#as i am typing up some completely differently url naturally. going like hey yeah let's revisit. do i have this saved

[unproduciblesmackdown]

going like hang on my organic Winston Billions ft. Diegetic Makeup trackpad edits can Get Posted. if only

[secretagentspydetectiveninja]

hey so remember like last year when i was re-reading misadventures and fixing typos? (well, i say that, but it was just an excuse to re-read it and write some absolutely absurd commentary on it...) i found old notes in my phone from january with even more so guess i may as well post it because people seemed to find it funny at the time, it’s basically just The Misadventures of Aish Realizing Things though

[yeah so here’s the original notes i’m not even gonna change anything even though lots of Lore has happened in the show and we Know things now, you just get to see what january aish typed]

ok well let’s go then chapters 31-35 oh god

oh yeah the ML Blackout! I remember that

hm it’s occurring to me maaaaaybe I should post a bit of a warning on this chapter. like “yes this starts off stupid and cracky and fluffy but takes a complete 180 in the middle and you will end up sobbing.”

or maybe I should put that as a disclaimer on the whole fic cause it’s one hell of a ride

THE AROACE SCIENCE JOURNAL YESSSSSSS THAT COMES BACK LATER

yeah the reason why the early parts of this chapter are very lighthearted is honestly because the fic was getting a bit too bleak, I needed something cheerful, so paper planes and arm wrestles it was

wait... isn’t this just that scene from Anansi??? where like Nora challenges Nino to an arm wrestle but then he wins because Someone Else Nearby Did A Thing

also this is Peak characterization, damn Aish, you rly outdone yourself, congration

any time I drop the word “inkling” into a fic it is always 100% a splatoon reference

MAX WOW TONE DOWN THE GAY

heh... BI-ceps...

oh my godddd Max trying to play off his ogling as “ah yes I am scientifically studying Kim’s arm muscles ofc, it’s science I swear” is SO frickin funny I’m already losing it

Alix: “scientifically speaking I’m hot therefore you have to lose this arm wrestle” hshdhdghshskkjkdhshs

^literally the kind of nonsense every single teen I know spouts irl

including me when I was a teen, I just said things

(I still just say things)

you can’t bring up the sports bra thing goddammit, I agree it’s cheating because it has the power to one-hit kill anyone in the vicinity

I love how Max thinks his crush on Kim is “under control” while like. visibly swooning over him

OH MY GOD THE PILLOWS SHHDJDHDHDHSKHS

OKAY SO LIKE I was supposed to put the thing about Kim snogging a pillow in chapter 20 but I forgot or something and then I just had to get it in somehow, oh it kills me dead just thinking about it, I’m dying, I’m dead

and the fact that he admits to it as well, holy moly

KIM

K I M

THAT’S GAY

OH WOW

this is the moment when Alix’s Kimax shipper heart was suddenly feeling validated like “omg wait Kim DOES like Max??? like for real??????”

awwwww Kim, Max doesn’t have those kind of superpowers, you just have a crush on him that’s all <3

THE SKATEBOARDING SNEK!!!!!!!!!!!!

“What the heck is that?” “My snake.” DYINGGGG

Kim trying to figure out if the snake is sitting or standing is a whole mood

ohhhhhhhh my gosh poor Alix trying so damn hard to subtly ask Kim if he likes Max and Kim’s just. so DUMB he doesn’t even get it no matter how obvious she is

she’s even trying to pull out those stupid amatonormative “so is he MORE than a friend???” questions just to get this idiot to figure it out because she knows allo-romos are Like That and he still doesn’t get it,,

[future aish says: the word is alloro, past aish. it’s alloro]

AND SO NOW SHE ASSUMES THEY’RE NOT INTO EACH OTHER BECAUSE SHE THINKS EVEN KIM CAN’T BE THAT STUPID

YOU UNDERESTIMATE HIS STUPIDITY

oh no... oh NO.... the letter.... here we go....

btw yes Gabriel had Kim’s grandad assassinated, it was indeed his doing

...isn’t this lowkey the plot of The Lion King?

or Long Live The Queen

hmmm let’s just say in the sequel poor Kim really will have to deal with the stresses of ruling a country >:D

NO MY POOR SON HAVING A BREAKDOWN, I WANT TO HUG HIM

(also can I just say like... this chapter is actually well-written for the most part? I’m actually kinda impressed)

unfortunately I know the feeling of wanting, needing to return home, but it fills you with dread... *hugs Kim forever*

Kim crying all over Max both hurts me and sort of heals me because Max is so sweet and comforting about it ohhh my heeeaaart

AWWWWWWWWWWWWWW

THIS IS LOWKEY A LOVE CONFESSION I SWEAR, IT’S SO CUTE

chapter 32 being called “Un chat noir” is kinda dumb af but also it just so happened that I accidentally had the chapter called “Coccinelle” be chapter 64, aka exactly double of 32, so that was kinda neat

Plagggggg!!!!!!!!!!

and Wayhem lol, I think I’ve already mentioned how originally this noble was just some random irrelevant unnamed OC until I decided way later it’s gay stalker fanboy

oh yeah that’s how the nobility recognize the royalty, I forgot lol

(also nobles from countries with widespread newspress or tv will recognize them from news reports and stuff I guess)

the fact that Plagg just hates Wayhem is funny to me for some reason

MISADVENTURES

HOLY SHIT I ACTUALLY THREW IN THE ACTUAL WORD

except it was in reference to Adrien... let’s just say that The Misadventures of Imperial Prince Adrien may or may not make an appearance in the sequel >:D

...the Adrienette is literally just in this fic so that people would read it, ngl

hhhhhhhhhhhh okay it’s true Alix is an aro idiot who doesn’t know anything about romance but for once she’s RIGHT, Kim IS in love with Max, but she assumes she’s wrong hshgshdjhdnsnsh

oh my god noooo timeline twin go away and stop giving me nightmares

I still love how they hate each other, that’s some top-notch self-hatred right there and I need to get on their level

[future aish note: no past self!! be nice to yourself!! you are a cool bean!! own it!!]

YOU FOOL... EVERY CLASSMATE WOULD TAKE A SWORD TO THE HAND FOR ALIX, WHY WOULDN’T THEY

ỳïķèš,,,

honestly I probably should stop being lazy and actually go back to like idk chapter 8 and put in an actual monopoly game (it had to have been before the oracle sessions in ch10 at least)

fun fact!! I have indeed very nearly had a fist fight over the last dark blue card in a monopoly game!! also I blatantly cheated, and the main opponent locked someone else (an 8 year old btw) in a cupboard... it was Wild(TM)

me and my irl friend actually came up with the butterfly thing when we were at the cinema once, she made up this random angry gardener OC who stepped on a butterfly after being fired or something lol

I mentioned Rose liking unicorns!!!! before Captain Hardrock!!!!!!!

shdhdhkshs Alix is such a moody emo brat in this fic I adore it

“The only real difference between you and me is one dead butterfly.” goddammit that’s the creepiest fucking thing, I’m genuinely shaking

technically it’s a butterfly’s fault for ALL the timelines which means that we’re all one butterfly away from death at any moment

cheerful stuff

no, no, you’re not trying to block it out on purpose... I’M trying to block it out on purpose bc I’m highkey shamelessly projecting

god I wish my timeline twin would manifest in the astral plane and punch me in the arm too

“Count yourself lucky you’re not a pillow, idiot.” in-context this is contender for Most Cursed Line I Have Ever Written In My Life

and yes Alix was about to straight-up swear

Mylène rollerskating is extremely blessed and good

pfffffffff Max you coward, I stand on swivel chairs all the time

*me, chanting at the spider in my room* KIMAX! KIMAX! KIMAX!

Kim literally making every excuse to not put Max down is amazing honestly

Kim and Max’s origins story is sooooooooooo cute wtf

THIS IS SO BLESSED OH MY HEART

HE’S JUST STANDING THERE CUDDLING HIM I’M

DECEASED

I,,,, swear to god,,,,,,,

so like. I know it’s now canon in the show that Kim really is as oblivious to his feelings as I wrote him in this. but MY GOD. IT’S FRIGGIN PAINFUL

KIM YOU ARE IN LOVE WITH MAX, FULL HOMO, THAT’S WHY YOU’RE FEELING LIKE THIS, IT’S NOT THAT COMPLICATED DAMMIT

oh yeah I wrote the kimax bits rly early and my old url was @queenkubdel haha

aight now a no-kimax chapter, but at least it’s a goodun

there’s that catradora-esque weather girls frenemyship again

Kim having a full-on breakdown when he finds out Alix’s hair isn’t really pink is actually really blessed, no lemme explain

so this universe has magic, right?? so he thinks to himself that the reason his friend has pink hair is because she must be some sort of anime protagonist or Really Important and Cool or something, and it never even occurred to him to doubt her

in other words he’s betrayed because he WANTED HIS FRIEND TO BE A COOL SHONEN HERO

which is both hilarious AND very sweet

...oh wait I’ve scrolled down and it turns out I literally explained all that in the fic itself hhdgjdvzjdjhs

and yeah honestly I can’t blame poor Kim for taking it so badly, he’s still reeling from his grandfather’s assassination so it’s natural his emotions are not exactly Regulated atm

actually when are his emotions ever regulated

1703-1899 hm... might change that since the fic takes place in 1957-1960 so even though it’s a commissioned history of the empire it was before Gabriel was even born so like why would he even care lmao

“Great Western Ocean” so pretentious, just say the Atlantic omg

I’ve been playing way too much civ because the first thing that came to mind was that everyone’s denounced Agreste due to the high warmongering penalties of the industrial/modern eras

Chloé and Kim is one hell of a brotp okay I still firmly believe that

also Chloé still loves her rococo fashion, she’s just toned it down enough that she can fit through doors and it’s not quite as “in your face” towards commoners

listen I know in the show Kim still liked Chloé for a while after Dark Cupid but in this he got over her quicker because his crush on her wasn’t as deep in the first place

Kim literally tells Chloé he gave the brooch to Max and yet STILL doesn’t realize he likes him!!! KIM!!!!!!!!!!

