Heart disease is the cause of hundreds of thousands of deaths a year in the U.S. alone. There are many theories about what causes heart disease. So what is the truth? Is it cholesterol? And what is the link between saturated fat and heart disease?
I recently had Dr. Jack Wolfson – another holistic cardiologist — on the podcast to give his more Paleo perspective on the causes of heart disease. This week, I wanted to also have Dr. Joel Kahn on the podcast to give another perspective on this important subject. Dr. Kahn is a holistic cardiologist and is known as America’s top heart doctor. He’s a strong advocate of a plant-based diet, and he’s the author of The Plant-Based Solution. He’ll be talking about the science on cardiovascular diseases and the optimal strategies to minimize or eliminate the risks of getting heart disease.
I think this podcast is a wonderful complement to the podcast with Dr. Wolfson, because you can now get a balanced view of two perspectives of a couple of the worlds’s top holistic cardiologists who agree on many things, but also have some differences of opinion and differing perspectives on what the best diet for human health is.
(Note: Some of you might recognize Dr. Joel Kahn from a previous podcast about fasting and longevity. If you haven’t yet listened to that one, go to the bottom of the article where you can find the link to that podcast.)
In this podcast, you’ll learn
- Why saturated fat is linked to heart disease
- Which genes can contribute to heart disease
- How to eat to prevent heart disease
- The truth about cholesterol
- Should you be mindful of meat and animal fat consumption?
- Why there are so many people promoting saturated fat despite the science stating that it can cause health problems
Listen outside of iTunes
The Truth about Saturated Fat and Heart Disease with Dr. Joel Kahn – Transcript
Ari Whitten: Hey everyone, this is Ari Whitten and welcome back to The Energy Blueprint podcast. I’m here with Dr. Joel Kahn who is America’s heart healthy doctor and one of the top cardiologists in the world.
I brought him on, I’ve actually had another holistic cardiologist on just a few weeks ago. I wanted to bring Joel on, and Joel wanted to come on, to give a nice kind of counterbalance, and kind of discuss some of these issues from another angle, which I think is an important thing to do.
Another little thing I’ll add here is, actually over the last year or so of getting to know Dr. Kahn, and he’s also been a guest on the podcast previously, he’s become a friend, and I’ve been reading his articles for years. What strikes me about him is his commitment to the evidence, just really sticking to the evidence, wanting to debunk myths and really just, I mean, there’s so much nonsense out there. Dr. Kahn is really a force for clearly communicating what the evidence really is.
Welcome, Dr. Kahn. It’s a pleasure to have you on again.
Dr. Joel Kahn: Thank you very much. I think we can all agree that I’m really here. That evidence is accepted.
What Dr. Joel Kahn has found to be the central causes of heart disease
Ari Whitten: I want to talk to you today about cardiovascular risk factors, and how to modify them, how to prevent cardiovascular disease. I want to talk to you about nutrition myths.
I know you did some gene testing recently that you’re really excited about. We talked last time about fasting, which I highly recommend everyone listens to that podcast if you haven’t already. Let’s start with cardiovascular-related stuff and nutrition myths.
First of all, there’s so much different discussion out there of what causes cardiovascular disease. We have some people, mainly vegans, kind of focused on animal fat, animal proteins, saturated fat, dietary cholesterol, and we also have kind of the low carb, keto world, paleo world that basically says, ”hey, all that stuff is nonsense. Saturated fat is not bad for you. In fact, it’s good for you. You should be adding butter to your coffee and getting more saturated fat. You should be having more red meat and more animal foods, and so on.” I mean, how can we make sense of this. It seems to me that there’s cherry picking going on, on both sides.
What’s your take on sort of the central paradigm or central causes of heart disease?
Dr. Joel Kahn: Sure. I’ll just say, although I chose to adopt the vegan diet 40 years ago, I’ve been doing this for a long time. I’m a medical doctor first and foremost, talking to you, talking to patients today. I’ve said this before and I believe it firmly, just show me data that I can reverse coronary disease with a steak, with egg, with a stick of butter, and my moral obligation would be to tell a patient these are reasonable options and here’s the data, and here’s the serial angiograms, or the serial carotid ultrasound, something. That data doesn’t exist. There has been no change in our core understanding of how you can halt and reverse coronary artery disease.
It is a plant-based world, so I actually became vegan before I was a medical doctor. It happened to fit into my toolbox of being a cardiologist extremely well, but that was actually a coincidence. If it wasn’t right, I wouldn’t tell heart patients or the general public about it as a preventative strategy for heart patients as a reversal strategy. I think I’m very concerned, you’re one of the best people out there that looks for honesty and also parses out the recommendation for the general public may not be the recommendation for the patient with heart disease, diabetes, or trying to reverse. Those are huge goals, and it takes huge efforts, and moderation, and everything, and this confusion in the nutritional world.
I mean, we have an advanced understanding here of what causes coronary artery disease, heart disease, the number one killer of men and women. The president of the American Heart Association in November gives a lecture at the national meeting of the American Heart Association, in the morning on a Sunday, how to prevent heart disease, four hours later has a cardiac arrest due to the presence of a 99% blocked artery he had no clue about.
If the president of the American Heart Association, and he would have died if his family not jumped in and given him CPR or followed quickly by a defibrillator. 52 years old, fit man, running a big department in Dallas, Texas. If he can go down, we can all go down.
