, etc. After a few years she started to not feel so well, she tried everything to make it better, she went back to eating animal products and within hours she started to have a miraculous turn around in her health.

She originally tried to counter her health problems with, “superfoods, fancy juicers, superherbs, tonic herbs, prepping foods various ways to optimize nutrients, following rules for combining or not combining certain foods like having vitamin c with iron rich plants – just to name a few….”

Although there isn’t much to indicate that Kristen was suffering from iron deficiency, I’m impressed with her attempt to add vitamin C to meals with iron rich plants which is scientifically based. In terms of the rest of her attempts to reclaim her health, if only she knew about all the vegans who are not failing, who she might describe as “junk food vegans.”

At one point, Kristen’s cholesterol was measured at 95 mg/dl. Her animal food cravings started out with “dreams of eggs.” Craving eggs seems to be a common theme, and I take the egg cravings as a possible sign of nutrient deficiency for a few reasons. One, eggs are fairly disgusting, especially if you haven’t eaten them in a long time and don’t happen to be craving them. If someone said they were craving Häagen-Dazs, I’d be skeptical of a nutritional basis. KFC? Might be the 11 herbs and spices. But eggs? Something must going on here.

To sum up the situation, we have someone with very low cholesterol at 95 mg/dl craving one of the main sources of cholesterol, eggs. And after eating animal products, she quickly started to feel better. Following Occam’s razor, it seems to me a safe bet that she was craving eggs because her body needed cholesterol and she improved so quickly because she got an immediate boost from it.

Admittedly, I don’t know for certain if this is what is going on. Eggs are also high in choline and sulfur. And perhaps people just cannot crave what they need and these cravings are the brain misfiring. But, in my humble opinion, the evidence is mounting to implicate low cholesterol in many of these cases of failed raw foods/whole foods vegans.

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Past Posts on Ex-Vegans

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88 Responses to “The Winter of Their Discontent”

  1. Christina Arasmo Beymer Says:

    Please get to the low cholesterol part earlier. Make a post about it separately. It’s the low fat that equals the low cholesterol.

    When I was pregnant, I wasn’t vegan (ovo/lacto), I ate a massive amount of eggs (which I did crave). Pregnant women can crave dirt too. After I delivered my daughter, the depression was severe.

    http://www.ncbi.nlm.nih.gov/pubmed/11959358
    http://www.psychologytoday.com/articles/200304/the-risks-low-fat-diets

  2. Alex Says:

    Speculating, but I imagine the problem here could be a diet that is too low in fat, and perhaps protein, because you’re eating nothing but fruits and veggies. Eating some grains, beans (yes, even soy), and nuts would fix many of these cases, if I had to guess.

  3. Tyler Says:

    I don’t know, her story seems too well scripted along paleo talking points to be legitimate.

    The idea that the brain can determine what nutrients are in foods, can detect when those nutrients are low and hence produce cravings for foods as a result is far fetched. Occam’s razor would prefer the explanation with the least assumptions, that would be a simple psychological explanation not one that requires a number of unknown mechanisms. Taste is subjective, if the majority of people thought eggs were disgusting they wouldn’t be such a popular food. I know that I’ve never found the taste to be disgusting, instead enjoyable. I’d suggest that egg craving are common in vegans because eggs are a common animal food that are a bit less offensive than meats. That is, the psychologically barrier is lower for eggs than a steak, etc.

    I wouldn’t count vague anecdotes as evidence, but deficit cholesterol levels can be the result of a poorly planned diet. Is there any evidence (science based) that vegans consuming a well planned diet have deficit cholesterol levels? If not, then shouldn’t the focus be on diet and not cholesterol in particular?

    The common theme I notice from these ex-vegan stories is some sort of carb-phobia (often starch-phobia) and I don’t think its by accident. Carb-phobia pretty much sabotages any effort to consume a healthful plant-based diet so promoting such things is a great way to promote animal products. Failed vegans, ironically, are great tools in meat, egg, etc marketing.

    “Its the low fat that equals low cholesterol”

    A number of foods, including fats, can promote higher cholesterol levels but low-fat intake doesn’t result in deficit cholesterol levels. If that were true, you wouldn’t have so many cases of societies thriving on low-fat diets. Until recently, human diets were predominately low fat (10~25% fat).

  4. Tyler Says:

    “Speculating, but I imagine the problem here could be a diet that is too low in fat, and perhaps protein, because you’re eating nothing but fruits and veggies. Eating some grains, beans (yes, even soy), and nuts would fix many of these cases, if I had to guess.”

    Judging by her recipes, her diet wasn’t low fat. Raw food diets aren’t necessarily low-fat, only the fruit based ones end up being low-fat. She wasn’t a fruitarian.

  5. Sugarlake Says:

    I think most ex-vegans who failed on plant based diet were focusing too much on raw foods. When i ate mostly raw i also had cravings all the time and i had never eaten more fruits and vegetables in my life. The cravings disappeared immediately once i started eating less fibrous vegetables and mostly potatoes, rice, lentils etc.

    The center of my diet shifted from fruits, veg to grains and potatoes with some greens on the side. I’m also not afraid of tofu or vegetarian meats anymore.

    I think that humans are not raw fooders even though it seems logical at first because no other animal is eating cooked food. But humans just aren’t like any other animal. Technology and cooking is part of our evolution. I don’t think it is just cultural that most people prefer cooked over raw. Cooked food is our natural diet.

  6. Christina Arasmo Beymer Says:

    @ Alex:

    Yes. I agree. But I would add more fat.

    I can’t find her old recipes, unless you want to buy a book. But her recent ones are omnivore. And just because you have a recipe and a photo, doesn’t mean you are eating it too.

    Low fat is relative to the human being and their internal constitution.

  7. Christina Arasmo Beymer Says:

    Tyler,

    ““Its the low fat that equals low cholesterol”

    A number of foods, including fats, can promote higher cholesterol levels but low-fat intake doesn’t result in deficit cholesterol levels. If that were true, you wouldn’t have so many cases of societies thriving on low-fat diets. Until recently, human diets were predominately low fat (10~25% fat).

    Where are you getting this information? Before the introduction of sugar, the Inuits ate a blubber diet with root veggies, and didn’t have heart disease rates like they do now. Indians in india eat a lot of ghee mixed with their dal and milk fat is loaded in their tea which they sell everywhere and give away.

    Until recently, humans ate what is local. From what I’ve gathered, if you were located near almonds, that would be almonds, which are fatty and they don’t run from you, causing you to burn off energy and the fat stores that are necessary to survive during the winter months.

    DIfferent locations, equals different options for food whether it’s plants or animals. Humans tend to go with the easiest.

    One person’s low cholesterol is fine for that person whereas another person would suffer significantly.

  8. Dan Says:

    This seems silly – on hot days, there are more ice cream sales. On hot days, there are more drownings. Ice cream consumption causes drowning.

    On vegan diets, cholesterol goes down. Some people who once loved the taste of eggs no longer eat them because they are now vegan. Eggs contain a lot of cholesterol. Therefore, their craving for eggs must be due to low cholesterol.

    Actually many egg-feeding studies that I have seen do not show any increase in cholesterol over time, unless tremendous supraphysiological quantities are consumed (well above what any sane person would want to eat). The association cited between low cholesterol and disease is spurious. There is no evidence of cholesterol deficiency disease; indeed in a recent Mendelian randomization analysis from the University of Michigan, children who were born with low cholesterol experienced lifelong protection from heart disease (JACC 2013, University of Michigan researchers).

    Also I don’t buy that grain is necessary as part of a vegan diet. Some degree of carbophobia is necessary to combat metabolic syndrome, now present in 1 in 4 individuals according to the latest data (which is probably biased as it included people on medications which reduce metabolic syndrome laboratory signs making up the diagnosis).

    The problem here is probably deficiency of fat and/or protein, as well as certain micronutrients – vitamin A, vitamin B series, iron, possibly even iodine, vitamin D and calcium (who knows?). Any of these deficiencies could have caused significant fatigue, dysphoria and a state of impaired well-being.

    I am living well on a vegan diet that is low in carbs. Breakfast – a smoothie made with unsweetened almond milk, seven types of nuts and seeds, wheat germ, wheat bran, hemp protein powder – and an avocado on the side. Lunch – a salad with soy beans, tahina, nutritional yeast flakes, various vegetables, lemon juice, paprika, and a large carrot on the side. Dinner – a hot mexican vegetable soup with black kabuli chickpeas, tomatos, onions, garlic, green chilis, jalapeno peppers and various spices. I actually consume too much protein in this diet. There is very little fruit in it (other than tomatoes, avocados) and no endosperm-containing grains (to minimize carb intake). Almost no processed food – except the almond milk, and if you count wheat and hemp stripped into its starch-free components. To this I supplement with 3 vitamin tablets – iodine (kelp), B100-complex, vitamin D3. I do not crave meat, fish, eggs or dairy. I no longer need to test my cholesterol – it’s been optimal for more than a year. Weight is stable in 125-128 lbs. range. BP is lowest it’s ever been. Despite other stressors in my life, I believe my example shows that a well-planned vegan diet, even with restrictions to account for my tendency towards metabolic syndrome, can keep one thriving and healthy.

  9. Karen Says:

    I read Kristen’s post when she posted in on FB and I have her raw cookbooks, I am not a raw foodist, but enjoy having the ability to incorporate raw foods into my plant based vegan diet. On her blog, Kristen used to publish what she ate for the day. I personally would starve. Her postings often contained one smoothie with added protein powder and many different supplements, a salad, another smoothie and a raw desert.
    I don’t think her problem was her vegan diet, but her reliance on all the protein powders, supplements and being high raw. While some raw foodists do great, others who pioneered the movement have gone back to incorporating cooked vegan foods into their diet.
    I was very dismayed when she started eating eggs and meat again instead of simply looking at incorporating more cooked plant based foods into her diet such as beans and legumes, tofu, tempeh, etc. Her food intake was very low and during this time she also was pregnant and nursing for over a year. It’s a shame that ex-vegans feel that suddenly eating meat or eggs makes them healthy again in less than a day. Sorry, I don’t buy it.
    I wish that she had simply looked at her strict raw foods diet and tried a balanced plant based diet to see if that would get her health back under control.