Chlodemption arc yesssssssss

also she’s a lesbeean

(ye Pollen will be in the sequel don’t you worry)

god I’m so proud of her <3

it feels believable too, so I’m proud of myself!! (I’m trying to be nice to myself before next chapter where I will no doubt roast myself so badly I’ll never recover)

outdated laws about marriage... jeez was that cursed foreshadowing or what

YES IT’S IVAN, I LOVE THIS BOY, HE’S SO GRUMPY AND ANGRY ALL THE TIME AND HE HATES KIM

...actually wait this is sibling culture

I literally speak like this to my brother and he’s my best friend so in conclusion Ivan thinks of Kim as an annoying brother

Jalil why are you a historian. just go be a psychologist and stop your sister accidentally hecking up the country

omg the Antarctica thing, I’m just imagining Jalil in the freezing cold with a massive coat on and getting chased by penguins

I love how the timeline twin’s plan was “escape school, force Adrien to get a venomous pet, then abandon him immediately in the middle of nowhere” and later on it turns out she skipped step two and just ditched him lmaoooooo

being so ace that your brain goes straight to “death and murder” before anything else is the biggest mood, I speak from experience

Jalil knows... he had that conversation with Kim in chapter 20... he Knows

“a bit unsupportive” um that is an extreme understatement good grief he was more savage than ME

RISE OF THE KIMAX SHIPPERS

oh don’t worry the venom death still haunts me too

chapter I Hate You... “A rather rotten winter party” well it should have been named A RATHER ROTTEN CHAPTER DO YOU KNOW HOW IMPOSSIBLE THIS ONE WAS TO WRITE OMG I HATE WRITING MYSELF INTO CORNERS

you see I had to have a motive for the timeline twin to explain things properly so that I could put in a really really dumb pun later but that meant I had to unfortunately suffer many allergic reactions again

[future aish note: forgot to mention, i also needed a motive for kim to stop eating chocolate forever, so i had to Curse this chapter as a sacrifice in order to save his life later on]

alright, alright, here we go, I’ll stop procrastinating and just get this over with

oh yeah it’s chapters like these that the fic’s rated T lol

the Adrikim friendship is indeed important... for later... like, plot-relevant levels of important... life-saving levels...

“some event” is the Peace Ball actually and I can’t wait because that chapter’s actually a good one

KIM BRAGGING ABOUT KISSING ADRIEN LAST YEAR IS SO FUCKING FUNNY OH MY GOD I’M LOSING MY MIND???

like last year he was LITERALLY LIKE “oh boo hoo I cannot tell anyone about this because Adrien is Ã Bøyê” and now he’s just like “yeah I kissed a hot boy and what about it???”

to be fair he is on an extreme sugar rush from all the chocolate he ate, which will... be a plot point in just a moment...

PILLOW GIRLFRIEND

I’m the amused nobles, they are me

oh my god Kim we get it you want to kiss someone (Max) and you don’t want to outright say it

holy shit do any of these kids ever think before they speak??? not to sound like the timeline twin or anything but alix... you could have avoided this if you’d bothered to use your one (1) brain cell

[future aish note: bold of me to assume that alix has a brain cell]

Kim wants to now fight his PARALLEL SELF oh my god, get on my level Kim, I want to fight my actual self like right now so there

stfu all of you, this is poisoning my liver

Max is the biggest mood and at least mildly sensible thank god, but he really shouldn’t have left those two alone for even a second

I AGREE PLATONIC LOVE IS UNDERRATED

the chair... the fucking c h a i r... I’m already lying down but I need to lie down harder just to process the absurdity of this

(I think I was gonna have Alix fall off the chair just because that’s hilarious but I forgot)

look I can’t take heartrate seriously but if you ever write it then you are legally required to put in kissing contests or you’re doing it wrong

fudgin Adrienette kiss offscreen and irrelevant

DJWIFI!!! AND ACTUAL PROPER DJWIFI!!!! I was sick of seeing it treated as some kind of pair-the-spares beta couple so I flipped the script and had them literally call out that trope while treating Adrienette as irrelevant instead, which is also why the sequel will be extremely djwifi-centric

“super swanky bae” please stop misusing commoner slang I’m begging you

THERE’S THE PLOT POINT I WAS TALKING ABOUT

Theo was right here, he witnessed with his own eyes how much chocolate Kim ate, so he knows for a fact that if you give Kim chocolate he will scarf it down without a second thought... so hypothetically if one sent him poisoned chocolates... dyou see where I’m going with this...

oh and Theo still has like every job btw

Alya!!!! no!!!!! hire him again!!!!!!!! then he won’t send the chocolates!!!!!!!!!! aaaahhhhhhhh!!!!!!!!!!

there goes me hinting how alyadrininette is the ultimate ot4 again

...do I really wanna scroll down and keep going? no I don’t but I guess I gotta, and relive every one of my most embarrassing school sleepovers in the process

full offence to everyone bothering to read this but kissing sounds gross, actually

(for the record it was probably like... 10 seconds or something idk it was Not Long At All)

“probably not more than 5 minutes” omg I just said it was 10 seconds??? hmmm m okay like 20 seconds maaaybe, Kim just has no sense of time perception

neither do I based on my microwaving skills

SHIT THIS IS LITERALLY A SCHOOL SLEEPOVER

INNOCENT DUMBASS AROACE ASKING “what does that mean? what’s this? what’s that? it’s okay you can tell me :-)”

omg I forgot the snake was there ahshdhdkshfs I’m the snake, probably wants to launch itself out of the window so big mood

most of the fic so far had Alix being really aro so I was like damn... gotta make her really ace too

(if I ever bother writing the Kimdine AU then you actually get an aro character who isn’t ace, because we need more of them, but I won’t say who) (okay fine it’s Luka)

I tend not to be too British in my writing so as not to give the Americans heart attacks whenever they see someone referring to their mother as “mum” etc, but like... sometimes you just gotta throw in the word “snogging”

(I’m typing this out on my phone rn and it has exactly 69% battery, I hate this and also hate that I felt the need to mention that)

THE HOCKEY THING MAY OR MAY NOT HAVE BEEN BASED OFF A REAL LIFE THING. *SWEATS NERVOUSLY*

honestly I was soooooo tempted to actually write The Talk bit, it would have been the funniest thing ever, but I was also 99% sure I would have to change the rating to M (despite it not even remotely being smut lol, just a regular biology lesson) and there was no way I was doing that, pretty sure I pushed the T rating at some points as it is

[future aish: god i am still so tempted to write it. man, i’m tempted. it would be the funniest thing. but no... i have sworn not to write anything above a T rating so guess i won’t.]

YEAH THE THROWING UP THING TOO WAS DEFINITELY NOT BASED ON REAL LIFE OR ANYTHING *MORE NERVOUS SWEATING*

(it genuinely wasn’t a flowerpot though. it’s my life’s goal to throw up in a flowerpot and I still haven’t achieved it.)

all of this is an Ace Mood(TM)

also I love how elaborately I’ve worded this, like yeah idiot royal teenagers are too royal and posh to ever bother just saying the word “sex” like a normal person

to any 17 year old aces: you aren’t too young to know, I told myself that aggressively when I was 17 but now I’m 22 and I’m still just as ace as I always was sooooo yeah

I also hope I can wake up tomorrow and forget I read this trash

well tbh... it’s not total trash... it highkey reminds me of my school days, like, maybe that was subconscious or something... god who even knows

jeez if timeline twin slapped me in the face I’d just keel over and die from sheer terror, other than that that’s HILARIOUS

timeline twin: “YOU HAVE ONE (1) BRAIN CELL NOW P L E A S E CONSIDER USING IT”

fuckeninf hell listen,,, so when I was writing this chapter I didn’t know I was aro... I mean, I was kinda questioning it?? but all I knew was I was ace, and that me not knowing that as a teenager almost totally screwed me over because like

to be normal or to feel normal there’s things you do or say that you don’t want, and things you know would happen or whether you want something or not you’ll take it because you think you’re expected to, because otherwise you’ll have to confront yourself with the fact that something is wrong with you and you don’t know what or why or how to fix it

and being aro on top of that is misunderstanding how to navigate close friendships because of this fundamental fear that if you want to be close with someone then friendship can’t suffice, that how much you care about them doesn’t matter

and things I did or almost did, or had the chance to do and only stopped because (awfully enough) crippling anxiety which ironically saved me (let’s just say the dude turned out to be a creep)... yeah basically this is all a callback to that aroace teenager feel where you can’t help not being true to yourself because you don’t want to, because you don’t know what’s wrong or right, only what’s “normal” and the ache of knowing that you’re not, no matter how much you try

and I didn’t know I was aro while writing this but in hindsight it’s easy to see how that played into it too, and writing this definitely played a part in me realizing I’m aro and was somehow trying to work through some very pent-up feelings about friendship and closeness with people, as well as pent-up feelings about being ace and how that tied into everything too

...in short, do not phuck the pharaoh or you will get HOUSE ARRESTED and DIE

(jk jk she’ll just be awkward around you forever lol, and then SHE’LL get house arrested and die, because you’re not commoners so your actions actually have consequences you dumb idiots)

this entire thing is just a whole mood and lowkey my teenage years holy fuck holy fuck I hate that I’m only just realizing how bloody hard I was projecting

I literally read a post the other day about how unrequited love is only ever usually explored from the perspective of the person who’s in love, whereas aros are usually on the receiving end of it and it’s a tragedy in its own right that you might do things that wind up driving you apart because you can’t bring yourself to love them back but you can’t tell them because of the fear that it’ll push them away... and I gotta say, I totally nailed it 💪

...you know what I’ve changed my mind, chapter 34 is good actually, and now I need to make a time machine and go and hug my 17 year old self for living this, and then hug my 20 year old self for writing this, I’m sorry I was mean to this chapter it’s very relatable and I shouldn’t keep beating myself up over it

thinking makes me miserable too!! that’s why it’s optimistic nihilism only lads

impulse control, hmmm... someone who’s good for him, hmmmmmm... it’s almost like someone like that is right there and exists and is already in love with him 😏

so apparently timeline twin’s idea of “fixing her life” is burning all her bridges and then hecking off to the Kazakh wilderness for over a year

did Alix just... ask the snake if it’s aroace too???