We have to take the fact that talking about heart disease is not hypothetical. It’s hundreds, and hundreds, and hundreds of thousands of deaths a year. We’ve got to be very precise about it. Watching a PBS show late at night might have some allure about getting a flat belly before a wedding, but it should be distinguished from, is that really a proven heart therapy or not. Yeah, sure, there are lots of gray areas, but we have lots of black and white here.
Going back to, we’ve learned long ago the five basics. Do you have an early family history of heart disease, brother, sister, mom, dad, 45, 50, 55 years old, heart attack, stroke, early death? Do you smoke? Do you have a high cholesterol, and that number varies, but let’s just leave it at high cholesterol. Do you have a high blood sugar or an actual diagnosis of diabetes? Do you have high blood pressure? Those five exist, there’s no question. We sort of added obesity on 15 years ago, though obesity overlaps with blood pressure, blood sugar, blood cholesterol because of a common fact that they go together in a bad way.
We can add now a dozen more things. We can add genetics like Apolipoprotein E, APOE, which also has big implications for brain cholesterol handling and Alzheimer’s development. If you’re APOE-4, or particularly your homozygous-4/4, you’re in trouble and you better get that lifestyle underplay. Something called your homocysteine level, your lipoprotein-A level, very simple, inexpensive blood test that the biggest loser trainer, Bob Harper, made popular in the last year because he announced that from the Dr. Oz show that the reason he had a massive heart attack and almost died at age 51, even younger than the president of The American Heart Association, was a genetically inherited, cholesterol disorder that he didn’t know about. [inaudible] times is a premier article about three weeks ago.
Something called TMAO. Probably most people haven’t heard. TMAO was reported in 2011 from the Cleveland Clinic. Three guys sitting around and saying, there has to be more than just cholesterol, diabetes, smoking. There have to be other chemicals that can be adverse to heart health. They identified three. They narrowed in on this one called Triethylamine N-oxide TMAO, four letters, and they’ve shown that the more extensive heart disease you have, the higher it is. They show that it’s created by eating red meat and egg yolks, interacting with our microbiome and then producing in the liver, this molecule that circulates in the blood. It directly causes plaque to develop in the arteries. It directly inhibits your HDL cholesterol from cleaning out arteries, it damages kidneys. Over 1,000 research studies now.
There’s no blocker yet. The common sense thing would be to reduce egg yolk and red meat if you find out your blood levels elevated. I’ve drawn thousands of these blood tests on patients, the Cleveland Clinic draws about five a year even though that’s where this test was developed and patented. It’s a fascinating test that really does guide on nutritional counseling until we get something more specific. It helps me. There’s even more than that, fibrinogen levels. To answer your question you asked, that’s sort of the analysis from the bench, from the lab.
The connection between saturated fat and heart disease
From a nutritional standpoint, you can go back to this very controversial figure, Dr. Ancel Keys, two Ph.D.’s, one from Oxford, one from San Diego, and you can talk about his research data boom. He published data in 1970. The Seven country study, it took 12 years to develop that first dataset. He showed the foods that were correlated with the development of coronary heart disease in fairly simple areas around the world. In areas in Japan, Croatia, Italy, the United States, [inaudible], Finland and such.
He showed that things like saturated fat and butter, saturated fat in red meat, saturated fat in chicken and such, were correlated strongly with heart disease, but he also showed one of the top foods was pastries. He talked about how pastries are a perfect mixture of too much saturated fat, refined white flour, added sugar. He analyzed the relationship of dietary sugar to heart disease.
It existed, it just wasn’t as powerful as animal-based foods, like just eating a big piece of steak with a slab of butter on top. Know this was 1970, you could argue we’ve known before that it was excess calories, processed food, the combination of foods rich in sugar, foods rich in saturated fat, and pastry being that perfect example.
There’s really been no hidden agenda about sugar, but it statistically, the relationship remains strong. I don’t remember if we talked about this first time. The country of Finland remains an unspoken but important analysis. In the late 60’s, early 70’s, the highest heart that great in the world was in Finland and a small region called North Karelia, could no longer afford guys your age, because you’re considerably younger than me. Guys your age, going down with heart attacks and robbing the workforce of a lot of healthy people, or apparently healthy people. They got together and they realized it was the diet. They smoked a lot, like all of Europe, but they were the typical lunch was a piece of sausage, butter, cheese and a piece of bread in your lunchbox, and you’re a lumberjack.
They went through this whole region of Finland, and they promoted at the food industry level and the schools and the post offices, put some beans instead of beef. Cut back on your cheese and butter, and actually within five years they cut back on animal saturated fat about 80%. Even the sausage industry started putting meat substitutes in the sausage because they were cooperating with the government.
Got some subsidies. Heart attack rates dropped to 85% in five years, and then they extended the study to the rest of Finland and the same observation was found. That study has continued on since the early 70’s.
It’s a stunning example and when you see these little anecdotes in here, you’ve got a whole country that radically improved the health of their population by limiting and advising fruits, vegetables, nuts, seeds, whole grains, and limited access to animal fats. It’s a powerful, powerful message about where reality lies, and not much has changed. Really?
The truth about Ansel Keys’ research
Ari Whitten: Yeah. There’s so much in what you just said. I have so many questions I want to ask you. Real quick, I want to digress on the point of Ancel Keys, because I know that there are a lot of people in the Paleo world who have kind of tried to attack the seven countries study and debunk, and kind of demonize Ancel Keys as misrepresenting data and I know that they’re doing it based on some misinformed, that they don’t really understand the facts. I know that you’ve written an article about this. Can you talk just a bit about Ancel Keys, kind of clearing up misconceptions?