  10. Dan Says:

    I have never seen any conclusive experimental scientific data (in humans) to suggest that dietary-lowering of cholesterol levels produces either psychological or bodily harms. Yes there is a wealth of observational studies CORRELATING low cholesterols with a range of bad outcomes (including suicides, homicides and cancer), but these are likely confounded by reverse causality. None of the intensive statin trials which produced very low cholesterol levels for 5 years or more showed any significant harm. Ditto with sustained dietary interventions. I just don’t buy it.

  11. Christina Arasmo Beymer Says:

    There is “Disorders of Cholesterol Synthesis”. People with one of these disorders can’t produce enough cholesterol due to a problem having too low levels of the 7-DHC reductase enzyme.

    Purely speculative, but if the occurrence of carriers is 1:30 (as the Wiki doc claims on SLOS for northern or central European ancestry) and it takes two people to make a malformed child with this inability, then it’s rare for a full blown case. But that would also mean that there are a lot of people (1 in 30 is a lot of people with northern or central European ancestry) that have basically normal appearances but their levels of this enzyme are just sort of low and they are in need of dietary cholesterol or have a lousy time making it from their diet.

    Thank you Mom, for having sex with an Asian!

    http://hmg.oxfordjournals.org/content/12/suppl_1/R75.full

  12. Drew Hensley Says:

    Yeah I agree it’s all about fat. We really need fat to process vitamins but beyond that, meat eaters crave fat, cholesterol, salt and sugar. That’s how most of us were raised. I had vegan lethargy just a few months after going vegan which I cured with a vegan daily vitamin supplement. A few years later I had hunger and lethargy issues that were resolved by a tablespoon of peanut butter everyday. The peanut butter has not increased my weight, but I feel more energetic with it in my diet. Some peanut butter on rye bread with a glass of Silk everyday gives me the energy I need and I feel good.

  13. Christina Arasmo Beymer Says:

    I have seen conclusive scientific data, or what I consider conclusive, regarding mood and cholesterol:

    http://www.ncbi.nlm.nih.gov/pubmed/11959358

    During pregnancy, the total serum cholesterol concentration rises up to 43%, followed by a rapid fall after delivery. Mild depressive symptoms (‘postpartum blues’) are a common complication of the puerperium and affect 30-85% of women in the early postpartum period. Based on these observations, it has been suggested that the sudden fall in cholesterol levels after delivery could serve as a ‘natural model’ to test the suggested association between cholesterol and mood. The present study was designed to expand the database concerning the association between cholesterol levels and mood in the postpartum period and to address some methodological problems raised by previous studies. Forty-seven healthy primiparous women were interviewed with a structured clinical interview on two occasions: during late pregnancy (median: day -20 before the expected delivery) and during the early postpartum period (median: day 32 after delivery). On both occasions, serum concentrations of total and HDL cholesterol were measured and mood symptoms were assessed with the state form of Spielberger’s State-Trait Anxiety Index (STAI), the state form of the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). We found significant, albeit moderate, relationships between serum cholesterol levels and mood symptoms in the postpartum period that were not present during late pregnancy. Lower postpartum levels of total cholesterol were associated with symptoms of anxiety (r=-0.30, P=0.04), anger/hostility (r=-0.31, P=0.04), and depression (r=-0.35, P=0.02), and lower postpartum levels of HDL cholesterol were associated with symptoms of anxiety (r=-0.34, P=0.02). This study confirms that the physiological fall in blood lipids in the postpartum period can be a useful model to test the relationship between serum cholesterol levels and mood.
    *** end copy/paste ***

    After I delivered my daughter, I wanted to kill myself. I was severely depressed beyond anything I’d ever experienced.

    Another one:

    http://www.bmj.com/content/313/7058/664

    from the comment:

    “Nevertheless, dietary lowering of cholesterol in monkeys led to a significant increase in aggressive behaviour.”

    And so, this and my own experience, is evidence enough.

  14. Andreas Says:

    Another example of an ex-vegan that was eating a highly processed oxidized diet by using a blender and a food processor. What irks me the most is these type of women with no morals whatsoever that are making money on the backs of others by regurgitating information from others.

    Why Deficient Raw Vegans Become Meat Eaters:
    http://www.youtube.com/watch?v=hFNFGgGGi8U

  15. Dan Says:

    Every person is different. However, if you believe Dr Dean Ornish (UCSF) or Dr. Caldwell Esselstyn (Cleveland Clinic), it is not necessary to have any fat in one’s diet, and eliminating that actually reverses coronary artery disease (they have published data to support that in landmark journals like JAMA and The Lancet). It’s possible there are some people who physiologically incapable of living on low fat diets.

  16. Dan Says:

    Andreas what do you have against the use of blenders and food processors? Are you inferring calorie hyperabsorption or degradation of polyphenols and flavonoids?

  17. Andy Says:

    Christina Arasmo Beymer

    >Before the introduction of sugar, the Inuits ate a blubber diet with root veggies, and didn’t have heart disease rates like they do now.

    The health of the Inuit diet is a lot more complicated than that.
    http://www.youtube.com/watch?v=RoAflQdc3CE

  18. Christina Arasmo Beymer Says:

    @Andy, Health is sometimes more complicated than the simple statement that I made. In this case, it’s not. People see what they want to see, and for me, I see a correlation of increased heart disease, and other “Western” maladies with the introduction of sugar, specifically fructose devoid of the fruit it came from.

    @Dan: I think that the results they are getting are because they are not including sugar in the diet. By sugar, I mean sugar without it’s accompanying fruit. So if you eat an orange, good. Orange juice, not a good idea. Fructose is the culprit, not glucose. There are recent studies on this.

    http://www.medicalnewstoday.com/articles/262014.php
    Researchers at the University of Texas Health Science Center at Houston (UTHealth), have revealed that consuming too much sugar can greatly increase the risk of heart failure.

    Harvard’s article:
    “Eat a low-fat, low-cholesterol diet” was the mantra for healthful eating for decades. Touted as a way to lose weight and prevent or control heart disease and other chronic conditions, millions of people have followed (or, more likely, tried to follow) this advice. Seeing a tremendous marketing opportunity, food companies re-engineered thousands of foods to be lower in fat or fat free, often increasing the salt, sugar, or refined grains in these foods to make up for lost flavor and texture.

    http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-full-story/index.html

    There’s been controversy brewing over the past decade about just how bad saturated fat is for health. Fueling the debate, in part, has been the resurgence of the Atkins Diet, which eschews carbs but allows liberal use of high-fat foods, including foods high in saturated fat—butter, bacon, steak, cheese, and the like. (20) More recently, several studies seemed to suggest that eating diets high in saturated fat did not raise the risk of heart disease—a finding that ran counter to decades of dietary advice. (21,22) One highly-publicized report analyzed the findings of 21 studies that followed 350,000 people for up to 23 years. Investigators looked at the relationship between saturated fat intake and coronary heart disease (CHD), stroke, and cardiovascular disease (CVD). Their controversial conclusion: “There is insufficient evidence from prospective epidemiologic studies to conclude that dietary saturated fat is associated with an increased risk of CHD, stroke, or CVD.”(21)

    And the American Heart Association on limiting sugar:
    http://circ.ahajournals.org/content/120/11/1011.full.pdf

    This is why Paleo eaters are not failing their health, they remove sugar and viola. And also why a lot omnivores have good health if they remove sugar. I spoke with a PhD in Lipids and he and his colleagues have known for years that it’s the sugary drink with the ground cow and fries that contribute to heart disease and a heart attack. Statins are big business but recent evidence suggests that their benefits are the same as a baby aspirin.

    Be a vegan for animals, no other reason. That’s my reason.

  19. Kitty Fantastico Says:

    It is a very long post with many “out-there” nutrition ideas, so I do not encourage anyone to bother reading it. Instead, I will comment on what I found interesting.

    Stopped reading after I saw this. Anybody who tells me to trust them and not bother reading all sides of an issue has zero credibility. How very rude and arrogent. Please take it in consideration for future writings.

  20. Jack Norris RD Says:

    Kitty,

    I didn’t mean to imply that you should trust me – I just didn’t want people to feel compelled to read it. I’ll modify that statement a bit.

  21. Jack Norris RD Says:

    On second thought, I just cut that sentence and toned down some of the other rhetoric in the post. It is really annoying to read these incredibly long explanations by ex-vegans that are filled with all sorts of pseudoscience about what healthy eating is and is not. But my annoyance has now worn off enough to move it from the actual article to the comment section. :)

  22. Dan Says:

    I was on an Atkins’ type diet for a while and experienced severe hypercholesterolemia. Two cardiologists looked at my cholesterol panel and thought I had familial heterozygous hypercholesterolemia – but they never saw the ‘before diet’ numbers. It all remitted on a plant-based diet. I believe certain people with either baseline hypercholesterolemia or a tendency to overproduce or overabsorb cholesterol can be greatly harmed by a paleo or Atkins diet.

    The positive thing about paleo and Atkins is the minimization of refined carbohydrates in the form of sugar and starch from sweets, flour, high glycemic index fruit and juices and starchy tubers and crops (e.g. white rice). Everyone by now has heard of the “no white foods” diet – I take this to mean no salt, sugar, cream, milk, white rice or white bread. But in my opinion, paleo and Atkins type diets go overboard in their emphasis on high saturated fat and cholesterol intake, and this can harm certain people. A low carb vegan diet, supplemented by a few key micronutrients, perfectly balances my metabolism, blood pressure, lipids and weight. The only downside is that it requires creativity, research, knowledge and intuition to create.

  23. Christina Arasmo Beymer Says:

    @Dan. I hear you. By eating a diet high in dietary cholesterol and fat you got Hypercholesterolemia. For you a plant based, relatively low fat diet works for you, with some creativity. You are not the same as other people, but I bet a lot of people would be perfectly fine on your diet or a variation of it.