I mean it definitely is, but...

UGH SNAKES DON’T BLINK, I’M STILL SO ANGRY ABOUT THIS

chapter 35, thank god, the title “Finally!” is very apt

(because I can finally change the music from Death Valley to something else lol)

oh poor Max, his heart goes on a real rollercoaster these few chapters doesn’t it? it’s okay buddy, in like 10 chapters you’ll get your man...

NO BUT SHE H A S FIGURED IT OUT!!! SORT OF!!!

I just misread “despite” as “despacito”, I’m going to bed and continuing this tomorrow dammit

alright I am now funky refreshed and ready to roll, let’s get this kimax party started

Max is angsting internally like “no one’s realized I like Kim :( well except Juleka but she’s a lesbian so she doesn’t count” ashgdjsghskk that mlm/wlw solidarity is holding out I see

YES ALIX YOU DO NEED TO TALK TO NATH MORE, THAT’S YOUR FREAKING BEST BUD IN THE SHOW MAY I REMIND YOU

this is all so Irony it’s murdering me dead

okay yeah I’m gonna be really honest and salty here for a second, this bit where Max is annoyed that Alix takes Nath more seriously as a contender than him was me being a bit salty over the fact that like... kimnath/tomato ketchup is a great rarepair but got so weirdly popular amongst people who didn’t seem to care about Max as a character at all despite how close he is with Kim in canon, and as a Max Stan it made me sad because he’s already not very appreciated in fandom

[future aish note: HE IS NOW BABEY!]

THERE IT IS

I WANT TO HUG MAX TOO, BLESS HIM

I also want to hug Alix because godddds I’ve been in that situation where if you were allowed to just TELL the idiots that they like each other then all their problems would be solved but noooo, you’re sworn to secrecy... *sigh*

“I’ll make sure that doesn’t change, ever...” me: *thinks about the sequel and cackles evilly while cracking my knuckles* well,,

A R O M A N T I C

listen it was VERY IMPORTANT to me that I actually put in all these actual words in the fic and made them relevant, like gay, lesbian, bisexual, etc (I think the only one I didn’t was trans, oops?? gotta remember that for the sequel, at least Nino IS trans in this even though I never said the word)

[future aish note: i feel like i didn’t say pan either, or nonbinary... more stuff for the sequel folks! i can’t put in everything but i may as well try!]

bc you see all these tv shows where a character is bi but they say they “don’t like labels” or a character with no love interest get suddenly paired up with someone random at the end... like NO I wanted to do the OPPOSITE of that bc people’s identities are IMPORTANT so I wanted to MAKE IT RELEVANT 💪

and even though I didn’t yet know here that I was aro and highkey projecting, there’s already a fair few fics dealing with asexuality but not aromanticism?? so I rly wanted to make the aro side of things important

almost relieved??? Max, you buffoon, she IS relieved, extremely

Malix friendship is good and severely underrated and I still haven’t forgiven myself for not putting more of it in this

“He was never eating chocolate again” HO-HO-HOLY SHIT THAT’S SOME FORESHADOWING RIGHT THERE

Rose is a distinguished bi who doesn’t realize Kim is a disaster bi

Kim oh my god you can’t just out Adrien “just about functional bi” Agreste like that

I love that Rose calls Kim a casanova even though he’s very much not... how many people are even into him over the course of the fic? Max, Adrien, it’s implied Marinette used to be, Lila is ambiguous, same with the lacrosse guy later, oh yeah Ondine highkey lmao along with 90% of the teenage population of Saharan Africa, Kim himself in about 2 chapters time...

Rose giving Kim the gay talk is so blessed omg I need more interaction between these two

“If you swung one way you were gay, if you swung the other way you were straight, more than one way made you bisexual, if you didn’t swing any way at all then you were probably just Alix...” I will literally NEVER be able to outdo this line, this is Peak

hmm I don’t think at any point in the fic Max says to Kim that he’s exclusively into boys... I guess he said it offscreen then lol, point is He’s Gay

OMG KIM, YOU FINALLY REALIZED WHAT THE NOSEBLEED SCENE MEANT, GOD BLESS YOU

this is like in Syren when he realizes the mermaid is Ondine and that she was trying to tell him she likes him... except this is the gay version of that

yeah Rose I really do need to get more sleep, that one was directed at me and I know it was

Kim being all like “fellas is it gay if you take off your shirt and a guy swoons at you 🤔🤔🤔”

no, no... Max is definitely a complete trainwreck at romance, just slightly less than you

god freaking dammit not the sports bra again,,, I s2g later in the fic all Ondine would have had to do is to show up in a sports bra and Kim would immediately go full ot3 mode no questions asked,,,,,,,, (I mean he does see her in a swimsuit but that’s not the same??? sports bras are in a different league okay shush)

psssssst!!! you should read heartbroken!!!! it’s a kimax fic and it’s so good!!!!! this was a lowkey shoutout!!!!!!!!

genuinely tho, even if Kim hadn’t liked Max too here, he’s being so sweet about it?? he’s worried about his poor friend’s emotional state and wishes he could have done better to help!! gahhhh their friendship/relationship is just So Blessèd

hsndhkdhdkshdh I only noticed it after finishing the fic and occasionally skimming back through, but so much of the time whenever Alix shows up Kim’s all like *ungrateful* “oh not you again” like WOW that’s one way to greet your friend?? mood tho

[future aish note: i did the exact opposite in No Romo, funnily enough! kim’s not in it much but whenever he sees alix he’s like “friend!!! friend!!!!!” and she’s just like -_- “oh it’s that guy again”]

he’s not even paying attention to her omg she’s trying to save the timeline here you idiot

POOR ALIX how frustrating,,, and also I’ve literally been there,,, the woes of being a wing-girl indeed

and now Kim wants to fight himself, why am I not surprised

aND YES HERE’S WHERE IT HITS HIM, THE EXACT FUCKING MOMENT

WHERE HE’S SUDDENLY LIKE “OH WAIT MAX’S LOVE FOR ME ISN’T UNREQUITED??? I LIKE HIM TOO HOLY SHIT????”

aaaaaaand he immediately asks the aro for love advice, why is he like this omg

gosh this is sooooo sweeeeeet

I did not let up, did I? just went ahead and made this as cheesy and cutesy and over the top as I could because It’s What Kimax Deserves

(there wasn’t rly much Kimax content yet in the fandom at this point so I had total free reign and went all-out with it)

sfjsgskdhs and there goes Alix getting her wing-efforts sidelined again

“I’m never asking out someone on a whim again. Or, uh, confessing that I like someone on a whim either.” so uh... you know how I said I’m considering making the sequel Kimaxdine? well if I do then uh. hm. this might change. because reasons.

I don’t know why I made nothing Alix ever says make sense but I’m glad I did because she’s so freaking funny

I swear I talk about Max’s eyes being “magnified in his glasses” multiple times in this fic, either that or I’m having serious deja vu

Kim’s so cute dammit!!! now that he knows he likes Max he’s just swooning over every little thing and it’s!!!! adorable!!!!!

(I wonder if this is how it was with Kimdine in the show? it does seem like Kim already liked her but just hadn’t noticed...)

huehuehuehue Kim later on you do indeed recklessly propose to Max on the spot... in like 18 chapters or so

also the fact that Kim thinks things through better when he’s around Max is just the total sweetest and also what Alix was basically trying to aim for

I love Kim showing off that he can pack all his stuff in half an hour like buddy, the porters can literally help you with that, you’re royalty remember

omg I’d forgotten I left a note here later for binge-readers!! being all like “drink water and eat food and go to sleep uwu”

lmao guess I’ll take my own advice then and leave it there for now

[future aish note: same, goodnight]

[thepencilnerd]

- 𝐅𝐥𝐨𝐚𝐭 - 2

➳ Part 1  || Part 2 || Part 3 || Part 4

➳ Pairing: Jaebum x Reader

➳ Summary: AU! After taking a gap year from college to pay for your tuition, you felt like your life was finally back on track- until you met him. What happens when life doesn’t go the way you intended it to? What happens when you find out that your anchor is just as broken as you are?

➳ Genre: AU, fluff, angst, friends to lovers

➳ Word Count: 2k

➳ Warnings: Swearing, awkward first encounters? 

♪ Winter Aid- The Wisp Sings 

a/n: Masterlist & links to other parts can be found @ my main URL

“That’ll be $4.65, please.” Swiping the credit card against the machine, I typed in an order for a caramel macchiato with an extra shot of espresso. 

Working at the on-campus coffee shop was probably the only good thing that had happened this year, and I only had my counselor to thank. 

The schedule for this semester was pretty simple. Working for 2 hours in the morning at the café had allowed me to fit afternoon classes into the day, which left me with half an hour for lunch and half an hour to tutor some classmates while eating lunch. Three times a week, I had evening classes that lasted until 10 at night, but the remaining two days of the week allowed me to have some free time to study and relax or tutor more classmates. 

It was exhausting, but it was better than the situation I was hurled into last year. With my parents unable to support or aid me financially, I decided it was best to take a year off to save up for tuition fees and re-evaluate my entire life. After saving enough money for a two semester’s worth of school, I had a talk with my counselor about what scholarships and certificates I was eligible to apply for. 

All I had to do semester was stay focused, steer clear of all distractions, and pray to the high heavens that the end-of-year exam scores would prove to the teachers and school board that I was eligible to receive a late scholarship. 

If last year had taught me anything, it was that life was a bitch to live. This year was going to be different. It was going to be. It had to be. 