Dr. Joel Kahn: Yeah, and if anybody wants to read, really, an exhaustive paper, there’s a group of nutritional experts around the world called True Health Initiative.org. We don’t sell anything. 400 plus people that are very diverse.
This isn’t Vegan, it isn’t Paleo. We agree you should eat, mainly plants, close to nature as found, or locally sourced, and mainly water, tea, and coffee as your liquid. Kind of four core nutritional principles, pretty hard to argue with, and then you can do whatever you want based on your ethnicity and your historical patterns.
We published a white paper, and if you’ve got a truehealthinitiative.org, there’s a white paper about Ancel Keys. It’s actually 65 pages long, and it dispels myth by myth, how his data inquiry was fraudulent because he studied them during the Lenten in Crete. They didn’t have their normal dietary pattern.
There’s a lot of answers to that. He visited three times, Crete, not just once, only once was it during Lent. It turns out they fast almost half the year in Crete, for various religious ceremonies, so if you really want to get a cross-section of their health, you have to visit them on some kind of fasting day. That’s just a small little example, but there are people that, I get an alert from Google when Ancel Keys name is mentioned. It’s all the time that he didn’t have seven countries in this study. He had 22 countries, and he hid 15 of them to only report seven. That’s the most extreme bastardization.
There’s even an article on the web where Gary Taubes may be the first person in 2007, in his book, to make that statement in a way that a lot of people read it. You can follow any bloggers that literally cut, paste, cut, paste, cut, paste. It was originally like the game Operator. Based on the erroneous information, it’s simply not true. There was a hypothetical paper five, eight years earlier that involved, you can argue, 16 or 22 countries. Nobody cares. Dr. Mercola mixes them all up. I’ve written them, I’ve asked them, I mean, just for the integrity of your medical degree, get this right and stop beating the guy up.
Was he a strong, powerful figure? Yeah, so are a lot of people that get stuff done in life. He had a personality and all, but it’s time to move on and then let’s realize, a lot of what he identified is held up if you want to say that the American Heart Association gets things right once awhile. They basically have endorsed almost all of his findings based on science, based on Harvard School of Public Health data.
Ari Whitten: Okay, so we’ll leave it at that, but I just wanted to mention because I know you brought up Ancel Keys and some people listening might say, ah Joel’s bringing up these Ancel Keys data, which we know, from [inaudible] Paleo blogger, Gary Taubes, that, that’s actually wrong. Well, I just wanted to point out to anyone thinking that, that actually there’s a lot more to the story than you realize. Stepping back a bit to this place in, what was it, Finland, where they’ve lowered saturated fat?
Dr. Joel Kahn: Right, The whole country, North Karelia, exactly.
Why there are so many nutritional gurus promoting saturated fat when the evidence shows it is directly contributing to heart disease
Ari Whitten: Okay, what you just said is really powerful data, right? I mean, they’re doing this population level intervention, lowering animal food intake, lowering saturated fat, dramatic, huge reduction in cardiovascular disease. Yet we have data like that and yet at the same time, somehow we’re living in a world where tons of nutritional gurus are promoting more consumption of saturated fat and, and red meat and so on. How does that even, I’m not even exerted saying my personal opinions on this, but how does that even exist? How can those two things both be out there?
Dr. Joel Kahn: Well, I’ll tell a story I believe is accurate, but people can challenge it. It’s been reported from, actually one of the co-investigators of the seven countries study, a very elderly European epidemiologist, that in 2008, the dairy industry met in Mexico City with the concern that the production of soy milk and just starting coconut milk and non-dairy alternatives, a dairy consumption was down, sales were down. That’s a problem. Get the whole world dairy industry together in Mexico City.
We’re going to come up with money. We’re going to find sympathetic researchers, medical doctors, bloggers, and we’re going to fund them to promote. Hey, you don’t think that happens in life. That happens. Within a few months, Ronald Krauss, a prominent MD researcher in lipids in Oakland University, gives the keynote address at the United States Dairy Association on how wonderful it is to drink and eat dairy foods Just a few months later, the first of the two studies, this was a Meta-analysis published in American Journal of Clinical Nutrition, 2010.
The first author is Patty Siri-Tarino. The last author is, Dr. Ronald Krauss, who may, it’s on his curriculum [inaudible], which is online, that he’s gotten dairy funding for years and years and years. They do a Meta-analysis. What? We could not confirm that there was a relationship in the literature between extra consumption of animal saturated fat and the development of heart disease. No one, they never said that put butter in your coffee. They just simply said they couldn’t confirm what had previously been shown in other studies.
The study, you could argue, the type of analysis, meta-analysis, has many flaws, and this particular study had so many flaws that the journal published in the same exact edition, a criticism of that study. Why they accepted it, who knows, but a very prominent epidemiologist named Jeremiah Stamler said bad science, bad science, bad science, bad science, but you know, once the word gets out, those that want to advocate, advocate.
Siri-Tarino, 2010, things started rolling. Butter may be back. Meat is good. Then there was a similar publication in 2014, a different group called Dr. [Chowdhury], not new research. This analysis of prior studies, which studies you leave in, which studies to exclude, what criteria to use. Published this study. It really flamed the fire. Another study that wasn’t bad, but the Harvard School of Public Health, Walter Willett, said retract it. There are so many flaws that should never be in a medical journal.