    However, there’s two types of LDL cholesterol, one is a light buoyant kind that does not stick to arteries and the other is MGmin-LDL which is created with the addition of fructose/sugar and does stick to the arteries. When you get your levels of LDL you get both combined (the light buoyant kind and the MGmin-LDL) and so it’s not your level of LDL that puts you at risk, from what I understand, it’s your triglycerides that will determine risk. This is from reading a load of this stuff from various sources over the past couple of years or so.

    Also, it makes sense. Fat is slippery and even my favorite fat, coconut fat, when heated up to less than my body temp. is liquid, and sugar is sticky crap.

  24. Andreas Says:

    Dan,

    “Are you inferring calorie hyperabsorption or degradation of polyphenols and flavonoids?”

    Both. Calorie hyperabsorption would most likely promote the faster absorption of oxidants and oxidants induce apoptosis. I am against anything which promotes oxidation of foods. Eating oxidized foods causes further oxidation in the body and hence, promotes disease. Eating more antioxidants, having fun in the sun and avoiding stress is the key to longevity.

    I have tried blending and food processing food, I lost muscle mass fast when blending greens and fruit. I feel a lot better on a grand scale when I properly chew nuts/leafy greens instead of processing them. Saliva the most important first step in digestion.

    I am not against steaming vegetables in a pot with a little bit of water at low temperatures until the cell walls of plants have soften enough. Its a slow and steady way of cooking which prevents the loss and destruction of nutrients.

    http://morelife.org/references/full_papers/14568010.pdf
    http://www.ncbi.nlm.nih.gov/pubmed/21862577

    Christina Arasmo Beymer,

    According to the research MGmin-LDL is only formed when antioxidants are low in the body and when atherosclerosis is already present, since atherosclerosis prevents sugar from entering the cells, hence raising blood sugar levels. Low antioxidants levels basically promote the further production of oxidants since there isn’t any antioxidants available to neutralize the oxidants by donating electrons.

    http://www.healthhabits.ca/2011/05/27/mgmin-ldl-cholesterol-kill-you/
    http://www.ncbi.nlm.nih.gov/pubmed/9486950
    http://www.ncbi.nlm.nih.gov/pubmed/15892182
    http://www.ncbi.nlm.nih.gov/pubmed/21165710

  25. Christina Arasmo Beymer Says:

    @Andrea:

    Thanks! I will read more. Have you seen this article, it’s more recent than a few of those links:

    http://www.sciencedaily.com/releases/2011/05/110526204953.htm

    Yep: Amylase is in saliva and its there for a reason.

    “Eating more antioxidants, having fun in the sun and avoiding stress is the key to longevity.” — Yep again.

    I am glad to live in Florida again. My mood improved dramatically when I came back even though my mother had brain cancer. Now, 2.6 years later, her incurable grade four brain cancer is gone. So much for oncologists’ omniscience.

  26. Dan Says:

    Mendelian randomization analysis and studies of kindreds with familial hypercholesterolemia clearly show that high LDL cholesterols lead to atherosclerosis. Thus just having a high LDL is sufficient to cause atherogenesis. I liken this to the “boots on the ground” concept. Without soldiers in the field, no devastation to the arterial wall. Conversely, low LDL is protective against atherosclerosis. Again these concepts are independent of ox-LDL or LDL particle size. You can have the most perfect diet in the world, but if you have too much LDL, your chances of getting a heart attack, stroke, angina or peripheral vascular disease are significantly higher than someone with a perfect diet and low LDL. This has been known for more than 50 years, and indeed the long-term follow-up data are now that long.

    What has been appreciated recently is that the quality of your LDL also matters. Highly oxidized and small dense LDL particles are more likely to be taken up by scavenger macrophages in the arterial wall than are large, buoyant, fluffy LDL. Patients with insulin resistance and metabolic syndrome have sdLDL, so do diabetics, smokers, hypertensives, and patients with inflammatory diseases. But the total amount of atherogenic particles – whether measured by LDLp or some other metric – is probably equally important.

    I think we are way off topic here. The question is why some people fail on vegan diets and then feel so much better on meat diets. To be honest, it is much easier to eat a meat diet and get adequate quantities of healthy fats, proteins and micronutrients than to do it on a vegan diet. You have to carefully plan and balance vegetarian diets, and supplement them with key micronutrients which are missing. If you are sloppy on an omnivorous diet, your chances of developing a major nutritional deficiency are significantly lower. I wish people would stop saying that vegan diets are healthier than omnivorous diets – the level A evidence to support that (large randomized trials with hard outcomes and long-term follow-up) is just not there. I eat vegan for ethical reasons and to reduce my ambient suffering. Many omnivores do very well on an omnivorous diet without the need for any vitamin supplementation.

  27. Jack Norris RD Says:

    Dan,

    > The question is why some people fail on vegan diets and then feel so much better on meat diets.

    I would modify that to:

    “The question is why some people fail on vegan diets and then feel so much better on meat diets in a matter of hours.”

    The fact that it takes so little time indicates the distinct possibility that there is a significant nutrient deficiency.

  28. Anthony Says:

    It is my understanding that saturated fat has a much greater influence on serum cholesterol levels than dietary cholesterol. Of course, about a third of the fat in eggs is saturated, but this is still a little lower than beef. I haven’t read the post in question, but my suspicion is that her craving for eggs, if she is being straightforward and truthful in recounting her story, was likely not because of her low cholesterol levels, or at least not solely because of that.

  29. Jack Norris RD Says:

    Anthony,

    > It is my understanding that saturated fat has a much greater influence on serum cholesterol levels than dietary cholesterol.

    This is true in most cases. But eating it directly will get cholesterol in your system faster than eating saturated fat (it seems safe to assume). Craving a direct source rather than craving an indirect source makes more sense to me.

    > was likely not because of her low cholesterol levels, or at least not solely because of that.

    What it a better guess?

    It seems like a lot of the people commenting on this post just cannot believe that someone could benefit from higher cholesterol levels. Her cholesterol was 95 mg/dl. It wasn’t 160, 130, or 110. If her cholesterol has been 160 and her health was failing and she was craving eggs, then it seems less reasonable to conclude that she was craving cholesterol.

    Something I didn’t mention in my summary was that she was suffering from irregular menstruation which is possibly related to estrogen levels, a steroid-based hormone that is made from cholesterol. Upon going back to animal products her menstruation normalized.

    I just did a quick Google search and according to Joel Fuhrman, the average cholesterol level in the China Study was 127 mg/dl (the blood was pooled together from many people before being measured, something I’m not so sure about). That’s still 30 points higher than Kristen’s.

    I have also wondered if people of European descent require higher cholesterol levels than people of African and Asian descent and that’s why many vegans I have heard from with cholesterol levels 110 mg/dl or less (the cutoff point where I have found people write to me with problems) have problems while at the same time people from these other cultures do well. It might also be a difference in how they are obtaining such low cholesterol levels – a large amount of physical activity vs. a very low-fat diet. I’m sure someone on this thread will let me know if that’s been teased out at all.

  30. Dan Says:

    Why do people feel better within a matter of hours when they restart meat diets? Could be purely psychological, in that they have associated their current diet (veganism) with feeling lousy, in which case the “cure” for them would be stopping the plant-based diet and eating meat. Something that dramatic within a matter of hours is likely a placebo effect related to expectation, not something physiologic. It usually takes months if not years to develop nutritional deficiency because for many if not most micronutrients the body has adequate storage pools (e.g. iron, B12), and thus can continually replenish the peripheral tissues where the nutrients are being used in biochemical reactions as cofactors, etc. Thus a single meal will never replenish the storage pool adequately, and the person will go back to feeling terrible unless the meals are sustained. Thus I would argue it’s a case of psychological expectations and classical conditioning.

    As to egg cravers, could they be craving choline, or simply the taste and smell of cooked eggs? (which many people find appealing?)

  31. Tyler Says:

    Christina:

    “Where are you getting this information? Before the introduction of sugar, the Inuits ate a blubber diet with root veggies, and didn’t have heart disease rates like they do now. Indians in india eat a lot of ghee mixed with their dal and milk fat is loaded in their tea which they sell everywhere and give away.”

    Its based on ethnographies from a variety of cultures and notice that I said predominately, I didn’t say all. The Inuit are one culture with a very specialized diet, one with a number of downsides, and by no means represents the typical human diet before modern technology. The vast majority of vegetarians in India don’t eat that much glee,cream, etc because its expensive so overall their fat intake is fairly low. The rich Indian foods served in America aren’t representative of what Indians eat on a daily basis.

    “Until recently, humans ate what is local. From what I’ve gathered, if you were located near almonds, that would be almonds, which are fatty and they don’t run from you….”
    I guess this depends on what you mean by “recent”, humans have been trading goods and producing food via agriculture for at least 15,000~20,000 years. Also, almonds as we know them today, are the product of agriculture.

    In any case, it is only in modern times that people can selectively eat fatty foods. In the wild, or even before the industrial era, the vast majority of available foods were low fat foods. Even societies that ate plenty of meat tended to have low-fat diets because most wild animals are lean. All the fatty meats one finds in the grocery store is a product of modern agriculture.

  32. Tyler Says:

    Dan:

    “Also I don’t buy that grain is necessary as part of a vegan diet. Some degree of carbophobia is necessary to combat metabolic syndrome, now present in 1 in 4 individuals according to the latest data.”
    Carbophobia is not necessary to combat metabolic syndrome because high carbohydrate intake doesn’t cause metabolic syndrome. The consumption of whole grains, legumes, whole fruits, etc are all associated with lower BMI and if you look around the world societies that consume very high carbohydrate diets are some of the leanest.

    Carbo-phobia sabotages vegans, its very difficult to create a well balanced vegan diet without it containing significant amounts of carbohydrates. Vegans, from my experience, that avoid carbohydrates (especially starchy ones) end up deficit in some micro-nutrients, calories and often protein.

    Sure grains aren’t essential, but avoiding them just makes vegan diets more difficult and there are no credible reasons to avoid them (with the exception, of course, of certain diseases).