Taking off my apron and throwing on a jacket, I quickly said goodbye to my co-workers before leaving for my philosophy class. I wondered if it was okay to miss today’s lecture since the TA was subbing and I was pretty good friends with him, but I realized that I didn’t have anything better to do and would be better off going. A month into the semester and I already felt too comfortable for my own good. Nothing had ever come easy in my life, so why did the universe all of a sudden decide to take a turn for the best? 

Shaking off the thought, I couldn’t help but admire at the outside weather. Closing my eyes, I took it all in; the smell of fresh petrichor on the concrete, the soft trickle of water droplets as they hit the shop’s patio cover, and the delicate fog that had enveloped and rolled over the entire campus grounds. Looking at the people walking around with umbrellas, my focus shifted to a red umbrella across the road. 

A couple dressed in matching beige coats and scarves were grasping the handle together, looking into each other’s eyes with an air of complete harmony. My smile quickly dissipated, however, realizing that a broken person like me might never feel anything or find anyone like other people. Almost as instantly as I had spotted the couple, the two walked off and reminded me that I was probably late for class. 

Throwing on my hood and shielding my eyes, I sprinted across the wet cement and felt like a maniac as I laughed heartily, enjoying the feeling of the cold air and rainwater on my face. Getting drenched in rain was probably one of my favorite childhood activities, and none of my friends really understood why I kept doing it even when I got sick. 

Once I got to the classroom, I was relieved that I made it on time and early enough to grab a good seat at the front. I couldn’t escape the few jokes that came from my friendly familiar classmates. 

“If you get me sick before midterms, I’m going to kill you,” one said in an overdramatic and ominous. 

“Did you lose your umbrella again?” another asked. 

“I’ll buy you a matching pair of boots and a raincoat for your birthday, Y/N!” one more cheered. 

Giving them the finger and smiling at the familiar playful banter I missed so much, I grinned, realizing that I was finally getting my old life back. 

“Maybe she left it at home with her report card from last semester.” 

The room went dead silent. I was on good terms with everyone and appreciated a good joke occasionally, but all of my classmates knew where the line was. This particular person, however, did not. 

Turning my head slowly towards the nasal voice that spoke, I squinted at a pip-squeak excuse of a girl who couldn’t possibly be bigger than a yard sale Christmas decoration. She was sat in the middle row of the room and went from intimidating cheerleader to quaking chihuahua as soon as my eyes caught hers. 

“What?” she stuttered, trying desperately to fake confidence in her tone. Newbie, my brain automatically identified. “You—you all know why she had to take time off last year. It’s not my fault everyone’s been spreading rumors about her tuition fees and parents—”

Before she could utter another word, I stomped over the staircase array of desks and placed my hands firmly onto the table in front of her, fists clenched and knuckles turning white. 

“You want to know why I took a gap-year?” I asked vacantly, not for the sake of getting an answer. “Because I couldn’t afford it.”

“Burberry and a Louis Vuitton?” I inquired, gesturing to the coat hung on her seat and bag under her chair. “I’m not exactly ‘well off’ like you. My family can barely make enough money to put food on the table, and yet you seem like you have more than enough to burn.” 

She quivered and gulped as she tried to pry her eyes away from mine. 

“We’re not in middle school anymore; let’s stop acting like it.” Lowering my head so that I was eye-to-eye with her, I stared at her head on before speaking. “I may not be rich, but at least I don’t look the way that I am on the inside.” 

Gathering my stuff, I quickly texted the TA and said that I had a family emergency come up. He replied telling me that he didn’t have a lecture planned and that I wouldn’t miss anything, so I responded with thanks and walked back outside. 

The rain had stopped, but it was still freezing cold. Against my better judgment, I decided to do what I always did when I needed to clear my head; go onto the roof. The rooftop of the main building was kind of my secret hideout. The few people who knew about it were some of the art majors who would come up very rarely to sketch and take pictures of the mini garden that grew there. Other than that, no one really ever went up there. The only downside was that the rooftop was accessible solely through the back stairs. 10 flights of stairs, may I add.

Huffing and puffing up to the door, I opened it to find the rooftop just as beautiful as ever. Flowers of all kinds lined the planter boxes and string lights hung from the side poles, mimicking the setting of a fancy restaurant. The lights never turned on though, and I couldn’t remember if I’d ever seen them lit at all. I tossed my bag onto the ground and found my usual spot near the roses. The wind was blowing just enough so that the scent of the freshly bloomed and still-damp flowers wafted towards me. 

Outlooking onto the campus below, I sighed. 

“Hey, mom and dad...” I spoke quietly as I stared into the gloomy but bright sky.

Looking down at a rose petal that had fallen onto the dirt, I picked up it up and stroked the colored fauna. “Are you guys having fun in the Bahamas? Australia? Cancun? Maybe Mexico?”

A gust of wind blew across my face that made me close my eyes, and it was immediately followed by a rustling noise that came from behind me. 

“Who’s there?” I asked, standing up. 

A familiarly shaped figure arose from behind one of the rose bushes. Stretching out his arms and letting out a yawn, the random field boy from the first day of school was now standing clearly in front of me. 

“Who are you?” I looked at his similar choice of simple attire, noticing his white shirt and pair of distressed jeans that coincidentally mirrored your outfit. 

“Good morning to you too,” he greeted while yawning again. 

The boy simply chuckled, his deep tone causing a strange feeling in the pit of my stomach. “Im Jaebum. A pleasure to meet you.” Extending his hand, I shook it cautiously. 

“Y/N. Y/N Y/L/N—” The second that I replied and his hand enveloped mine, he pulled me close into his chest. 

What the fuck is wrong with this dude

Observing his features up close, attractive would have been an understatement. His eyes were the darkest shade of brown I had ever seen, while his angular features gave him an edge that only animated characters possessed. To top it all off, I counted seven individual piercings that decorated his ears. 

I snapped back into reality when I noticed that I had been staring much longer than what was considered normal and shoved him abruptly off of me. He simply smirked. 

“You’re that girl who saw me on the field, right?” he asked softly, taking slow but deliberate steps back to me, trying to close the distance between us.

Of all the times I was able to compose myself and structure my sentences, my throat felt as dry as the Sahara Desert. 

“Yeah,” I somehow managed to reply. 

“You’re a lot taller than I originally thought you were...” he admitted quizzically, circling me and examining my physical features. I sat down forcefully, crossing my arms over my chest and scowling slightly at his perverse nature. 

I decided to take charge of the situation. “What are you doing up here?” 

Jaebum kept his distance and sat two-arms lengths away from me, likely sensing my discomfort. “I just like coming up here sometimes. It helps me clear my head.”

Although I admired his relatable and honest answer, I still held back. 

“Do you come up here often?” he asked this time. 

Nodding my head yes, I also told him about my rooftop therapy sessions. A slightly awkward silence began to grow between us. With neither of us willing to compromise and start the conversation up again, I stood up before Jaebum stopped me. 

“That was a night feat you had before class today.”

I turned my head towards him so quickly I almost pulled a neck muscle. “Oh. You saw that?” 

He laughed, flashing a perfect white smile. “I didn’t really realize it until that night on the football field, but we’re in pretty much all of each other’s classes.”

“Oh...” Thinking over it, I must have made an expression of confusion because Jaebum immediately began explaining. 

“I sit behind you during French 103? We worked on a project during the first semester of physics. I’m in the same major as you, so I hope you don’t think I’m a stalker or anything. I never see you, and you never see me. We’re both kind of invisible, right?” he admitted, fidgeting slightly with his hands in whenever he would try to think of sentences. 

“I guess you could say that...” I mumbled. 

“How about we be invisible together?” he asked while smirking and shooting me a wink. 

I scoffed. 

Oh. Of course, he had to be that kind of guy. 

“Uh, I hate to break it to you, but I don’t do—” I chuckled awkwardly while trying to think of the word. “—that.” He looked at me confused, wondering what message I was trying to convey when I outlined a circle with my hands. 

Time to come clean and do what you do best, Y/N.

“Partying and going to clubs with friends? Smoking so much that you feel like your lungs might collapse any second? Staying out until 4 in the morning and drinking so much that the hangover the next day makes you want to throw up, crawl into a hole and die?”

Jaebum was silent, eyes magnetized at my brutally honest tone. 

“I don’t deal with any of that, but above all of the stupid and dumb shit a college kid can do? I don’t do that,” I repeated, drawing the circle again. “I don’t do hook-ups. I don’t mess around with guys or let them mess around with me and waste my time. I don’t go out with anyone for the sake of just ‘having fun’ and most importantly, I don’t date. Sorry to get your hopes up.”

Getting up from my sitting position, I grabbed my back and turned to Jaebum once more, his widened eyes and appalled expression telling all. 

“I’ll see you around in class.” I waved him goodbye and smiled, jogging down the stairs before he could reply.

Don’t you dare think about his smile, Y/N

He’s not any different.

No stupid decisions.

No reckless choices.

No broken promises.

And absolutely no falling in love.

[paleorecipecookbook]

RHR: The Truth about Saturated Fat, with Zoё Harcombe

In this episode, we discuss:

Why you need to eat fat

Why the Paleo diet template makes sense

Where these misguided ideas about fat came from

The Seven Countries Study

Zoё Harcombe’s research on fat

Why you should be skeptical of some news headlines

Why dietary guidelines don’t work

The epidemiological evidence

Conclusions about saturated fat

Show notes:

The Obesity Epidemic: What Caused It? How Can We Stop It?, by Zoё Harcombe

“Evidence from Randomised Controlled Trials Did Not Support the Introduction of Dietary Fat Guidelines in 1977 and 1983: A Systematic Review and Meta-Analysis,” by Zoё Harcombe

“The Nitrate and Nitrite Myth: Another Reason Not to Fear Bacon,” by Chris Kresser

USDA Food Composition Databases

“Re-evaluation of the Traditional Diet-Heart Hypothesis: Analysis of Recovered Data from Minnesota Coronary Experiment (1968–73),” by Christopher Ramsden

“The Challenge of Reforming Nutritional Epidemiologic Research,” by John Ioannidis

[smart_track_player url="https://ift.tt/2pzvMar" title="RHR: The Truth about Saturated Fat, with Zoё Harcombe" artist="Chris Kresser" ]

Hey, everybody, Chris Kresser here. For the past 50 years we’ve been told that eating meat, saturated fat, and cholesterol is unhealthy. Recently, a growing number of people are turning to a vegetarian or vegan diet with the goal of improving their health.