Two studies come out. That is the be all and end all that has led to this giant confusion. There isn’t any new science. If you really want to look at the new science from the Harvard School of Public Health last in the last 18 months, they’ve confirmed over and over and over 120,000 doctors and nurses filed for more than [inaudible] years. Every time you take butter and Lard and substitute vegetable oil, and I’m not advocating eat lots of vegetable oil, but the science says when you do that, you drop your cardiovascular risk phenomenally, by eliminating butter and putting in.
Now we don’t have vegetable oil with trans fats anymore, so they may actually be a little better than when mom and dad had the Mazola tub when I was a kid and it was full of trans fats, which we learned, subsequently, was a rather bad industry choice. Those are out now. That’s as much as I see and I want to share with you because it’s really pertinent to your question, I think your viewers will be able to see this.
We talked about fasting last time I was on. You’re a big student of fasting and so am I. This is a little diagram by Dr. Valter Longo and his book that came out January 2nd, Longevity Diet. What it says is that the issue of nutrition, the issue of nutrition is so critical to making recommendations to patients, to countries, to children, that we’ve got to base it on the strongest possible foundation possible.
He says there are five pillars on which the judge diets and they are the basic science of what happens with single amino acids to [inaudible], single amino acids, the growth hormone. What happens in clinical epidemiology, which is like the seven countries studies. What happens in randomized studies like maybe the Mediterranean study, I’m blanking on the name with 4,000 people that were published a few years ago. [inaudible], sorry, 7,000 people.
What happens in Centenarians? That’s really critical. If you have a diet you’re promoting, let’s look where people are active over age 100, which is the blue zones and a few more, and see if it’s consistent. Then finally, he calls a big system, or complex systems of farming, and the environment, and the whole big picture. One by one by one, he just slices and dices Paleo and Keto as being one pillar industry, maybe one or two epidemiology studies. I’ll give you one last example, then I’ll be quiet. I truly don’t have an ax to grind.
Why you should question articles from nutritional gurus and look for the evidence that backs up their claims.
Ari Whitten: You don’t have to be quiet. I’m interviewing you.
Dr. Joel Kahn: I truly would like to know the truth for my health, my family’s health, my patient’s health. When I write, I like to be right and give good advice.
Just in the last few days, in the LA Times, my friend Nina Teicholz, though I’ve never met her and I don’t think she’d probably make that title. I just [crosstalk], the Dash study, the number one rated [inaudible] World report. The Mediterranean Diet based on the [inaudible] and others. Terrible studies that have misled the public lead and led to poor health, even though they’ve only had thousands of patients and followed them for so long, and then in the same [op] ed piece, but there’s this study about the Keto Diet and diabetes, promoted by a for-profit company, Virta health that has under 100 patients, has no control group, is not randomized, is short term, and yet they praise that study as if thousands of people, long-term university based studies have no value and they find this of value.
It’s that kind of distorted … Now it may be true, it may be true that properly done, a randomized study of a Keto diet, low in protein, it was a very specific kind of Keto Diet, may have some short-term metabolic improvements to weight loss and all the rest. Still, have to be very concerned with, does that translate to long-term health.
That kind of distortion, just in 2018, in a major paper, with no opportunity to write a comment at the bottom of the op Ed. You can’t even respond. That’s about as biased and bad as it gets, But controversy sells papers, so there you go.
Ari Whitten: Yeah, I actually wrote a comment to all the members of the energy blueprint yesterday. I don’t know if you saw it because I know you’re in the group.
Dr. Joel Kahn: Yeah.
Ari Whitten: Basically saying exactly what you just said. I mean they presented a few sentences on the Mediterranean diet and they’re like, based on this one study, the Mediterranean Diet didn’t show benefits. I’m like, and then they go on to the next thing to talk about how great low-carb diets are as if they’ve now debunked the Mediterranean diet based on one study that didn’t show much effect, when in fact there’s a huge body of evidence on the Mediterranean diet showing all kinds of benefits on cardiovascular disease, on diabetes, on obesity, on neurological disease, on cancer, on overall longevity.
They just bring up one study that they’ve cherry-picked and then move on to the next thing. This kind of stuff where people, like if you have a particular diet that you believe in great. Present the evidence in favor of it but don’t mislead people. Don’t be dishonest and misrepresent the overall body of evidence.
Dr. Joel Kahn: Yeah we’ve had a few setbacks. There were three Harvard researchers that appeared in the 60’s to take some bucks to a bias and editorial in the New England Journal of Medicine, more anti-fat and anti-sugar. I’ve read the paper. Nobody read the paper. It’s so scientific and dense. It didn’t make headlines anywhere, but they shouldn’t have done it. It’s terrible. It probably happens throughout the industry. Hans is frail. There’s been a lot of pushback. The sugar data was hidden in sugars with the only health issue we have in America, where it’s not. It’s a complex excess calories, 800 calories, more a day of every variety of mainly processed crap.
How to live and eat for a healthy body and avoid heart disease
We should get together, as I say because your listeners will say, well, what do I do now with the LA Times and Joel and Ari Witten?
Heck, I’m just going to dip my bacon in cheese sauce and have fun because nobody knows. This true health initiative, which says, eat locally sourced, close to nature, mainly plants, water, tea, and coffee is kind of four principals to live by.
400 plus professors and dietitians and MD’s and Ph.D.’s that disagree on a lot but agree on, that’s where we know we can feed humans and do well, and we’ve got to worry about environmental stress. We’ve got to worry about pollution nowadays. It really is a serious issue. Although, I think this factory farming and food technology, in the next 10 years, you’re not going to buy meat at the grocery store.