    “However, if you believe Dr Dean Ornish (UCSF) or Dr. Caldwell Esselstyn (Cleveland Clinic), it is not necessary to have any fat in one’s diet, and eliminating that actually reverses coronary artery disease…”
    The Ornish and Esselstyn diet aren’t fat-free diets, all whole plant foods contain fats to some degree. A whole-food plant based diet that limits nuts, seeds, etc ends up being around 10~15% fat. Without any nuts, seeds, etc it would be 8~10% fat.

    But if these very low fat intakes were a common problem for people, you’d expect to see this show up in these studies….and they don’t.

  33. Jack Norris RD Says:

    Tyler,

    > Vegans, from my experience,

    What exactly *is* your experience? I’m wondering how you have so much experience observing vegans.

    > But if these very low fat intakes were a common problem for people, you’d expect to see this show up in these studies….and they don’t.

    I don’t recall them looking for any low-cholesterol-related problems in those papers.

  34. Anthony Says:

    Jack:

    This is true in most cases. But eating it directly will get cholesterol in your system faster than eating saturated fat (it seems safe to assume). Craving a direct source rather than craving an indirect source makes more sense to me.

    You’re right, that seems plausible.

    What it a better guess?

    I honestly have no idea. I’m no dietician. ;-) However, your suggestion that she was going “straight to the source” for cholesterol answers my question already.

    It seems like a lot of the people commenting on this post just cannot believe that someone could benefit from higher cholesterol levels. Her cholesterol was 95 mg/dl. It wasn’t 160, 130, or 110. If her cholesterol has been 160 and her health was failing and she was craving eggs, then it seems less reasonable to conclude that she was craving cholesterol.

    Sorry, I was not suggesting that her cholesterol levels were normal. 95 seems very low.

    Thanks for your response and for your additional thoughts. I just rediscovered veganhealth.org and this blog and am really enjoying it.

  35. Jack Norris RD Says:

    > Could be purely psychological, in that they have associated their current diet (veganism) with feeling lousy, in which case the “cure” for them would be stopping the plant-based diet and eating meat.

    Granted, but it is a very strong psychological response. I can see feeling better, but having your periods normalize?

    BTW, if someone is severely B12 deficient, it is not uncommon for them to feel better almost immediately upon taking high-dose B12 supplements.

    I am very wary of attributing people’s better health to a psychological response. It’s jut an easy cop-out, in my opinion. Though it would make my life a lot easier if I could just blame every case of failed veganism on psychology.

    Kristen had tried plenty of other solutions previously without such a psychological response.

  36. Christina Arasmo Beymer Says:

    If Jack has no problem posting off topic stuff, then here’s the last one:

    “Dr. Ronald M. Krauss, director of atherosclerosis research at the Oakland Research Institute, explains that higher LDL levels do help set the stage for heart disease by contributing to the buildup of plaque in arteries. But something else has to happen before people get heart disease. “When you look at patients with heart disease, their cholesterol levels are not that [much] higher than those without heart disease,” he says. Compare countries, for example. Spaniards have LDL levels similar to Americans’, but less than half the rate of heart disease. The Swiss have even higher cholesterol levels, but their rates of heart disease are also lower. Australian aborigines have low cholesterol but high rates of heart disease.”

    As far as vegan diets, I think that just by adding coconut fat and more protein would cover many of the people currently ex-ing out, but it would not cover all. We don’t hear about the ones who don’t have blogs, but you can find them here and there online and in person. One contacted me the other day, a low fat vegan and never had cavities her entire life until she went low-fat vegan and her hair is falling out too. She’s not happy about the so-called “greatest diet in the world.” Duped and pissed off.

    Clever transition goes here.

    I appreciate Jack’s voice MOST of all because he is not a guru doctor making money hand over fist. He is not a famous person with an image to protect. Because his agenda is in the right place, his “discrimination and determination” in regards to nutrition and helping people stay vegan, or mostly vegan, for animals is very important.

  37. Jack Norris RD Says:

    Anthony,

    Glad you’re enjoying it! You found us on a particularly active day. There’s nothing like an ex-vegan story to get us going.

  38. Tyler Says:

    Jack:

    “Something I didn’t mention in my summary was that she was suffering from irregular menstruation which is possibly related to estrogen levels, a steroid-based hormone that is made from cholesterol. Upon going back to animal products her menstruation normalized.”

    I’m still not clear why you want to make this about cholesterol and instead of the quality of diet consumed. Are you recommending the consumption of cholesterol rich foods? A deficit diet, long-term, would result in irregular menstruation and a number of other factors. Low cholesterol, irregular menstruation, fatigue can easily result from a poor diet but you seem to insist that the causal picture is low cholesterol -> fatigue, irregular menstruation, etc.

    “I just did a quick Google search and according to Joel Fuhrman, the average cholesterol level in the China Study was 127 mg/dl (the blood was pooled together from many people before being measured, something I’m not so sure about). ”

    Traditional societies, of a number of races, that consume lower fat diets typically have cholesterol levels between 120~140. Women tend to have higher cholesterol by 5~10 points. China is not racially homogeneous, many Chinese in the east are more similar (racially) to Europeans than hans in the east of China.

  39. Jack Norris RD Says:

    Christina,

    > I appreciate Jack’s voice MOST of all because he is not a guru doctor making money hand over fist. He is not a famous person with an image to protect. Because his agenda is in the right place, his “discrimination and determination” in regards to nutrition and helping people stay vegan, or mostly vegan, for animals is very important.

    Thank you for the kind words. I don’t think anyone is questioning my integrity, though perhaps my intelligence. :) It is true that I am, at my core, not a defender of any eating style and if I thought low-fat, whole foods veganism was the best way to thrive, I’d be happy to say it. My main goal is to figure out how vegans can thrive as well as meat-eaters. Due to individual variation, there cannot be one answer for everyone (I strongly suspect).

  40. Tyler Says:

    “What exactly *is* your experience? I’m wondering how you have so much experience observing vegans.”

    I say that to note that my comment is based on personal observation and not scientific data, I’m really not interested in trying to justify the amount of experience I have because the whole point in in say “in my experience” is to note that the data is unscientific. Whether I’m a doctor, a researcher, or whatever else doesn’t matter.

    “I don’t recall them looking for any low-cholesterol-related problems in those papers.”

    What low-cholesterol problems? This is a narrative you’re creating. Ornish,etc aren’t going to track a number of speculative “low cholesterol problems”, but they certainly tracked cholesterol levels and a number of bio-markers and the results were consist with what you’d see in traditional societies eating lower fat diets.

  41. Jack Norris RD Says:

    Tyler,

    > I’m still not clear why you want to make this about cholesterol and instead of the quality of diet consumed.

    That’s not my intention. Yes, it was the quality of her diet (most likely) and not that she needs to eat foods with cholesterol.

    There are a number of things that could lead to extremely low cholesterol levels and it could be a combination of high fiber (including from nuts) shuttling cholesterol out of her system, low-fat and/or low-calories, or metabolic problems. Given that her diet was on the extreme side (in my opinion), I suspect it was a combination of the fiber and fat/calories.

    As I implied in my original post, Kristen considers the diet that many vegans are thriving on to be a junk-food vegan diet. If Kristen’s prime motivation for her diet is to eat as naturally as possible, then good luck to her on her journey of natural eating. But she started out as a vegan for protecting animals and then got caught up in the natural eating movement (I can’t think of a better way to describe it) and failed. Why then, not try eating as a non-whole foods vegan for awhile? Just throw out all the rules and start eating how you want? She might have failed at this too, I’m not sure. But it seems worth a try if you care about animals.

  42. Christina Arasmo Beymer Says:

    Almonds have been around for centuries. They don’t require modern agriculture to grow. I read a few years ago that the natives to the Pacific Northwest ate a lot of them and anyone in a Mediterranean climate would also consume them. I have problems with “The Paleo Diet” since that diet is relative to the location.

    I’m not talking about Indian restaurants. My husband lived in India for 14 years and I’ve been numerous times since ’87. The villagers drink chai with thick, fatty milk and lots of spices to keep their appetites down and they chew paan for the same reason. They are all very skinny. This is in the villages where they may have goats or cows and share/trade mutton for milk. Fat and protein from dairy is very important. Gandhi tried an animal free diet, he couldn’t hack it. He drank milk.

    A Chinese person’s constitution, including their low cholesterol, is different than people from other ancestral backgrounds. People with darker skin have much, much lower rates of skin cancer. Everyone is different.

    This is the last of the responses.

  43. Jack Norris RD Says:

    Tyler,

    I was not suggesting that you should not be stating things that are not based on science. I, myself, have given many opinions that are not based on scientific studies in this thread. But you talk as though you have some sort of important amount of experience dealing with vegans and their ability to thrive, otherwise what would your experience even matter? If you happen to be a vegan doctor who works with a lot of vegan clients, then I’d like to know so that I can differentiate that between someone who happens to know a handful of vegans they are basing their opinions on. You and I have a clear disagreement in that most of the vegans you see fail do so because they eat too much processed food whereas my experience is almost the opposite. I’d like to know if you’re talking about 100 vegans or talking about 2. In my case, I’m talking about only dozens that have failed. But if you don’t want to tell me, that’s fine.

    > Ornish,etc aren’t going to track a number of speculative “low cholesterol problems”,

    Maybe they did their studies too long ago, but the problems with low-cholesterol and hemorrhagic stroke, depression, and mortality seem to have been well-known for some time and a 2013 meta-analysis recently found an association with hemorrhagic stroke (i.e, the findings have not been dismissed): http://www.ncbi.nlm.nih.gov/pubmed/23704101

    I don’t think monitoring for such things would be asking too much.

    I also don’t understand why, if Ornish’s plan is a great success, he doesn’t repeat it. One study and done? That seems odd to me. Maybe because his treatment doesn’t work as well as statins and would thus be unethical (I’m asking, not stating)?

  44. Derek Says:

    Jack, are you saying that a 95 cholesterol is too low? If so, what should she be doing (other than eating meat, etc) to raise her total cholesterol? I think my cholesterol has tested under 100 before (100-130 usually) and I certainly don’t dream about eating eggs.