But is it really true that meat and fat are bad for us? And are vegetarian and vegan diets a good choice for optimizing health and extending lifespan? If not, what is the optimal human diet? Join me on the Joe Rogan Experience on Thursday, September 27th, as I debate these questions with vegan doctor Joel Kahn. You can tune in live at 12 noon Pacific Time at JoeRogan.live. That’s J-o-e-r-o-g-a-n.live, or you can catch the recording at podcasts.joerogan.net, on YouTube, or in iTunes or Stitcher.

If you’d like to receive updates about the debate, including links to the recording and new articles and information I’ve prepared on this topic, go to Kresser.co/Rogan. That’s Kresser.co/Rogan and put your email in the box.

Okay, now onto the show.

Welcome to another episode of Revolution Health Radio. This week I'm very excited to welcome Dr. Zoë Harcombe as the guest on the podcast.

Dr. Harcombe is a Cambridge University graduate with a BA and MA in economics and math. Zoë enjoyed a successful career in blue-chip organizations before leaving corporate life in 2008 to pursue her passion. Her early career involved international roles and management consultancy, manufacturing, and marketing in global organizations from FMCG to telecoms before specializing in personnel and organization. At the peak of her career, Zoë was vice president for human resources for Europe, Middle East, and Africa. Having written three books between 2004 and 2007 while being head of people, Zoë left employment to research obesity full time. This culminated in the publication in 2010 of The Obesity Epidemic: What Caused It? How Can We Stop It?

Zoë returned to full-time education in 2012 to complete a PhD in public health nutrition, which was awarded in March 2016. Her PhD thesis was entitled “An Examination of the Randomised Controlled Trial and Epidemiological Evidence for the Introduction of Dietary Fat Recommendations in 1977 and 1983: A Systematic Review and Meta-Analysis.” A number of peer-reviewed articles have emanated from this work, and the first was the 64th most impactful paper in any discipline in the year 2015. Zoë lives with her husband and rescue animals in the Welsh countryside surrounded by food, a.k.a. sheep, hens, and cows.

Now I'm really excited to talk with Zoë because she recently published a paper critiquing the U.S. dietary guidelines and the U.K. dietary guidelines for the lack of evidence behind their recommendation against eating saturated fat or limiting it to less than 10 percent of calories in the diet. And she, as I just suggested with her bio, has probably spent more time looking at this than anybody else. She wrote her PhD thesis, as the title suggests, on the evidence, or lack of evidence, rather, behind the dietary guidelines around total fat and saturated fat. And she went all the way back to the late 70s and early 80s to look at the studies that were used to create the original dietary guidelines. And then the second half of her paper looked at all of the research that has been published since then through 2016.

And as we’ll discuss in the show, the conclusion is that the dietary guidelines never really had any meaningful evidence behind them to justify restricting saturated fat back in the late 70s and the early 80s. And the same is true today in 2018. So I hope you enjoy this interview as much as I did, and let's dive in.

Chris Kresser:  Zoë, it is such a pleasure to have you on the show. We were just chatting before the show, and I can't believe we haven't connected by now. We walk in many of the same circles, and I’ve followed your work for some time. So I'm really, really grateful that you’re able to join us.

Zoë Harcombe:  Oh, I thank you so much for having me. I’ve just followed you for so long and your “nitrates in bacon” is my just absolute go-to blog. Stop, people, worrying about bacon.

Chris Kresser:  All right. Well, we’re going to talk a lot more about that and there’s so many things we could talk about today. But the main reason that I wanted to have you on the show is to talk about your recent paper critiquing the dietary guidelines both in the U.S. and in the U.K. related to total fat and particularly saturated fat. And everyone who’s listening to this knows that for many, many years, really, I guess about 40 years now, right? It goes back to about 40, 41 years now, we've been told that fat in general, although that's maybe slightly changing in the public perception recently and even in some of the dietary guidelines that fat in general is bad, and particularly saturated fat is terrible.

But as we’re going to discuss in the show, your research has shown that that's maybe not what the evidence actually says. So before we dive into that, why don’t you tell everyone a little bit about your background and how you came to this work.

Zoë Harcombe:  Okay, I’ll do a really quick one because I know you’re not sort of a three-hour podcast man. So I’ll give you a composite history. First fascination came when I was studying at Cambridge University in the late 80s, early 90s and started seeing obesity growing around me. And it was just a fascination to me because it's the last thing that people want to be. People do not want to be overweight, let alone obese, and it was just starting to explode and had already exploded in the U.S. And I was just fascinated.

So I wanted to understand, why do we have an obesity epidemic? When you start looking at why, you go back to looking at when, and you can't help but see, particularly on the U.S. graph, that it just takes off like an airplane at about 1976 to 1980, that pivot point in the NHANES data. And of course, therefore, you go back to look at that period of time. Did anything particularly happen? Did we suddenly start eating 10,000 calories a day and sitting around on our backsides? Well, actually, no we didn't.

Did you grow up hearing that saturated fat would give you a heart attack? You’re not alone. Check out this episode of RHR for an in-depth look at the science surrounding saturated fat with researcher and author Zoё Harcombe. 

And the UK data was particularly interesting. We seem to be eating fewer calories nowadays than we did back in the 1970s, when we were much slimmer. Barely any obesity in the UK by about 1972. And you then start looking at an event called the dietary guidelines, which came in with the Senator McGovern committee in 1977, and of course these were then embedded in the US Dietary Guidelines for Americans in 1980 and then every five years since. And there is debate.

There are people who will say the introduction of the dietary guidelines has nothing to do with the rise in obesity and type 2 diabetes and more beta conditions related to diet and lifestyle. But it at least needs to be looked at. I mean, I say it coincided with the epidemics in obesity and diabetes, and we need to therefore explore was that a coincidence or was it a factor that was material in the changes in our health. And I am one of the people who thinks it is material and that our shift to basing our meals on starchy foods, grains, fruits, vegetables, largely carbohydrates, being encouraged to consume as high as 60 percent of our diet in the form of carbohydrate, the one macronutrient we don’t actually need, I do think it has made a difference. And I’m not alone in that view.

And then of course you look at guidelines and say, well, what were they about? And of course, they were about restricting total fat to no more than 30 percent of calories and saturated fat to no more than 10 percent. And because they were only three things that we ate and because protein is in everything other than sucrose and oil, so it tends to be fairly constant in any natural diet, and the peer study showed this beautifully, nice evidence for this, protein tends to stay constant around 15 percent. So as soon as you set the fat guideline, you’ve automatically set a carbohydrate intake minimum of 55 percent. And that’s what we did.

So I wanted to understand why did we set that total fat guideline. If that was the thing that started everything, why did we do that? And did we get it right or did we get it wrong?

Chris Kresser:  So you have a BA and an MA from Cambridge in economics and math, and then in 2016 you got a PhD in public health nutrition. And what I find really fascinating is what you … tell us a little bit about your PhD thesis.

Zoë Harcombe:  Yeah, so the PhD thesis was using the relatively modern techniques, and they have been around since the 1970s, but we’re really using them a lot now. And that’s the systematic review and meta-analysis. And when we pulled together evidence from randomized controlled trials, ideally, if not from cohort studies, it’s considered to be the pinnacle of the evidence that we could examine. So I approached looking at the dietary fat guidelines in four ways. And one was to say, what was the RCT evidence at the time available to the committee? Had they looked at it back in …

Chris Kresser:  That’s “randomized controlled trials,” for those who are not familiar.

Zoë Harcombe:  Yes. Yeah, so the randomized controlled trial evidence available to the US committee in 1977, and then the UK committee deliberated in 1983, and that allowed one more study available to the UK committee that wasn't available to the US committee, and that was the Woodhill Sydney Diet Heart Study. And also to look at the epidemiological evidence available, had the committee chosen to look it at the time the guidelines were set? So that was the first two papers, the first half of the PhD. And then the second half was to bring it up to date and to say if the committees were deliberating again today and they had all the RCT, randomized controlled trial, evidence available and all the epidemiological evidence available we have today, what would the conclusions be, looking at it in an up-to-date scenario. And that was the four parts.

Chris Kresser:  Yeah, so you’ve spent, how many years did it take for you to get your PhD?

Zoë Harcombe:  Yeah, three and a half. I did it full time. I just decided to stop everything else I was doing and do it full time. And as anyone who’s ever done one meta-analysis knows, to try and do four …

Chris Kresser:  Yeah, that’s a lot of work. But the upshot here is that you have a PhD in public health nutrition. You spent the better part of four years examining the evidence base for the last 40 years connecting fat and saturated fat to health and disease. And this is exactly why I wanted to have you on the show to talk about this topic because it's one thing if you have a kind of armchair critic who's cherry picking one or two studies to make their point, which often happens on the internet, right?

Zoë Harcombe:  Yes.

Chris Kresser:  It's another thing to have someone who's trained at the level that you've been trained at who spent four years objectively looking at this evidence and then publishing on it and showing where it doesn’t add up. So let's dive into that now.

I want to start by talking about some basics because I think they’re really important. I love how you did this in your recent dietary guidelines paper. Just a few facts about fat that maybe not everyone is aware of or has thought about much.

Zoë Harcombe:  Okay, so I shared these in conference presentations and I was really pleased that when I did this, there’s peer-reviewed study. They didn’t get edited out because I thought they might be a bit chatty, if you know what I mean, for a peer-reviewed paper.

Chris Kresser:  Yeah, yeah.