You’re going to buy meat in a machine and you can dial in how much Omega three and how much fiber and out will come something that looks kind of like that chew fruit we used to buy. There’s your meat buddy. I truly think it’s where the money’s going. First, it’ll be synthetic leather, then it’ll be synthetic egg white, and then it’s going to be synthetic meat very quickly.
Some of this back and forth may start to diminish a bit. Again, anybody, you held up the book, I held up the book, Dr. Longo, may be one of the world’s leading experts on nutrition and aging in the world. 18 plant-based meals a week, three fish meals a week, very little egg, butter, dairy, if you do any, and a lot of whole grains, a little bit of wine. It’s kind of, again, another statement born in 30 years in nutritional research. Five pillars of evidence we can hang our hat on.
Ari Whitten: Actually, by the time this podcast is published, I will have published the one with Dr. Longo. I just had him on last week. I haven’t published it as of this filming, but it’s going to be released by the time people are listening to it.
Dr. Joel Kahn: Your audience will benefit studying his words. They’re very powerful.
What science says about cholesterol
Ari Whitten: Most definitely. Let’s talk about cholesterol, and there are lots of layers to this story. Let’s talk about total cholesterol levels. There’s just been so much hype around cholesterol for decades now, and I would love to just tease out causation versus correlation, and how much of heart disease and coronary artery disease is actually being caused by the cholesterol levels, and how much is like elevated LDL a symptom of underlying causes.
We have lots of people kind of saying, it’s not the cholesterol, the LDL that’s causing the problem. The body is sort of intelligently elevating LDL or cholesterol levels to deal with the real problem. Therefore, taking statins or other cholesterol-lowering medications is misguided based on that paradigm. What’s your take on cholesterol and LDL as either cause or sort of just there as beneficial as an ally in your health?
Dr. Joel Kahn: There’s so much science that goes back a hundred years. About 1910, we started to find you could feed rabbits, cholesterol-rich food and they developed plaque. [inaudible] and some of these other Russian scientists. It just kept rolling. You look pathologically at the plaque. You don’t see sugar crystals. One of the prominent signs of an unstable plaque in the heart artery, brain artery, leg artery, are cholesterol crystals. They’re part of the pathology now. That hasn’t changed. Han nature hasn’t changed. There are animals like dogs. You can feed all the butter and fat you want to. They’ll never develop plaque. They have very different GI systems and breathing systems and dental systems. We’re very prone to it.
This relationship, very carefully done metabolic board studies. That means, you’ve got somebody locked, you can feed them what you want to feed them, you can draw the labs or do whatever you want to do. These were done in the 50’s, 60’s, 70’s when people were thin in the United States in general, and adding excess dietary cholesterol, adding excess dietary saturated fat, animal products, cheeses and such, will raise blood cholesterol, and that is associated with plaque. That was the findings of the seven countries study and others.
Bring it up to date, one observation is it’s harder to prove eating eggs, raises your cholesterol. One observation is the average American population weighs 40 pounds more, their cholesterol is 50 points higher than it was in the 70’s when those original studies were done. People use the analogy, if you took a smoking population of a pack a day and ask them all to spoke 25 cigarettes a day, it’d be hard to show much harm to those five extra cigarettes on top of the baseline 20.
If you an average American, put them in an egg feeding study, nowadays, it may be the equivalent of your 20 cigarettes a day smoker because they’ve got the excess pounds. Their average diet is not very plant strong and close to nature anymore.
We’ve muddied the waters. In terms of your, I think the coolest piece of data, just lately, a professor in New York, Dr. Valentin Fuster, a cardiologist, has been organizing a study of Madrid of 4,000 bank workers who say, I’m healthy. I’m 45 years old. There’s nothing wrong with me. They’re all getting an ultrasound of their carotid to look for silent plaque, a CT scan of their heart arteries to look for silent calcified plaque, and an ultrasound of their femoral artery to look for silent plaque in the femoral artery. They’re getting blood work. They just published in November. They had about 50% of this group that says, I have excellent health, have silent atherosclerosis in their mid 40’s.
There’s an extremely strong correlation between LDL cholesterol and the amount of plaque in that study with, naturally, the lowest LDL, low-density lipoprotein cholesterol having the least amount of plaque, the highest having the most. Another confirmation using rather novel, free-living humans. That LDL at least correlates very strongly with a plaque. You could argue, as you said, it’s a reaction, but then, why are their cholesterol [inaudible] plaque?
Why is such a large percentage of almost any plaque that you remove at time of surgery, heart surgery like I’ve done for years, is a plaque and waxy and cholesterol based.
Then why is there, generally, whether you use plant-based nutrition, wellness, and lifestyle, or you use medications. There’s this famous study, this is where it all disappears. Anybody who’s never heard of the Posch study, P-O-S-C-H, forgive me, I don’t remember out of Minneapolis, but they convinced about 800 people with high cholesterol and heart disease To actually get a surgical bypass to their stomach, and the other half didn’t. By doing that you can create a very low cholesterol … This wasn’t a weight loss strategy. It was surgical treatment of hyperlipidemia, high cholesterol.
You could show definitively in that group, that by lowering their cholesterol surgically, drugs are out, biases out. It’s just as clean as it could be. You dramatically lower their risk of heart attack, stroke, and improve their longevity.