  45. Jack Norris RD Says:

    Derek,

    I’m saying it might be too low. If you feel fine and your doctor has no problem with it, then I wouldn’t worry. The quickest way I’ve seen to bring cholesterol levels up on a vegan diet is by adding some coconut oil each day. Maybe 2 teaspoons per day would be a good starting point.

  46. Tyler Says:

    Jack:

    “You and I have a clear disagreement in that most of the vegans you see fail do so because they eat too much processed food whereas my experience is almost the opposite.”

    I don’t think processed foods are the only issue and I wouldn’t blame processed foods as a whole, instead a particular class of processed foods. That is, refined sugars, oils and starches and the foods created from them. I’m not sure how anybody would benefit from adding these foods to their diets instead of the whole foods they were derived from. You seem to clump all whole-food based eating patterns together,but a whole-foods diet based on cooked grains, cooked legumes, nuts, fruits and vegetables is a lot different than a fruit based diet, raw diet, etc.

    In any case, Kristen doesn’t say much about what she use to eat but the few comments that she does make seem to indicate she was eating some sort of high fat raw diet so its a bit strange that one of the focuses in the comments has been on low fat intake.

    “Maybe they did their studies too long ago, but the problems with low-cholesterol and hemorrhagic stroke, depression, and mortality seem to have been well-known for some time and a 2013 meta-analysis recently found an association with hemorrhagic stroke”
    As far as I can recall the association with hemorrhagic stroke has been known for awhile, but when you control for blood pressure the association largely vanishes. That is, its low cholesterol coupled with high blood pressure (as happens in some very high sodium/low fat Asian diets) that is problematic.

    http://www.ncbi.nlm.nih.gov/pubmed/21079399

    “I also don’t understand why, if Ornish’s plan is a great success, he doesn’t repeat it. One study and done That seems odd to me.”

    A study of this depth isn’t cheap to run, who is going to fund a repeat of the same study by the same group? Also, even if there was funding, it wouldn’t make much sense in the first place because the results should really be peer reviewed and repeated by other researchers.

    But Dean Ornish hasn’t done one study, he has authored and/or co-authored a number of studies. He is an accomplished researcher, as such I’m a bit confused by your smarmy tone.

  47. Dan Says:

    Coconut oil boosts LDL cholesterol quite strikingly, probably due to stimulation of the liver by saturated fat. Walter Willett at HSPH has expressed caution in the Harvard Heart Letter about the use of coconut oil (Harv Heart Lett. 2006 Sep;17(1):8.). I know you will now quote all those subtropical cultures who live on a coconut oil based diet and “never” get heart disease – ecological comparisons are fraught with problems, and we will never know what aspect of their environment is protective (intensive physical activity? constant sun exposure and high ambient vitamin D levels? lack of junk food and SAD dietary items? etc)

    Coconut oil was the only thing I used to cook with the Atkins diet I was on for 5-6 months, when I developed severe hyperlipidemia. Don’t know if it was the eggs or meat or the oil, but I do know that saturated fat is considered a stronger contributor to high cholesterol than cholesterol-laden foods like ovine products. Conversely, unsaturated fats, of which there are barely any in coconut oil, lower cholesterol.

    I have never heard of anyone craving cholesterol before and unfortunately most cholesterol levels are drawn in the fasting state, rather than postprandial. But we eat multiple times per day (some people eat up to 6 times per day), so fasting overnight for 12 hours does not represent a normal physiological state for most people. My point is that postprandial cholesterols could be high in someone with low fasting cholesterol. Peaks and troughs. As you know, cholesterol is also synthesized in the body and thus if she was truly deficient from diet (<20% of the cholesterol pool comes from the diet), she should be able to ramp up production in her liver – I wonder if she had a genetic defect here.

    Perhaps my baseline hyperlipidemia is what is allowing me tolerate a vegan diet so well. However, I know many people with very low cholesterol levels who are completely asymptomatic and doing well, both on and off statins.

    Ornish has replicated his diet in a prostate cancer clinical trial. It has also been used in his cardiac rehabilitation patients and published in the literature. I am not skeptical about Ornish, only the tolerability of ultra-low diets for most people. They are also not classically vegan as they include egg whites and low-fat dairy.

  48. Dan Says:

    I think some people could have distinct genotypes or phenotypes that make it impossible to tolerate certain diets, such as a very low fat Ornish or Esselstyn diet. Certainly my genotype – cholesterol hyperabsorber – makes it impossible for me to tolerate an omnivorous diet. The problem is that dietary recommendations are not really targeted to individuals, more to huge demographic groups characterized by age/sex/pregnancy/lactation status. The fields of nutrinomics and nutrigenomics are still in their infancy, clinically speaking.

    And it does take a lot of work and time to achieve a balanced vegan diet. Once it’s achieved, it becomes more easy, and you may forget all those growing pains of buying the wrong foods, gradually becoming tolerant of foods you thought you could never find palatable, etc. Many vegans seem to forget this and they dismiss the ‘ex-vegan’ as a whimp or misguided. It took me over 17 months to make the full transformation (omnivore to pesco-lacto-ovo-vegetarian to lacto-vegetarian to vegan), some of which was the result of ethical contemplation and spiritual change, and some of which was surmounting real culinary and knowledge limitations.

    Also please be wary of what people post in their comments on the internet. Much of it is totally unscientific nonsense – in my highly judgmental opinion. Caveat emptor I suppose!

  49. Andreas Says:

    I doubt fats alone can raise cholesterol synthesis because I never get a morning erection from the intake of extra virgin olive oil but the intake of walnuts, other nuts and seeds gives me [one] the next morning. There is some research which indicates that gut bacteria is able to convert phytosterols in other sterols and/or hormones. I would love to see more research on this.
    http://ocw.nagoya-u.jp/files/1/chap6.pdf

    “Decreased cholesterol absorption is also associated with increased cholesterol synthesis, and increasing phytosterol intake has been found to increase endogenous cholesterol synthesis in humans.”
    http://lpi.oregonstate.edu/infocenter/phytochemicals/sterols/

    Coconut does contain phytosterols.

    Dan,

    Are you confusing lipoproteins with actual cholesterol?

  50. Dan Says:

    Andreas, I suspect your a.m. erections are from intake of foods that contribute to NOx production.

    Re: cholesterol vs lipoproteins – must be my orthorexia nervosa acting up! I am going to ease off a little on the diet.

  51. Anne Says:

    No one here has mentioned her weight and this is something which struck me: 117 lbs! It sounds like she was undernourished and probably underweight to me, and possibly also why she was having problems with her menstrual cycle. She probably just wasn’t eating enough. Period. Someone also mentioned that she used to post what she ate daily and that it wasn’t much… Her approach to food seems obsessional, she may be the victim of an eating disorder?!

  52. Healthy Longevity Says:

    @Christina

    Why not read/cite this editorial rather than just promoting saturated fat propaganda.
    http://m.ajcn.nutrition.org/content/91/3/497.full

    Why not list Krauss’ s conflicts of interest while your ate at it? You do know he receives grants from the meat and dairy industry as well as Atkins right?

  53. Richard Says:

    Jack,

    low cholesterol, a problem? Are you serious?

    1) “Several lines of evidence suggest that plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl (Fig. 16 and ref. 120). In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels (9,119) . Second, the LDL level in newborn humans is approximately 30 mg/dl (121), well within the range that seems to be appropriate for receptor binding (Fig. 16). Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl. It only reaches levels above 100 mg/dl in individuals who consume a diet rich in saturated animal fats and cholesterol that is customarily ingested in Western societies (116,122)”.

    Brown & Goldsteinin, 1985

    2) Optimal low density lipoprotein is 50 to 70 mg/dl; lower is better and physiologically normal
    http://content.onlinejacc.org/article.aspx?articleid=1135650

  54. Andreas Says:

    Dan,

    NOx production? As in nitric oxide?

    I was referring to the info below, how cholesterol is the precursor to androgen hormones, if androgen hormones are at OK levels, then we will experience spontaneous morning erections, then we know cholesterol is sufficiently being produced. An external indicator that we are producing cholesterol.

    http://en.wikipedia.org/wiki/Nocturnal_penile_tumescence
    http://en.wikipedia.org/wiki/Nocturnal_clitoral_tumescence
    http://www.ncbi.nlm.nih.gov/pubmed/1287683
    http://www.ncbi.nlm.nih.gov/pubmed/8848520 (NPT as androgen dependent)
    http://onlinelibrary.wiley.com/doi/10.1002/j.1939-4640.1982.tb00676.x/abstract

    I believe orthorexia is caused by being influenced. Make your own decisions, experiment and listen to your own truth. And above all, follow your instincts by eating as much food as you would like to eat that makes you feel good instead of portion controlling and listening to others, including me. ;)

    Here is a little program to make your life easier. http://justgetflux.com

  55. Reader Says:

    “I think that humans are not raw fooders even though it seems logical at first because no other animal is eating cooked food. But humans just aren’t like any other animal. Technology and cooking is part of our evolution. I don’t think it is just cultural that most people prefer cooked over raw. Cooked food is our natural diet.”

    Have you read Catching Fire by Richard Wrangham (not to be confused with the Hunger Games sequel Catching Fire)? It’s all about that hypothesis!

  56. Richard Says:

    Jack Norris wrote,

    “Maybe they did their studies too long ago, but the problems with low-cholesterol and hemorrhagic stroke, depression, and mortality seem to have been well-known for some time and a 2013 meta-analysis recently found an association with hemorrhagic stroke (i.e, the findings have not been dismissed): http://www.ncbi.nlm.nih.gov/pubmed/23704101

    Jack, this is an epidemiologic correlation. Do you think most free-ranging mammalians are prone to hemorrhagic strokes with physiologic, ultra-low cholesterol levels?