Zoë Harcombe:  But I actually had a couple of nice comments in the margin of people saying, “Oh, good point, I hadn’t thought about that.”

Chris Kresser:  Yeah, yeah. I had the same reaction.

Why You Need to Eat Fat

Zoë Harcombe:  Oh, thank you. So the most important one is that we must consume fat. Human beings must consume fat. We die without consuming dietary fat. We must consume essential fatty acids, that’s why they’re called essential.

“Essential” in nutrition means something that we must consume, not just something that the body needs. And of course we have the fat-soluble vitamins A, D, E, and K, and they come in foods with fat. And they need fat to be absorbed. So that’s pretty vital. When people demonize fat to the extent that they do, they always give the impression that we could get away without eating this stuff. And we couldn’t. I don’t know how quickly we’d die, but we would. So we need it.

Number two, again, that people seem to realize particularly when they demonize saturated fat is that every single food that contains fat, and it’s actually quite difficult to find a food that doesn't contain fat, sucrose doesn’t. But not much else doesn’t. So every food that contains fat contains all three fats. That’s:

Saturated fat

Monounsaturated fat

Polyunsaturated fat

And only the proportions vary. So again, people talk as if we can avoid saturated fat and only eat unsaturated fat, and that is completely impossible unless you're in a lab and you’re trying to create single fats. It is impossible if you’re going to eat food, which I recommend that all people do.

And then the other interesting factoid, I love playing around on the USDA all foods database and just looking at things that add up and things that don’t add up. And it was a real surprise to me when I first started looking at foods that when it comes to food groups, there is only one food group that has more saturated than unsaturated fat, and that is dairy products. So your struggle to find a meat, and I have not yet found one, that has more saturated than unsaturated fat, typically the main fat in meat is monounsaturated fat. And that goes for lamb or steak or chicken.

Chris Kresser:  Even pork.

Zoë Harcombe:  Absolutely. And therefore lard, which I just love, because people just think lard is pure disgusting.

Chris Kresser:  Saturated fat, yeah.

Zoë Harcombe:  Saturated fat.

Chris Kresser:  If you were to put lard or coconut oil together, people would say lard would be the unhealthy choice from a saturated fat perspective. But of course, coconut oil is 97 percent saturated, I think.

Zoë Harcombe:  Yes.

Chris Kresser:  Something like that.

Zoë Harcombe:  And lard is 39 percent.

Chris Kresser:  Right.

Zoë Harcombe:  So nowhere near as bad. And that’s not saying that saturated fat is worse than unsaturated fat. It’s just stating a nutritional fact. The only food group that has more is dairy products. And then of course you’re getting to, “Well, are dairy products bad for us?” And it’s really difficult to think that they are when you look at the nutritional profile of dairy products and the bone nutrients calcium, phosphorus, vitamin D. Look at any profile of any dairy product and you can’t help but think …

Chris Kresser:  And the evidence.

Zoë Harcombe:  Yes.

Chris Kresser:  I mean there’s a ton of evidence suggesting that full-fat, but not nonfat or low-fat dairy are beneficial for both cardiovascular and metabolic health. And there was actually a new study recently published, I’m not sure if you saw it. I am less persuaded by it. Or you mentioned it, the PURE Study.

Zoë Harcombe:  Oh, yes.

Chris Kresser:  Because it has within-country or between-country comparisons, which I think we’ll be talking about later, is problematic. That was an issue with the Seven Countries Study. But it does align with many of the other studies that have been done on this topic previously, showing that when people eat more full-fat dairy, that's associated with lower body weight, with lower blood sugar and better glycemic control, and with lower risk of heart disease based on cardiovascular markers. And that's actually the reason that the full-fat dairy works better than the low-fat or the nonfat dairy in that regard because some of the nutrients that are thought to be beneficial for cardiovascular and metabolic health are in the fat.

Zoë Harcombe:  Yes, amazing.

Chris Kresser:  So if you take out the fat, you take out the benefit.

Zoë Harcombe:  Yeah, yeah.

Chris Kresser:  Yeah.

Zoë Harcombe:  Absolutely, I’m a huge fan of dairy, personally.

Chris Kresser:  Me too. I mean, of course if someone is lactose intolerant or they’re intolerant of the proteins, it needs to be avoided. But for people who are not, what I always say is at least the evidence that we have suggests that it's healthy when it's well tolerated by the individual.

Zoë Harcombe:  Yes.

Why the Paleo Diet Template Makes Sense

Chris Kresser:  So given this, given that fat is essential, that all foods contain all fats and that saturated fat is not even the highest percentage of fat in any food except for dairy, this leads us to some pretty interesting conclusions. You mentioned in your paper, which I loved, and I loved that they kept it in here too, it’s illogical that the same natural food would be both helpful and harmful. Like you can't eat a steak and eat it so that you're only eating the unsaturated fats and not the saturated fats.

Zoë Harcombe:  Yeah, yeah. There’s no other way of putting that. It just, it doesn’t make sense. Whether your belief system is in God or nature, food is provided around us on this planet, and it makes no sense that in that same food that we need to thrive and survive, something has been put that is trying to kill us at the same time as all the things being there that are trying to save us and enable us to live. And we’ve evolved of course over—I’m reading Sapiens at the moment, so there’s an argument over our heritage—but, I mean, we’ve certainly been around potentially since Australopithecus, Lucy, two-and-a-half, maybe three-and-a-half million years ago. And we’ve done pretty well eating anything we can forage or hunt around us.

Chris Kresser:  That’s right.

Zoë Harcombe:  The idea that they came up with in the last 40 years that this stuff is trying to kill us, it’s just so stupid.

Chris Kresser:  It doesn’t add up at all.

Zoë Harcombe:  Yeah.

Chris Kresser:  It doesn’t add up. So another example you used which I love because it really turns nutrition-dominant paradigm ideas on their head is the olive oil versus pork chop example. Tell us about that.

Zoë Harcombe:  Yeah. So I have a little postcard that I leave on the chairs at conferences, as well, so there’ll be many around the world. And I put up a picture of a sirloin steak, mackerel, olive oil, and mention the pork chop. And a couple of interesting, fun factoids. One is that the mackerel has twice the total fat and one-and-a-half times the saturated fat as the sirloin steak, which isn’t a problem because both of them are great foods. But of course we’re told not to have red meat and we’re told not to have oily fish. So that’s illogical.

And then olive oil has 14 percent saturated fat versus a typical pork chop might be only sort of one to two grams, but then people say, “Oh, you wouldn't consume 100 grams of olive oil.” No, but a tablespoon of olive oil has more saturated fat than a 100-gram pork chop. And again, we can make a mockery of nutritional advice when you know something about food.

Chris Kresser:  Yeah, I mean, and it’s easy to see how you could have a salad, if you have a big salad with a couple tablespoons of olive oil and dressing versus a 200-gram pork chop, you’re still eating more saturated fat there.

Where These Misguided Ideas about Saturated Fat Came From

So, I mean, this is so obvious when you look at it this way, and it makes you wonder, how did we get the idea that saturated fat is bad in the first place? I know there are some political and social roots of this, and feel free to talk a little bit about that if you want. But in particular, how did this arise from the evidence? What was your sense of that as you did your PhD and looked deeply at all of this?

Zoë Harcombe:  Yeah, so one of the most important chapters in the PhD is the review of the literature. And you go back in the review of the literature, and of course in this topic area, you’ve got to go back to the Russian pathologists in the early part of the 19th century, when they noticed the cholesterol deposits in the arteries of the autopsies that they were doing. So they started to hypothesize, had these cholesterol deposits actually caused the death of this relatively young person that they were performing an autopsy on, and could they come to any conclusions about those sort of cholesterol stores of fatty deposits?

And many people know this, it’s been said in conference presentations, that at the time they then started experiments on rabbits, feeding them foods containing cholesterol, feeding them purified cholesterol, to try to see if they could mimic the impact that they thought food might be having on the human body. And of course, as some people have worked out, rabbits are herbivores and the only foods that contained artery cholesterol are foods of animal origins. No exception. So you find dietary cholesterol only in meat, fish, eggs, and dairy, which are things that rabbits can't tolerate.

Chris Kresser:  Yeah, it’s strange. In a certain way, this almost supports what we were just saying. Eat a species-appropriate diet. The message there is not “don’t eat cholesterol.” It’s “don’t feed cholesterol to an animal that’s not supposed to eat it and don’t feed humans foods that we’re not supposed to eat.”

Zoë Harcombe:  Absolutely. And very interesting. When they fed purified cholesterol not in animal foods to the rabbits, they didn’t have any problems. And when they fed cholesterol foods to dogs, they didn’t have any problems because dogs are omnivores.

The Seven Countries Study

So we then wind forward to the 1950s, and Ancel Keys gets a bit of a bad rap in our world. I like to look on him in quite a more balanced way because he did some brilliant work, like the research starvation experiment. But he did kind of fall by the wayside a little bit on the fat thing.

So his first exploration was with the Russian experiments in mind to try to see if dietary cholesterol impacted blood cholesterol. And he concluded it did not, and he never deviated from that view. And the best quotation I found on that was from the 1954 symposium on atherosclerosis, and he said, “Cholesterol in food has no impact on either cholesterol in the blood or the development of atherosclerosis in man.” Which was brilliant because he had actually exonerated animal foods. But he didn't make that connection at the time. Maybe his nutritional knowledge just wasn't good enough and he just hadn't quite worked out, “If I’m finding nothing when I’m feeding human subjects,” because you could do that then with ethics, “human subjects massive amounts of dietary cholesterol via loads of animal products, they don’t develop any blood cholesterol problems and they don’t develop any signs of atherosclerosis,” he should’ve concluded, “I therefore just exonerated what I’ve been feeding them.” Which would be:

Eggs

Cheese

Meat

Possibly fish

But most likely meat, cheese, and eggs. But he didn’t. For some reason he was convinced that fat was the bad guy. If it wasn’t cholesterol in food, then it had to be fat in food. And yet again, having given his human subjects animal foods, he should’ve said, “What are the macronutrients in those animal foods? Okay, so it’s fat and protein. Dairy products have got a little, little bit of carbohydrate, but essentially what I've just fed them is fat and protein. So I should turn my attention to the one thing I haven't fed them, which is carbohydrate.” But he didn't do that.