Lowering cholesterol for the general population, at least those that are showing silent plaque or [inaudible] plaque is a very powerful therapy. It isn’t to create billions of dollars from Merck and Pfizer. Most statins nowadays are generic and very cheap. I don’t like statins. I don’t take a statin, but I don’t think it discounts this whole cholesterol theory.
In terms of your listeners, they should know, there have been tremendous advances. You shouldn’t just get a routine cholesterol panel anymore, cholesterol, HDL, LDL. Ask for an advanced panel. You should know what your LDL particle number is. These are available from Quest or LabCorp, from hospitals all over the United States. They’re $38 or $40, not expensive. Particularly, if you carry extra weight, and are pre-diabetic, the standard classical panel pales with accuracy compared to these advanced ones. Be Like Bob Harper. Get your Lipoprotein-A checked. Make sure you know that very atherogenic molecule that’s $22 and don’t walk around saying, my cholesterol is awesome and have a stroke because nobody checked that your lipoprotein-A level is 10 times the upper limits of normal. No family doctor will check it unless you ask, generally, if you have symptoms.
Ari Whitten: Let me, play devil’s advocate for a moment. We have some studies that have come out that have seemingly, and these have been presented kind of in the Paleo, low carb, keto worlds as kind of exonerating saturated fat, dietary cholesterol, animal protein intake. That kind of has existed where they said there isn’t a strong link there.
There’s also been, I’ve heard people draw the analogy as far as cholesterol is in plaques, that damage is being created by other factors and then maybe cholesterol shows up to repair the damage. The cholesterol isn’t causing the problem. It would be the equivalent of showing up to a crime scene a few hours after the crime and seeing police all around and then saying the police are here, the police must have done it.
Then, one other layer that’ll add here is, I’ve also seen trials on some cholesterol-lowering drugs, for example, Zetia, and I remember a trial several years ago where they used Zetia and Zetia did, in fact, lower cholesterol and LDL successfully, but it actually increased the progression of coronary artery disease. How can we make sense of all of that?
Dr. Joel Kahn: A lot of really good questions trying to focus down on it. Just step back. Clearly now, firmly in the lexicon of cardiology is inflammation’s real deal. Actually, that also was a theory that was promoted in the 1870’s and we’ve had this discussion.
Does measuring high sensitivity to c-reactive protein and now we have a half a dozen tests of inflammation beyond high sensitivity c-reactive protein. The majority of your listeners will never get their high sensitivity c-reactive protein done unless they specifically ask for it. It’s just not in routine panels.
We know that inflammation now is the real deal. In November 2017, a large international study called the Cantos trial, C-A-N-T-O-S. If you’re curious, just Google that. You can get all the slides in a PowerPoint. You can download them to your laptop and view them.
The investigator from Harvard left them for the public domain, and it was a trial of people with relatively normal a cholesterol values. They had heart disease, they had elevated c-reactive protein. They got this crazy drug or a placebo. An injection every three months. The drug cost $200,000 a year. It’s used for [inaudible] medicine for a rare syndrome, but it blocks the production of something called Interleukin one and ultimately lowers your c-reactive protein,
Would lowering c-reactive protein with pharmacologic drugs alter the outcome? Boom, it did. If you lower c-reactive protein, I’d rather you do it by exercising weight loss, avoiding food allergies or food intolerances you have. Eating more plant-based foods that are anti-inflammatory. Nonetheless, the theory was confirmed November 2017, and after 150 years, it’s not going to happen with it $200,000 a year drug. That same study, actually, is being redone now with methotrexate, another powerful anti-inflammatory drug that is pennies a day and may actually prove to be part of the [inaudible] material.
How to reduce the risk of heart disease
Please do it with lifestyle. Control your weight, control your diet, get your sleep, avoid psoriasis and all the rest. Inflammation matters. To actually just Zetia is a drug that inhibits absorption of cholesterol from the GI tract. About 50% of the cholesterol. If you only eat plants like I do, I won’t have any dietary cholesterol, but my liver continues to make cholesterol, and it’s going to be in my bile and it gets in my intestines.
If you eat eggs, you’ll have lots of dietary cholesterol. Zetia blocks half of it? It actually ultimately was shown in an 18,000 patient trial called Improve It. If you take a statin alone, the or statin and Zetia, there was a survival advantage and outcome advantage. Zetia got the stamp of approval that it had outcome measures, not just lowering cholesterol. It actually did, ultimately. There was a little wiggly data when smaller studies were done, but the bit mother study about five years ago proved the trial was positive.
You know that cholesterol is the bystander. I mean, go back to five pillars. I mean, we got Nobel prizes in medicine given for identifying LDL receptors, which strikes me. I was a cardiology fellow in Dallas, Texas. 1986. In 1985 the Nobel prize in medicine was given to two researchers, Dr. Brown and Dr. Goldstein, for identifying on our liver cells we have a receptor called the LDL receptor. If you have the receptor, the LDL cholesterol comes out of your blood, into the receptor, into your liver, gets metabolized, your blood cholesterol goes down. If you have half as many of those receptors, you have heterozygous familial hyperlipidemia, affects one in 250, so several people listening now probably have that. Cholesterol is 400 or 500. You get the premature coronary disease, strokes, atherosclerosis, like crazy. If you have almost none of those receptors, homozygous, hyperlipidemia, you’ll have a heart attack at age 10.