    The findings you referred to have not been dismissed since there’s nothing to dismiss in them. Certain genetic polymorphism that make their carriers prone to depression are linked to low cholesterol levels as well. Two things happen at the same time. If low cholesterol concentrations would CAUSE depression, then we’d see plenty of depression among the elderly people of Okinawa, among contempory hunter-gatheres, etc. Moreover, it’s well known that alcohol induces disturbances of the liver and may lead to low LDL levels. Low cholesterol together with high blood pressure is a marker of alcoholism. We never see increased risk of hemorrhage on low cholesterol levels in people with low blood pressure. The authors of huge Korean cohort study reported (~800 000 participants, ~10 000 strokes):

    “In our study, increased risk of hemorrhagic stroke in people with low concentrations of blood cholesterol (less than 4.14 mmol/l) was restricted to those with high GGT values [a measure of alcohol intake]; this relation was less evident when alcohol consumption was measured by self report. The measures of blood pressure might not have been a true reflection of risk, as transient high blood pressure associated with binge drinking may have an important role in hemorrhagic stroke. At low concentrations of GGT, low serum cholesterol was not associated with a higher risk of hemorrhagic stroke. In effect, low blood cholesterol may act as a marker of the health damaging effects of alcohol, rather than be a cause of hemorrhagic stroke” .

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488755/

  57. Ariann Says:

    Wow, what an active thread. Just chiming in to say I have a hard time ever believing that food cravings are associated with deficiencies in such a clear cut way. The most well known deficiency related craving is pica, which is all about craving things that will probably make your iron deficiency *worse*. I have high cholesterol, have been vegan for many years, and still crave eggs. They were a comfort food of my childhood, I remember them being very delicious (and still think they look delicious when I see others eating them), and I regularly make facsimiles (scrambled tofu with black salt, chickpea frittata, etc.).

    By the way, I have found the answer to low cholesterol. Gain weight. Doesn’t matter how you do it, carbs or fats or proteins, your cholesterol will almost certainly go up. Vegans who fail to thrive and are depressed or have bad skin/hair are often also just underweight. Eating more of anything would be helpful, and I definitely have immediate psychological benefits from eating a hearty and delicious meal. Gaining weight when you are underweight will also go a long way to correcting hormone imbalances and fixing menstrual problems.

  58. Ariann Says:

    PS I now eat a low carb diet to control reactive hypoglycemia. I feel a lot better than I did before and am losing weight (which is desired). But at the end of the day the animals are way up on my priorities list, and I will happily eat a pretty boring low carb vegan diet even though adding eggs or fish would make it more varied and easier. It’s all about priorities and how much research you’re willing to do and how much discomfort you’re willing to endure to deal with your health issues. Vegans are not immune from getting sick or having very particular nutritional needs to control their personal physiological quirks. Luckily it is a rare nutritional problem that is not solvable with a vegan diet.

  59. ghul Says:

    as some other people on the comments page i think she simply might have not been eating enough calories.

    it makes more sense to me than the cholesterol part

    i mean eating foods that contain saturated fat or cholesterol… wouldnt that just raise your systemic cholesterol levels slowly like say over the course of weeks or months?

    thinking of macronutrients though, if she was undereating i am pretty sure that there is the possibility that just eating enough food would have made her feel better … within a matter of hours :D
    isnt that the main reason for foods we crave? to get enough calories so we can sustain ourselves

    also dont people on energy diets (not enough calories, starvation) experience low cholesterol, dysphoria and menstrual irregularities as well?

    unfortunately i am not experienced at finding studies but maybe someone else could chime in and bring some sound science along :D

  60. Jack Norris RD Says:

    > low cholesterol, a problem? Are you serious?

    Serious as a heart attack.

    > 1) “Several lines of evidence suggest that plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl)

    That’s interesting. Kristen’s cholesterol was 95 mg/dl, quite a bit lower than 110 to 150. I say it’s interesting because about 110 mg/dl is about the cutoff where people who write me with problems that I cannot pin on anything else.

  61. Jack Norris RD Says:

    Ariann,

    > Just chiming in to say I have a hard time ever believing that food cravings are associated with deficiencies in such a clear cut way.

    This might not be the type of deficiency you’re talking about, but what about craving sugar when one’s blood sugar is low? That seems to be a pretty consistent phenomena with an obvious physiological basis.

    > Gaining weight when you are underweight will also go a long way to correcting hormone imbalances and fixing menstrual problems.

    How does the weight fix the hormone imbalances?

  62. Jack Norris RD Says:

    ghul,

    > as some other people on the comments page i think she simply might have not been eating enough calories.

    Seems possible. She does say that she lost a lot of weight while breastfeeding.

  63. Ariann Says:

    Jack,

    Low blood sugar is a good counter example, although it is unlikely that people experiencing acute low blood sugar and craving sugar are actually deficient in sugar! On the contrary, my hypoglycemia is best controlled by eating a LOW carbohydrate diet. This is a great example of the body giving us the wrong cues for long term health, even if we could satisfy a craving and feel slightly better in the short term.

    My understanding is that too low body fat disrupts estrogen production which can prevent menstruation as well as conception, how low is too low depends on the person. Whether that’s the pathway or not, it is a really common side effect of excessive exercise or dieting for women to experience amenorrhea.

  64. Jack Norris RD Says:

    Ariann,

    My response here is directed more towards the low-fat diet defenders on this thread than to you. So, I hope you don’t find it too antagonistic.

    > This is a great example of the body giving us the wrong cues for long term health,

    I appreciate that, but I don’t see how it matters whether the body’s cues are good for long-term health. If someone can crave cholesterol when their cholesterol is very low, and I think only the most adamant defenders of low-fat diets would possibly claim that a cholesterol of 95 isn’t very low, then this would be similar to craving sugar when the blood sugar gets too low. It might not be good for you long term, but you need it now. The long term health of either craving would be irrelevant and, I would expect the craving to subside once levels are normalized (as indicated by all the vegans who do not crave eggs), as they often do in sugar cravings.

    > My understanding is that too low body fat disrupts estrogen production which can prevent menstruation

    The question is “Why?” Since estrogen is produced from cholesterol, is it really that far out to suggest that perhaps it could be low cholesterol that could be causing the low estrogen? Or, perhaps, low body fat is leading to both low blood cholesterol and low estrogen? Either way, the craving makes (at least common) sense.

  65. Ariann Says:

    That’s all fine, although it is pretty easy to raise cholesterol just by eating more of anything and gaining weight. There are things that are much more effective at boosting cholesterol and body weight than eggs. Like cake.

    In any case, since there doesn’t seem to be any good evidence that our bodies are really good at telling us what we need through cravings, I’m gonna rely on nutrition experts such as yourself and my own dietician for advice on what to eat, rather than listen to my internal chocoholic who has often steered me wrong. It seems like if cravings were meaningful, we would have some interesting studies to look at about them already, rather than only relying on Internet anecdotes which may not even be truthful.

  66. Jack Norris RD Says:

    Ariann,

    Food cravings with respect to nutrient deficiencies don’t seem to have been studied much at all yet, unfortunately.

  67. Richard Says:

    “That’s interesting. Kristen’s cholesterol was 95 mg/dl, quite a bit lower than 110 to 150. I say it’s interesting because about 110 mg/dl is about the cutoff where people who write me with problems that I cannot pin on anything else”.

    Jack,

    a low cholesterol level may be a marker for poor nutrition, wasting disease, cancer, hyperthyroidism, and liver disease. There’s actually people who are with insanely low cholesterol levels (hypobetalipoprotenemia) and MOST of them do well, and in fact tend to live 9-12 years longer than their peers.

  68. Jack Norris RD Says:

    Richard,

    > people who are with insanely low cholesterol levels (hypobetalipoprotenemia) and MOST of them do well, and in fact tend to live 9-12 years longer than their peers

    I’ve looked for information on this and haven’t found any. Do you have citations for studies showing these people live longer? I’d be interested to know. But even if this is the case, it doesn’t mean that Kristen’s low cholesterol level wasn’t a problem for how she felt and her disrupted menstrual cycle and that eating cholesterol and saturated fat didn’t do a great deal to ameliorate her problems.

  69. Richard Says:

    Jack,

    Only those with the most severe forms homozygot hypobetalipoprotenemia face problems, but most of the cases are bening and leaves their carries with improved longevity and good health.

    See Daniel Steinberg’s article for sources:

    “Third, in some kindreds with hypobetalipoproteinemia, LDL cholesterol levels can be <15 mg/dL throughout life, yet the affected members show perfectly normal growth and development and actually have increased longevity.40,41"

    http://circ.ahajournals.org/content/118/6/672.full

    In addition see,

    Familial Hypobetalipoproteinemia: Absence of Atherosclerosis in a Postmortem Study
    http://jama.jamanetwork.com/article.aspx?articleid=360289

    Glueck C.J, Kelley W, Gupta A, Fontaine R.N, Wang P, Gartside P.S; Prospective 10-year evaluation of hypobetalipoproteinemia in a cohort of 772 firefighters and cross-sectional evaluation of hypocholesterolemia in 1,479 men in the National Health and Nutrition Examination Survey I. Metabolism. 46 1997:625-633.

    People at SW medical center have identified people with homozygot PCSKY-9 knock-out mutation; these people have their life-time LDLs around 7-14mg/dl, all so far identified individuals have been in excellent health.

    Rare Mutation Ignites Race for Cholesterol Drug
    http://www.nytimes.com/2013/07/10/health/rare-mutation-prompts-race-for-cholesterol-drug.html?pagewanted=1&smid=tw-share&_r=0

  70. Jack Norris RD Says:

    Thanks, Richard. I’ll check it out.

  71. Dan Says:

    People with a PCSK9 genetic mutation have lifelong lower LDL cholesterol levels and their rate of cardiovascular events is approximately 50% lower than the rest of the population (http://www.ncbi.nlm.nih.gov/pubmed/16554528). See also http://www.ncbi.nlm.nih.gov/pubmed/23083789

    Periods of rapid weight loss can actually cause transient hypercholesterolemia as shrinking adipose cells liberate stored cholesterol (http://www.ncbi.nlm.nih.gov/pubmed/2035468). Clearly that was not the case here.