So he was convinced that total fat was the problem, and of course we then had the Mount Sinai presentation in 1953, which gave us that famous Six Countries Graph, which has nothing to do with the Seven Countries Study. And then of course there were a number of countries that he'd left out. And Yerushalmy and Hilleboe found this out and unfortunately published a little bit too late, in 1957, saying, “Hey, hang on, you left out all of these other countries. And if you put them all on there it looks a bit like a spider scatter, that the pattern has gone. But the Seven Countries Study had already started in 1956. And Keys seemed pretty determined that he was going to come to the end of the Seven Countries Study and find fat guilty.

Now interestingly, and this is not terribly widely known, he could not find anything against total fat. So when, as part of my PhD, I pulled the epidemiological studies that were available at the time the guidelines were introduced, and of course the Seven Countries Study was one of those, and you’ve got Framingham and Honolulu, Puerto Rico, the London bank and bus study, and the Western Electric study being the others, none of those six found any relationship between coronary heart disease and total fat. So Keys acted. He went in with the total fat hypothesis. He accepted that it was not total fat. Now he had spent so much time and money on this study, he needed to find something. And he could find an association between saturated fat in the different cohorts, and coronary heart disease in the different cohorts. But at the same time he claimed, and this is in the summary paper, “I found no issue with weight, obesity, I found no issue with sedentary behavior activity, I found no issue with smoking.”

So things that we now know he was wrong about, we give him the benefit of the doubt on the one thing that he did find, which was saturated fat. And the other five peer studies, the ones I’ve just mentioned, did not find anything against saturated fat. And of course, they were all in country studies. So they were right, they were in community studies.

So you take Framingham. It’s a small town, it’s looking at people who eat a certain level of total fat or saturated fat versus people who don’t. So you’ve got all the other factors, or many of them, constant. You’ve got the same GDP, the same politics, the same community, the same access to healthcare. Go to Japan in the 1950s versus the US in the 1950s, you’re comparing efficiently.

Chris Kresser:  Completely different.

Zoë Harcombe:  Exactly.

Chris Kresser:  Not even apples and oranges. We’re not even in fruit category there. I just want to pause here and just highlight this for people who are less familiar with research and methodologies. What Zoë’s saying is that if you … the problem with comparing groups of people between countries is that there's so many factors that vary from country to country and lifestyle, physical activity, the type of foods they eat. Saturated fat comes in lots of different types of food. So what kinds of foods are people eating in the US versus in Japan, where saturated fat would be found in totally different type of food? So comparing between countries just makes the possibility of confounding factors and all of the other issues of epidemiological research, it just amplifies them and makes them even more likely. So typically, especially today, those between-country studies are often discounted or taken with a large grain of salt because it's so hard to control for factors even within the population, much less between different populations.

Zoë Harcombe:  Absolutely. Absolutely yes.

Chris Kresser:  Okay, so, I mean, this is … the crazy thing to me about this, Zoë, and I'm sure this struck you at many intervals throughout your PhD, is just how much of a house of cards the whole evidence base is behind the idea that saturated fat is bad for us. There’s this illusory truth fallacy that we were chatting about before we hit the record button, as well, which is the idea that if you hear something repeated enough times, you just start to believe that it's true, whether it has any basis in fact or not. And we think maybe that researchers and scientists are immune to this illusion. But the fact is, they’re not.

John Ioannides, one of the most famous epidemiologists in the world, one of my favorite quotes of his is, “Claimed research findings may often be simply accurate measures of the prevailing bias.” So, I mean, that sums it. He has all these pithy quotes that just sum it up in, like, 10 words. Which basically means that once you have a certain idea and it's out there because of groupthink and confirmation bias, that idea will often just be perpetuated, even if it was never based in fact in the first place. Because someone will link to that original study that turned out to be erroneous as proof, then someone does a later study and you link to that second study. And then it just becomes a chain of references that all point back to that original study that then it was later shown to be invalid. So it's crazy to me that 40 years of dietary policy has been based on such flimsy evidence.

Zoë Harcombe:  I should declare my own bias, actually, going in, because up until 2010 I’d been a vegetarian for about 20 years. Then my own bias going in was that fat was bad, saturated fat was bad, saturated fat equaled animal fat, which of course I now know absolutely that it doesn’t. All fats are in all foods, especially coconut oil, which is purely vegan. And I believed what I’d been taught at school, that we should be eating low-fat foods and healthy whole grains and plenty of fruit and vegetables. And I believed it too. And I was at a dinner party just a couple of weeks ago, and there were a couple of young people who were engaged and full of life and full of news and full of opinions.

And as we sat down to dinner, they were reliably informing me and my husband that they didn’t eat much meat because it was full of saturated fat, which of course it isn’t, and saturated fat is bad for you, which of course it isn’t. And I said, “You guys work in the finance industry. How did you pick up, how did you become authorities on dietary fat at your tender young years?” We had done a superb marketing job on fat and cholesterol worldwide and people have fallen for it.

Chris Kresser:  Absolutely. Yeah, yeah, and it’s deep. It’s really a form of conditioning. At least, I’m not sure what’s happening with with kids now, but I grew up certainly at a time where butter and eggs and all those foods were really demonized. And it becomes kind of part of your cultural conditioning, and it's so deeply hardwired in the brain, it can be really hard to let go of it. I, as my listeners know, I was a macrobiotic vegan at one point. So I took it about as far as you could go.

Zoë Harcombe:  Wow.

Chris Kresser:  And I remember in high school, I was an athlete and the whole carb loading paradigm. I was eating, like, bagels with nothing on them, like dry bagels and breakfast cereal with nonfat milk for breakfast, and eating pasta and pancakes before my basketball games because the thinking was that would be good for athletic performance and also good for my health.

So I can be pretty extreme when I go for something. I took it to the extreme and when I started to figure out, I mean, it took a very serious chronic illness for me to snap out of that. And even with that, I remember when I was first starting to eat more fat, I had this distinct feeling, like I was doing something wrong or I should do it behind closed doors, or that something bad was going to happen to me. And it took quite a while for that to unwind. So I think there’s that kind of deeper psychological influence happening here too.

Zoë Harcombe:  I’ve read your stuff on that. You write so, like it just happened yesterday. I mean you just describe it, and you just did it then. I could see you running around the track with your bagel. It sort of stays in your mind, doesn’t it, how we felt and what we thought we were doing when we did all of that stuff.

Zoё Harcombe’s Research on Fat

Chris Kresser:  Absolutely. So let's talk a little bit more. Let’s kind of dive in with a little more of a fine-toothed comb on your thesis and your review of the RCTs from 1977, the randomized controlled trials. Which again, if we’re looking at a hierarchy of evidence, it's not that RCTs are perfect or they don't have potential issues, but certainly when compared to epidemiological issues and all of the problems there, which we’ll discuss a little later, they are more reliable. So what did you find in your review of RCTs related to saturated fat and either death from all causes and death from heart disease?

Zoë Harcombe:  So this paper came out in February 2015, and it went nuts. And if you Google it, it was front page in New Zealand and in the UK papers. And I spent the whole day when it came out. The phone was ringing the second I put it on in the morning and it was the BBC, could I come in? And I ended up doing about 20 or 30 interviews that day, just back to back. And it just went nuts. So I think it went nuts because it was the unique part of the PhD that was looking at the evidence at the time. And so people were picking up on the idea that we’ve been eating low fat for 40 years and the evidence wasn’t there at the time to back up the call to do that.

So the major findings from that paper were first of all that there were only six studies, six randomized controlled trials that were available to the UK committee. Only five were available to the US committee, and they’ll be pretty well-known to people. It’s like the Rose corn oil, olive oil trial, the low-fat diet; the Leren Oslo Diet-Heart Study; the MRC soybean study; the Sydney Diet Heart Study; and the LA Vet study. And you pull all of those together, there is no difference whatsoever. Not even to just leak the significance, it was actually the exact same number of deaths in the controlled side as in the intervention side. There was no significant difference in coronary heart disease mortality, it wasn’t quite an identical number, but it was something like 221 versus 219, or something. It was so close. It was virtually identical, again.

A really interesting finding, and this just massively undermined the diet–heart hypothesis and was not a finding that we expected to come across. It just came out. We were able to measure the … Across the polled studies, there was a significant difference in cholesterol being lowered in the intervention studies. But of course that made no difference whatsoever between mortality or coronary heart disease mortality. And I then went on to try to understand why it may have been the case that cholesterol had been lowered by the intervention and not made any difference to health benefits apart from the fact that cholesterol is not bad for us. But why didn’t intervention diets lower cholesterol?

And I think it’s because the main intervention was to swap out saturated fat and to swap in polyunsaturated fat. And a lot of the polyunsaturated fats that they were putting in, corn oil, soybean oil, vegetable oils, contain plant sterols. And plant sterol is effectively plant cholesterol, and it competes in the human gut with the human cholesterol and it replaces it, to an extent. So if you take plant sterols in margarines or spreads or in vegetable oils or indeed in some grain plant products, or some people take them from tablets from the health food shop, which is a really crazy … they will replace your own cholesterol to an extent and lower your blood cholesterol. But I’ve looked at the evidence for the end outcomes on heart disease. I’ve got another paper on that that was published in an editorial, and that shows that actually the overall benefit is not there. It’s actually overall harm of administering plant sterols in the end outcomes of heart disease.

But I think that’s why they lowered cholesterol and perhaps the studies weren’t long enough for the harm from that replacement to actually manifest itself in a difference in outcomes. And I would then expect the interventions to have more deaths from heart disease and more deaths therefore from all-cause mortality.