I was taking care of kids in 1986 to 1989 because Dallas was the place to go for that problem. They were having bypass surgery at age 11. To argue that serum cholesterol, these weren’t smokers, they weren’t diabetics. They didn’t have a long history of eating a western diet. They were kids that serum cholesterol doesn’t impact? There’s just too much data.
I participated in a major science study at Wayne State University School of Medicine. There are certain SNPs, certain genetic variations that favor you having a low cholesterol your whole life. The one we did, it’s called genomic-wide analysis and modeling If you’re lucky enough to have a combination of those and from childhood on your cholesterol’s lower than the average American, the side effect is your lifespan is extended. Your chance of stroke and heart attack are reduced. There’s a lot of misinformation. We’re probably more confused about HDL cholesterol.
We thought it was simple. High-density lipoprotein. High, Good. Low, bad. Anything you do to raise it, like Niacin, like exercise, like alcohol. Good. Then we got some drugs that raised it. They didn’t work. They actually increased mortality. Those trials were stopped and now we’re totally confused. A recent study says if your HDL is very high, you may have double the long-term mortality of people that with kind of normally HDL, but may be exactly what you’re saying.
There may be an inflammatory process and HDL as kind of a scavenger, reacts by it becoming higher and higher, and it’s in reaction to something that we have to look for the root cause.
The functional medicine approach, inflammation diet, rheumatoid or connected tissue disease. LDL, it’s pretty clear that we can support healthy vitamin D, healthy testosterone and healthy brain function with cholesterol levels of 140, 145 total because that’s what they have in Okinawa. That’s what they have in Sardinia. That’s what they have in Ikaros Greece where they live to freaking 115, banging their wives and wives banging their husbands and climbing mountains. I’ll go for that plan. I’ll go for the centenarian plan, which is never a Keto plan, which is never a Paleo plan. It’s a whole food plant-based with 5 to 10% animals, sometimes high in [inaudible] like Crete and Ikaros, Greece, sometimes low in total dietary fats like Okinawa, traditionally, before KFC came in and ruined Okinawa and such.
Study those centenarian zones and say, is my meat only diet compatible with a long life and yeah, there’s a lot of guys on Twitter that I interact with have great ripped six packs and pecks, but I really do wonder what’s going on with their telomeres, what’s going on with the TMAO level, for God’s sake.
Sean Baker, he’s an orthopedic surgeon that Joe Rogan was interviewed about a month ago. I’ve eaten nothing but red meat for a year, Joe. I feel great. Joe Rogan. Did you check any lab work? Sean Baker, MD. Why would I check lab work? Why would I even bother with that stuff? I mean, that is as a medical doctor, so irresponsible as a message, of a guy who’s got a platform. It’s not like he’s doing it just as a pilot on his own health. He’s basically advocating this.
Ari Whitten: I’ve seen the all meat diet, zero carb diet, kind of emerged lately that completely avoids all plants. I thought Keto was kind of the far end of the spectrum, but to have an all meat, zero plant diet is…
Dr. Joel Kahn: It’s a testimony to how amazing the human body is that we can feed it a whole range of diets and survive, but when we’re making public health recommendations for optimal use to resources, optimal health, we have to come back to something a bit more normative. I don’t know those guys poop, but I don’t really want to find out.
The truth about statins
Ari Whitten: Okay, so based on what you just said about a dietary cholesterol, overall cholesterol levels, and kind of the role of that in heart disease, it would seem based on that, that we should all be taking statins and Zetia to lower our cholesterol as much as possible, and that would reliably prevent heart disease. What’s your take on that? Do you recommend statin use widely or do you hesitate? If so, why do you hesitate?
Dr. Joel Kahn: I don’t just because I, as many of the others just don’t like the idea of blocking an enzyme that for some reason is there for a purpose and blocking it forever, every day over and over and over and over. Plus, although we had a golden 10 to 15 years of statin data in the last 10 years, we’ve learned a lot about blood sugar elevation.
Probably, most importantly, that a lot that people don’t feel good on statins, no doubt. I use the least amount I can with the least frequency I can. I use them a nobody who has freedom from atherosclerosis. If you’re in my clinic, and your carotid artery, medial thickness test is normal, or your calcium score is zero, I think it’s rather criminal to think about putting you on the statin.
Just go back to the guidelines that say try months and months and months of lifestyle. In my clinic, I’ll use let natural agents, red yeast rice, bergamot. Something from India called [Omla]. These are just things that actually have peer-reviewed data with basically no side effects.
If people are willing to play with me a little bit and try all that. I mean, meditation lowers cholesterol, obviously exercise. There may not be a big urgency to lower cholesterol if you’ve proven, no guessing in my clinic if it’s proven that you have youthful arteries that are free of aging and atherosclerosis.
On the other hand, there is, and I’m not advocating it, but there’s something called the polypill, this crazy idea 10 years ago. What if we take a pill in countries that don’t have access to much medical care, put a little baby aspirin, a little bit of a blood pressure pill called the diarrhetic, little bit of a statin, like Lovastatin, very inexpensive, kind of a inexpensive, little bit, I think there’s a little vitamin D in there. Polypill, cover the basics of a lot of cardiovascular diseases. They have shown that in third world populations, you can reduce medical problems and manifestations of chronic disease with a pill.
Nobody’s advocating for first world countries. We’re still talking the need to exercise, eat healthily, get checked and all the rest. That’s, you got to talk the science. I don’t want statins in the drinking water. High profile people like Dr. Steve Nissen, head of cardiology at Cleveland Clinic, would say, he’d put it in the drinking water.