    I have seen many individuals with ultra-low LDL cholesterols on statins and other lipid meds who are thriving. They do not seem to complain about craving eggs or other cholesterol-rich sources, although I suppose it’s possible.

    The only way to properly test the hypothesis that diet-induced hypocholesterolemia caused craving in this case is to give a cholesterol supplement and see if the craving is attenuated. However, the 40% of people who strongly respond to placebos would mean you would have to do a placebo-controlled blinded n-of-1 trial to see.

    As mentioned previously, some people tolerate ultra-low fat diets (Ornish, Esselstyn, etc) but there could be key genetic differences between tolerators and non-tolerators and it’s certainly possible that this individual was genetically predestined to be a non-tolerator. Speaking only from my own case, I seem to require a certain amount of fat to induce satiety. There are genetic polymorphisms involved in weight loss response to specific diets so I do not see why other (or the same) genes could underpin craving, if it is truly based on biochemistry and not just culture and psychology.

  72. Tyler Says:

    I found this amusing, someone asking about a tofu craving on “paleo hacks”:

    http://paleohacks.com/questions/207582/craving-tofu-why

  73. Tyler Says:

    Dan:

    “As mentioned previously, some people tolerate ultra-low fat diets (Ornish, Esselstyn, etc) but there could be key genetic differences between tolerators and non-tolerators and it’s certainly possible that this individual was genetically predestined to be a non-tolerator.”

    What reason is there to believe, excluding potential diseases/genetic disorders, that there are such non-tolerators? Are there studies that demonstrate this? Given the large number of diverse societies that have subsisted on a low-fat diet, its hard to believe that non-tolerators would exist beyond rare genetic disorders/those with diseases.

  74. Dan Says:

    Tyler, are you familiar with the concept of genetic diversity between individuals and populations? It is the underpinning of evolutionary biology. I am trying to posit reasons for why this individual, or any individual for that matter, might not be able to tolerate a very low fat diet. Could it be that fat is satiating to some individuals? Is this genetic, biochemical, psychological or cultural? There are more genetic differences than “meet the eye” (see for example http://www.ncbi.nlm.nih.gov/pubmed/23446828). Many people have complained that they just can’t hack a low fat, or very low fat, diet.

  75. Tyler Says:

    Dan:

    Yes, there is genetic diversity between individuals and ethnic groups…..but you’re putting the cart before the horse. As I asked, what reason is there to believe that there is a class of healthy people that can’t tolerate low-fat diets? Before we try to give an explanation, shouldn’t one confirm the existence of this class of people? Personal anecdotes aren’t evidence, when people change their diets there are tons of confounding variables and there are plenty of ways one could craft a unhealthy low-fat diet. If we were to take such personal anecdotes seriously, one should also make similar conclusions about vegetarian and vegan diets. Perhaps there is a class of people that can’t thrive on a vegan diet? Plenty of personal anecdotes of people suggesting that this is the case….so perhaps the group is pretty big.

    Absence serious evidence that such a class of people exist, I think the hypothesis is implausible. Low-fat diets are extremely common in human populations, any genes that prevented one from thriving on such diets would quickly be eliminated. This is especially true of “civilized” populations, for example, until somewhat recently the vast majority of Europeans were consuming a semi-vegetarian diet rich in whole grains and legumes where fat intake would have been between 10~20%.

  76. Dan Says:

    >>As I asked, what reason is there to believe that there is a class of healthy people that can’t tolerate low-fat diets?

    ….from dropout rates in trials comparing different macronutrient compositions. There are fairly equal dropout rates on low fat vs low carb diets – so I take this to mean that some people do best on a certain type of diet (whether for cultural, psychological or physiological reasons who knows?).

    >>Perhaps there is a class of people that can’t thrive on a vegan diet?

    From all the reports on the internet, it seems to be a pretty big group. Likely they have not balanced their diet properly and therefore are missing key micro or macronutrients.

    >>until somewhat recently the vast majority of Europeans were consuming a semi-vegetarian diet rich in whole grains and legumes where fat intake would have been between 10~20%.

    I don’t find these cross-cultural comparisons to be very enlightening any more. People adapt to whatever the local climate and cuisine would support. Humans, like canids, are scavengers. Just because one group of people eat a certain macronutrient composition does not mean this should be extrapolated to all people (I believe the paleo dieters make the same mistake). Anyway, the evidence is that macronutrient distributions (fat:protein:carb) vary dramatically in pre-westernized cultures. Look at the local fauna and flora, and what instruments are available and whether the society is agricultural, nomadic, hunger-gatherer, etc – that will determine what people eat. And I don’t think that people who are genetically intolerant of low fat diets would have died off – they could simply have moved to areas with abundant game – we know humans are incredibly nomadic.

  77. Jack Norris RD Says:

    Commenter Richard above said this:

    2) Optimal low density lipoprotein is 50 to 70 mg/dl; lower is better and physiologically normal
    http://content.onlinejacc.org/article.aspx?articleid=1135650

    That paper is just a review paper and they say:

    “Evidence from hunter-gatherer populations while they were still following their indigenous lifestyles showed no evidence for atherosclerosis, even in individuals living into the seventh and eighth decades of life (15,16). These populations had total cholesterol levels of 100 to 150 mg/dl…”

    So is citation 15 a study that measured the cholesterol levels of such people? Of course not. It’s a citation for another review:

    Cordain L, Eaton SB, Brand Miller J, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: meat based, yet non- atherogenic. Eur J Clin Nutr 2002;56 Suppl 1:S42–52.

    And Cordain et al’s review says:

    “Over the past 64y, anthropological research has consis- tently demonstrated relatively low serum cholesterol and triacylglycerol levels among indigenous populations that derive the majority of their diet from animal products (Bang & Dyerberg, 1980; Biss et al, 1971; Corcoran & Rabinowitch, 1937; Day et al, 1976; Eaton et al, 1988a; Leonard et al, 1994; Scott et al, 1958; Shaper et al, 1961; Wilber & Levine, 1950).”

    The full Bang & Dyerberg citation is:

    Bang HO & Dyerberg J (1980): Lipid metabolism and ischemic heart
    disease in Greenland Eskimos. Adv. Nutr. Res. 3, 1 – 22.

    I can only find this paper cited, I cannot find an actual abstract for this paper. Anyone else want to try?

    Interestingly, Cordain also says:

    “For the majority (53%, n = 122) of the world’s foraging cultures the dietary fat intake would lie between 36 and 43% of total energy (Cordain et al, 2000a),..”

    Not exactly an argument for very low-fat diets.

    I’m now tracking down the second citation for Cordain. If that doesn’t bear fruit, I’m probably going to quit this (excuse the non-vegan phrase) wild goose chase.

  78. Dan Says:

    Jack are you familiar with this paper? http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0006590

    Tsimane are an amazonian tribe of hunter-foragers. mean+/-SD
    total cholesterol, 138+/-29 mg/dL and LDL, 75+/-22 mg/dL. These are very low values. They don’t get arterial disease. The mean total LDL in those who are 70+ years old is only 120 mg/dL. Compare that with US figures.

    “Whereas no Tsimane show high risk levels of total cholesterol and LDL, 20% of U.S. adults have elevated levels of each blood lipid, even though many Americans use lipid-lowering medications. The prevalence of high triglycerides for most age groups in the U.S. is double that of the Tsimane. There is little indication of age increases in these measures among Tsimane. Values are similar across ages after 40 and do not show increased CVD risk at older ages in any parameter”

    What is the actual question you are trying to answer? What lipid levels are like in indigenous vegans or near-vegans?

  79. Jack Norris RD Says:

    > What is the actual question you are trying to answer?

    At what level does low cholesterol become a problem. I’ve narrowed it down to somewhere between 160 and 0 mg/dl.

    And what I’m currently doing is weeding through many of the links people provided me with in this thread and checking them out.

  80. Dan Says:

    According to this follow-up paper from the same group (http://www.ncbi.nlm.nih.gov/pubmed/20721985), total cholesterol in 415 Tsimane people was mean 138.0, with a range of 69 to 258.

    In a follow-up paper, they demonstrate that these people lack the ‘normal’ increase in BP seen with aging – http://www.ncbi.nlm.nih.gov/pubmed/22700319

    Prevalence of hypertension is far below that seen in the West too (in Canada about 20% of the population has hypertension).

    On the other hand, they carry a lot of parasites and get a lot of infectious diseases, but don’t appear to develop cardiovascular disease.

  81. Jack Norris RD Says:

    > According to this follow-up paper from the same group (http://www.ncbi.nlm.nih.gov/pubmed/20721985), total cholesterol in 415 Tsimane people was mean 138.0, with a range of 69 to 258. On the other hand, they carry a lot of parasites and get a lot of infectious diseases, but don’t appear to develop cardiovascular disease.

    Good, then we can strive for a cholesterol level between 69 and 258 mg/dl.

  82. Tyler Says:

    “For the majority (53%, n = 122) of the world’s foraging cultures the dietary fat intake would lie between 36 and 43% of total energy (Cordain et al, 2000a),..”

    Not exactly an argument for very low-fat diets”

    But what is it an argument for exactly? Not much. Nearly everything about his study is problematic, but even if we assume its accurate it doesn’t tell us anything. Hunter and gather societies represent a very small fraction of the human population over the last ~10,000 years and we really have no idea whether modern hunter gathers are representative of how people lived 10,000+ years ago. The vast majority of people were horticulturists and agriculturists and these populations tend to eat lower fat diets since most food staples were starchy low-fat crops. In this context, its very unlikely that genes that prohibited one from subsisting on low-fat diets would be common.

    Of course all this is conjecture, what you need are studies that show that there is a class of healthy people that can’t tolerate low-fat diets. Do you know of such a study?

  83. Tyler Says:

    Dan:

    ….from dropout rates in trials comparing different macronutrient compositions. There are fairly equal dropout rates on low fat vs low carb diets – so I take this to mean that some people do best on a certain type of diet.

    There is another explanation, namely, people have trouble alternating their long-term habits and/or have trouble adopting a lifestyle that runs counter to mass society. We know that both of these psychological factors exist while no studies have shown that there are some people that “need more fat’ and others that “need less fat”.

    “Likely they have not balanced their diet properly and therefore are missing key micro or macronutrients.”

    Right..and my point of mentioning this is to point out that you guys aren’t being consist. When personal anecdotes conflict with something you want to believe then they are explained away by “missing some micro-nutrient, etc” but when personal anecdotes corroborate what you wish to believe they are supporting evidence. Its the confirmation bias at work….

    But in this case, its a bit strange because the person being discussed didn’t even have a low-fat diet…yet its being blamed.

    “I don’t find these cross-cultural comparisons to be very enlightening any more. People adapt to whatever the local climate and cuisine would support. Humans, like canids, are scavengers. Just because one group of people eat a certain macronutrient composition does not mean this should be extrapolated to all people (I believe the paleo dieters make the same mistake). Anyway, the evidence is that macronutrient distributions (fat:protein:carb) vary dramatically in pre-westernized cultures. Look at the local fauna and flora, and what instruments are available and whether the society is agricultural, nomadic, hunger-gatherer, etc ”

    I wasn’t making a cross-cultural comparison, nor was I suggesting one should use this information to extrapolate a diet…instead I was making an evolutionary argument. For the last ~10,000 years or so the vast majority of people subsisted on lower fat diets and there would have been intense selection pressure against genes that made it difficult for one to thrive on lower fat diets.

    Macro-nutrient ratios likely varied a lot before agriculture, but not so much after and the last 10,000 years would have changed our underlying biology.

  84. Dan Says:

    J Am Coll Cardiol. 2011 Apr 19;57(16):1666-75. doi: 10.1016/j.jacc.2010.09.082.
    Cardiovascular event reduction and adverse events among subjects attaining low-density lipoprotein cholesterol <50 mg/dl with rosuvastatin. The JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin).
    Hsia J, MacFadyen JG, Monyak J, Ridker PM.
    Source
    AstraZeneca LP, 1800 Concord Pike, Wilmington, DE 19850-5437, USA. judith.hsia@astrazeneca.com
    Abstract
    OBJECTIVES:
    The purpose of this study was to assess the impact on cardiovascular and adverse events of attaining low-density lipoprotein cholesterol (LDL-C) levels <50 mg/dl with rosuvastatin in apparently healthy adults in the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial.
    BACKGROUND:
    The safety and magnitude of cardiovascular risk reduction conferred by treatment to LDL-C levels below current recommended targets remain uncertain.
    METHODS:
    A cohort of 17,802 apparently healthy men and women with high-sensitivity C-reactive protein ≥2 mg/l and LDL-C <130 mg/dl were randomly allocated to rosuvastatin 20 mg daily or placebo, and followed up for all-cause mortality, major cardiovascular events, and adverse events. In a post-hoc analysis, participants allocated to rosuvastatin were categorized as to whether or not they had a follow-up LDL-C level <50 mg/dl.
    RESULTS:
    During a median follow-up of 2 years (range up to 5 years), rates of the primary trial endpoint were 1.18, 0.86, and 0.44 per 100 person-years in the placebo group (n = 8,150) and rosuvastatin groups without LDL-C <50 mg/dl (n = 4,000) or with LDL-C <50 mg/dl (n = 4,154), respectively (fully-adjusted hazard ratio: 0.76; 95% confidence interval: 0.57 to 1.00 for subjects with no LDL-C <50 mg/dl vs. placebo and 0.35, 95% confidence interval: 0.25 to 0.49 for subjects attaining LDL-C <50 mg/dl; p for trend <0.0001). For all-cause mortality, corresponding event rates were 0.67, 0.65, and 0.39 (p for trend = 0.004). Rates of myalgia, muscle weakness, neuropsychiatric conditions, cancer, and diabetes mellitus were not significantly different among rosuvastatin-allocated participants with and without LDL-C <50 mg/dl.
    CONCLUSIONS:
    Among adults with LDL-C <130 mg/dl and high-sensitivity C-reactive protein ≥2 mg/l, rosuvastatin-allocated participants attaining LDL-C <50 mg/dl had a lower risk of cardiovascular events without a systematic increase in reported adverse events.

    Jack, you have a great sense of humor, which I suppose you need with this website! You've got a lot of cranks posting – like me! :-)

    PS, two last questions re: DHA. If it is critical for neurosynaptic function, as the basic science suggests, why would lifelong vegans who are DHA-deprived for decades only be developing cognitive dysfunction after age 60? I have seen dementia in people under the age of 60 – it is not uncommon – and presumably those vegans who develop DHA-induced cognitive dysfunction or dementia must have genetic vulnerabilities predisposing them to the effects of ultra-low DHA levels in their diet. I have one lady with florid frontotemporal dementia in her early 50's (not a vegan!).

    Second question – why recommend DHA every 2-3 days? Is it because vegan DHA is expensive? But if DHA is critical for some individuals, and dementia takes years to develop, why wait until age 60 to start it every day? (and miss 60 years of neural existence)

  85. Jack Norris RD Says:

    Dan,

    I don’t consider you a crank. You seem genuinely interested in finding out what’s true rather than defending a particular point of view.

    > PS, two last questions re: DHA. If it is critical for neurosynaptic function, as the basic science suggests, why would lifelong vegans who are DHA-deprived for decades only be developing cognitive dysfunction after age 60? I have seen dementia in people under the age of 60 – it is not uncommon – and presumably those vegans who develop DHA-induced cognitive dysfunction or dementia must have genetic vulnerabilities predisposing them to the effects of ultra-low DHA levels in their diet. I have one lady with florid frontotemporal dementia in her early 50′s (not a vegan!).

    Good point. Vegan children also seem to develop fine (as long as they have a source of B12 and aren’t on an extreme diet). But I have been concerned that people who have lived off fish for DHA their entire lives might not be able to get the DHA-producing mechanisms going in later life. There’s also been a suggestion that older people have a more difficult time converting ALA to DHA, which is why it becomes more important later in life. It is possible, I suppose, that DHA isn’t necessary at all, and maybe DPA suffices.

    > Second question – why recommend DHA every 2-3 days? Is it because vegan DHA is expensive? But if DHA is critical for some individuals, and dementia takes years to develop, why wait until age 60 to start it every day? (and miss 60 years of neural existence)

    I’m trying to minimize supplementation while still being prudent.

  86. Dan Says:

    Tyler,

    I don’t want to belabor this argument but as a health practitioner, I have seen numerous individuals fail on a true low fat diet. Just to give you one example. The other day I saw a man whose atherosclerotic plaque burden has doubled in the past two years despite excellent adherence to Esselstyn, as evidenced by his very low LDL level (half what it was before Esselstyn two years ago, at which point in time his plaque was not increasing by much – I’ve been following him for 4 years). Unfortunately, in swapping out fat for carbs, his triglycerides and HDL have dramatically deteriorated and he has developed metabolic syndrome. He does not eat any processed food or sugar. I confirmed with a preventive cardiologist that many diabetics in his practice require more insulin after starting on Esselstyn and Ornish diets – again, swapping out fat for carbs would be the cause. Clearly the person I mentioned did not tolerate a low fat diet – or at least, his bodily system did not tolerate it. He was eating vegetables, whole grains, fruit, legumes and soy but no oil, fish, meat, eggs or nuts whatsoever (since these are prohibited on Caldwell Esselstyn’s diet).

    There have been more than a dozen well-conducted randomized controlled trials showing that low glycemic index diets and low carb high fat diets dramatically remediate metabolic syndrome and type 2 diabetes. Long term endpoints are not known. But to me, it makes perfect sense. Metabolic syndrome, which is often characterized by a rising tide of blood sugars and glycosylated hemoglobin A1c values (for the latter, upwards from 0.056 to 0.063 and beyond) are diseases of glucose and carbohydrate intolerance.

    Jack,

    Thanks for your kind words. Regarding “people who have lived off fish for DHA their entire lives might not be able to get the DHA-producing mechanisms going in later life” …. this could be due to epigenetic mechanisms, since presumably DHA synthesis is largely under genetic control (other than contributions from dietary intake level of the key precursors and competition by omega-6 LA).

    We may know a lot more about fatty acids in the near future, at least at mega-levels. There are two prescription grade EFAs on the market – Lovaza (purified DHA) and Vascepa (purified icosapentyl-EPA). At least for the latter, there is a very large (~8,000) patient trial in the works looking at hard endpoints (http://clinicaltrials.gov/ct2/show/NCT01492361?term=vascepa&rank=10). No doubt Lovaza is also competing in this market for trial patients. However, the doses are far higher than what are being recommended to vegans/vegetarians, and I doubt there will be subgroup analyses on vegans/vegetarians (although there may be analyses by pre-intervention DHA/EPA status). If vegans/vegetarians are 2% of the general population, and typically don’t like taking medication (at least many of them), they will be under-represented in these trials and there will be very few cases of true deficiency. Moreover, I don’t know if cognition will be studied (possibly in substudies – not sure). By the way, I’ve started taking B12 b.i.d. by following your example (TDD 150 mg/day). Thanks very much for that!

  87. Andreas Says:

    Dan,

    Unless those people were placed in cages like rodents, they aren’t going to admit to binging on processed foods. Period. It doesn’t matter wether they eat low fat or high fat.

  88. Tyler Says:

    “I don’t want to belabor this argument but as a health practitioner, I have seen numerous individuals fail on a true low fat diet. Just to give you one example. The other day I saw a man whose atherosclerotic plaque burden has doubled in the past two years despite excellent adherence to Esselstyn…”

    What is this suppose to support exactly? This is an anecdote from a diseased patient…and there isn’t even a way to confirm what the patient was actually consuming. What I suggested is that its implausible that there is a common genetic variant that prevents healthy people from thriving on a low-fat diet. Whether there are some disease states or rare genetic variants that could cause this is a different question.

    “There have been more than a dozen well-conducted randomized controlled trials showing that low glycemic index diets and low carb high fat diets dramatically remediate metabolic syndrome and type 2 diab”

    There are studies showing improvements utilizing a high carbohydrate whole foods based diet.

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