The UK kind of advocated that as an over-the-counter drug. There is that movement, but we can’t lose sight. It’s lifestyle, lifestyle, lifestyle. Let’s not go easy on people that are taking [probacol] and hitting Krispy Kreme donuts. That can’t be the medical message.
Veganism and a healthy life
Ari Whitten: I know we have to in just a few minutes here. Last question, veganism. You’re an advocate of veganism. Let me put it this way, is there a strong evidence to warrant the complete exclusion of animal foods versus an omnivorous diet that’s mostly plant foods by volume, at least 50%, maybe, hopefully, more than that and is inclusive of some degree of animal foods?
Dr. Joel Kahn: I think all we got to do is take Kyrie Irving, man, take it to the net and dunk it. We need to see the human performance on a plant-based diet. We needed a little bit more than this though. There is a new documentary out. All your peeps should look up a movie called Game Changers, just played at Sundance, and then it will be released to the public very soon, about athletes.
The world’s strongest man, Patrick Baboumian, being plant-based for a decade out of Germany, and Rich Roland and Scott Jurek running Appalachian Trail. There is something to be learned from super athletes who’ve converted and their testimony is them stronger and faster. I heal quicker and I repair. Then, I don’t know. We don’t know the answer to your question. If it’s 90% whole-food, plant-based 10% animal, 95 or 100? Is there a natural community that we have data on?
The only one that there’s data on Is out of the Seventh Day Adventist studies and Loma Linda if from 1958 on our government paid and [inaudible] paid a lot of money to research Seventh Day Adventist. If you answer, I’m vegan. If you answer, I’m a variety of vegetarian [inaudible], or you answer, I’m an omnivore. The lowest rates of heart disease, diabetes, obesity, hypertension, high cholesterol, are in those the 10% of Seventh Day Adventist that raise your hand and say 8 to 10%. I am a vegan. That’s an association that’s not a randomized study. We’ll never have a large population randomized study. Those Adventist studies do have 100,000 people track for years. 52-page questionnaires. This is a simple little process by which they’re analyzing them. I think that’s, you can do it.
Don’t be a dumb vegan Don’t eat crap food, don’t skip your D, B12 and a algae based omega-3. Eat whole food close to the earth, locally sourced if you can. Drink a lot of water, tea, and coffee. Be a smart, healthy, vegan. Still get your mammogram, get your colonoscopy, you gotta do those things. We’re not immune.
I’ve had it for 40 years eating plant-based. I still get a heart CT scan every decade. I still get my colonoscopy, because genetics are the last 15% and plants can’t overcome every environmental toxin, exposure to plastics that we all are prone to. Yes, the American Association of Nutrition and Dietetics, a very conservative and not very vegan-friendly group.
Publishes from pregnancy through the grave, the whole spectrum of life, you can be vegetarian or vegan, but be a smart one and don’t flaunt the fact that you don’t feel well because we never thought of supplementing with b12 or ever thought I’d be eating a red bug. That’s Pringles and Coke was some kind of environmentally friendly diet, which it is. Not very good for the environment you live within.
Ari Whitten: Yeah. Beautiful. Thank you so much, Dr. Kahn. It’s really been a pleasure to have you on again, and I know you have to run to get to a patient right now, so I’m going to let you go. I would love to talk to you for another hour, but hopefully, we can have you on again.
Dr. Joel Kahn: It’s awesome Ari, look forward to seeing you pretty soon, maybe in April, I think. Okay.
Ari Whitten: Yeah, likewise. Take care man.
Hey guys, Ari here one more time and just one quick thing before you go. I want to mention that Dr. Kahn has just come out with a brand new book called The Plant-Based Solution. If you go to Amazon.com, type in Joel Kahn, it’s K-A-H-N or Plant-Based solution. That’ll come up and I highly recommend going and grabbing a copy of this. It just came out January 1st, 2018 and it’s just a wonderful scientific argument for plant-based eating and also probably makes the best case, in my opinion, for veganism, even though I myself am not a vegan. I am a strong advocate of eating mostly plant foods, unrefined plant foods. I think most people need to definitely move in that direction.
If you want to move in that direction, if you just want to incorporate more of plant-based eating in your life, or if you want to go all the way to veganism. Or, if you’re just looking for maybe having some days or some meals that are entirely vegan and you just want recipes or you wanna see the science behind why eating this way is inarguably the best way to eat for health. By that, I don’t mean veganism, but I do mean eating mostly unrefined plant foods as the majority of your diet. That is pretty much agreed upon by every nutrition expert in the world. I would say 99.999% of them agree that that is the best way to eat for health. Grab a copy of this book, really wonderful. If you want to move in this direction, or just get some great plant-based or vegan recipes, a wonderful book to have and I highly recommend it.
The Truth about Saturated Fat and Heart Disease with Dr. Joel Kahn – Show Notes
What Dr. Joel Kahn has found to be the central causes of heart disease (1:16)
The connection between saturated fat and heart disease (7:46)
The truth about Ansel Keys’ research (10:42)
Why there are so many nutritional gurus promoting saturated fat when the evidence shows it is directly contributing to heart disease (14:21)
Why you should question articles from nutritional gurus and look for the evidence that backs up their claims (20:00)
How to live and eat for a healthy body and avoid heart disease (23:26)
What science says about cholesterol (25:25)
How to reduce the risk of heart disease (34:48)
The truth about statins (40:18)
Veganism and a healthy life (43:18)
Get your own copy of the book, The Plant-based solution.