One of the other really big aspects I think that grabbed the media is the point that we made at the end of the paper, saying that these six studies, when he pulled them together, amounted for fewer than two-and-a-half thousand men, not one single woman had been studied, and not one of those men was healthy. They had all had a heart attack already.

Why You Should Be Skeptical of Some News Headlines

Chris Kresser:  So this is just really key here. You cannot generalize, even if the results were consistent across all these studies, which they weren’t, implicating … Or it sounds like they were consistent in the opposite direction that people thought they were. But even if they had implicated saturated fat as increasing total and CHD mortality, coronary heart disease, that would only be applicable to men.

Zoë Harcombe:  Sick.

Chris Kresser:  With pre-existing, yeah, sick men.

Zoë Harcombe:  Yeah.

Chris Kresser:  Not women and not men that are not sick.

Zoë Harcombe:  Yeah, absolutely, yeah. And interestingly not one study called for change, and studies at the time were far more ethical, I think, than they are today. Far less media orientated, far less trying to get a press release. They would just say things how they were. And a couple of them were a bit nervous about potential toxicity of the fish oil that we’d administered, and they’re the ones that were a bit worried about … the corn oil study had more deaths in the intervention group, and said, “We’re worried about the potential harm from the fish oil intervention.” And the low-fat diet study, the last sentence of that study just cracks me up. It just says, “A low-fat diet has no place in the treatment of myocardial infarction,” which is heart attack.

Chris Kresser:  It's interesting to me what you just said that how much the, both the reporting on studies has changed in the media and also even the way that researchers talk about their findings themselves to the media. I think I was reading an article in Science that was published in 1993, and they were talking about relative risks, which we can get into more detail when we talk about epidemiological evidence. But this is the percentage increase in risk from a given intervention, and they were outside of nutrition, still today in any other field, epidemiologists would consider anything below a 200 to 400 percent increase in risk to be indistinguishable from noise, meaning they would consider anything less than a 200 percent increase in risk to be not significant statistically. And in this article, Marcia Angell, who is a former editor of the New England Journal of Medicine, was quoted as saying that, “They typically didn't really accept a paper unless it had a relative risk ratio of over three for nutrition.” And that just blew me away because today, like IARC's panel about red meat and processed meat causing increased risk of cancer, the percentage increase is 18 percent.

Zoë Harcombe:  Yeah.

Chris Kresser:  That’s not even remotely close to the 200 percent which is the lower end of the threshold. And yet the media headlines are not saying indistinguishable increase in risk observed in people eating more red meat. They come out and just claim causality. They say, “Red meat and eating red meat and processed meat is going to kill you.”

Zoë Harcombe:  And as Bradford Hill would say, “There’s nine criteria and that double is just one of them.”

Chris Kresser:  Yeah.

Zoë Harcombe:  “So hit the double and then you can look at the other eight.” But none of them hit the double, none today get anywhere close.

Chris Kresser:  Nowhere near and yet, and I think this is partly an artifact of the world we live in, just with, like, proliferation of the internet and so many headlines. Everyone's vying to get attention and so you have to … a headline that said, almost insignificant increase in risk observed in people who eat more red meat than other people. But of course there are other diet and lifestyle factors that we’re not considering. That's not to make a good headline, right? Nobody’s going to click on that. And so people want the flashy, clickbait headline saying low-carb diet will shorten your lifespan or eating red meat will give you a heart attack. Even though I would hope that the researchers themselves somewhere deep down know that that’s a gross exaggeration of their findings.

Zoë Harcombe:  Yeah.

Chris Kresser:  And as for the media, I guess it’s just that we don’t have science journalists anymore.

Zoë Harcombe:  We don’t. I do a note every Monday where I look at a paper from the previous week and dissect it. And you can tell, mostly the ones that get into the media have had a press release. And if you look at the press release and you look at the media article, the media have just taken the press release almost verbatim. The press release provides a couple of quotes, they end up in every single article. Completely lazy journalism. Occasionally they might call in the UK me or Dr. Aseem Malhotra or Dr. Malcolm Kendrick and just say, “Do you want to give an opposing quote?” and occasionally they’ll stick it in.

Mostly they’ll just run off the press release, and the researchers should be challenging the press release. I mean, our paper in February 2015 was press released, and I remember having a few toings and froings because I wanted it to be scientific. It’s a big enough claim in itself to say we only studied two-and-a-half thousand sick men, and then we introduced these guidelines for 250 million Americans and 50 million Brits. That’s okay, enough. We don’t need to sensationalize it anymore than that.

Chris Kresser:  Absolutely.

Zoë Harcombe:  So I tried to get it down to the facts that we found and not to put any spin on them.

Chris Kresser:  Yeah. Yeah, to your credit, I mean, that's so hard to do in this crazy media environment that we live in now. And to be fair, there are definitely researchers that make an effort to do that. And you still will see that in reports where, I was reading one on, I can't remember what it was, but it actually stood out to me because I don't see it as often as I do. I was impressed by both at what the researchers were saying and that the author of the article. Because they went out of their way to say this is just an association or correlation. It doesn't prove causality, and here are the reasons why it might not be a causal relationship, and why we need more research. But my sense of that is it's almost like when you watch, if you see a commercial for a drug and then you have like the 20 seconds of side effects after the 10 seconds of the commercial. People have heard that so many times they just kind of tune that out and they’re only really still paying attention to the headline.

Zoë Harcombe:  Yeah.

Chris Kresser:  So let’s talk. So you went back, you reviewed the RCTs from the late 70s that were responsible for creating dietary guidelines that, as you said, applied to hundreds of millions of people around the world and probably affected many more even just by osmosis. Those ideas becoming firmly entrenched in industrialized society, even if they weren’t part of formal dietary guidelines. And then you went back and analyzed all of the research that had been done from, was it from the late 70s to 2016?

Zoë Harcombe:  Yes, so we then took it up to date. And I actually said in the recent paper that’s just been published by the BJSM, the one on is saturated fat a nutrient of concern, and that’s because the USDA is now looking at it again for the next dietary guidelines. And I actually put in that paper that the day that the paper is saying there was no evidence at the time came out, I was astonished that Public Health England came out almost immediately on the day. I said, “Okay, so maybe there wasn’t evidence at the time, but we’ve got plenty of evidence today.”

Chris Kresser:  Right.

Zoë Harcombe:  I was surprised that they were prepared to concede. I thought they said, “No, no, no, this is ridiculous. The Seven Countries Study was marvelous and that’s all we need. And we can ignore everything else.” But they didn’t. They said, “Okay, there was no evidence, but there is plenty nowadays.” And of course it takes so long to get papers published that with my supervisory team, we’d already moved on to the next step, which was looking at the evidence available today. So we had that paper pretty much ready to go. And of course you keep in the original six studies, then you just add in any other randomized controlled trials that have looked at coronary heart disease, mortality, and total mortality. Those were our two outcome criteria so we wouldn’t lose some RCTs that only looked at events, for example. But then that then brought in the Women’s Health Initiative, the DART study, the STARS study, and the very well-known Minnesota Coronary Survey study.

Chris Kresser:  Zoë, before we go on I want to pause there. Let’s talk about why you chose total and coronary mortality as an endpoint and why that's important—to focus on the mortality endpoints versus just the events.

Zoë Harcombe:  Yeah, I’ve got to credit Dr. Malcolm Kendrick with this, and I am such a Dr. Malcolm Kendrick fan, it’s just not true.

Chris Kresser:  Yeah, me too.

Zoë Harcombe:  And I just remember, I mean, I’m fortunate enough to know him and consider him a friend and to meet him on occasions. And just every time I meet with him he says stuff and I'm just, why is this not just the only thing that’s being taught in medical school because it’s so sensible? So he’ll say, “I can guarantee that you won’t die from heart disease by pushing you off a cliff.” And it just, it then sticks in your head. Okay, so the important thing is total mortality because there is no point to reducing heart disease if you increase deaths of something else. So all this stuff going on with statins. Oh, we think we can reduce some events. We could have a whole different program on statins. But would there be any point in making any benefit anyway, even if they could, if they, for example, as they might do, increase your risk of cancer or dementia or mind health, etc., etc.? So it has to be total mortality. The only thing that matters is are you going to help people to live longer, to die later?

Chris Kresser:  Absolutely.

Zoë Harcombe:  That’s what we’re trying to do with health interventions. And so we’ve got to have all-cause mortality in there and then we’ve got to have heart disease mortality and not just events. Because that’s where the dietary fat guidelines came about. They were issued in the name of trying to stop deaths, particularly in men at the time, younger men at the time, from coronary heart disease. So if they’re not going to achieve that, then they’re not even going to achieve what they were introduced for. So why on earth were they introduced?

Chris Kresser:  Yeah, thanks for clarifying, and sorry to interrupt. But I'm banging on this drum all the time. I just want to make sure that people understand it because it's a crucial distinction. You frequently see headlines like “XYZ intervention reduces the risk of heart attack by 20 percent,” which again, as we just said, in an epidemiological study, that's meaningless. We can’t distinguish that from chance anyways.

But even if it's an RCT, then the first thing I’d do is go look at the table to see if they even measured total mortality. Which previously, that was less common. It’s more common now, I'm finding. But then when you look at total mortality, there is often no difference. So that’s where the disease substitution is happening that you were just talking about. The risk of death.

Zoë Harcombe:  A bit of gossip. Malcolm Kendrick wants to die from a heart attack.

Chris Kresser:  Rather than cancer?

Zoë Harcombe:  Exactly. Rather than cancer.

Chris Kresser:  Yeah, that’s what I tell people too.

Zoë Harcombe:  Yeah, he doesn’t want to go early, don’t get me wrong. He probably wants to go at sort of 98 drinking a glass of red wine, playing with his grandchildren when he gets them.

Chris Kresser:  Yeah. You just have a heart attack in your sleep overnight. You don’t wake up one morning. That sounds a lot better to me than dementia or Alzheimer’s or cancer.

Zoë Harcombe:  Yeah.

Chris Kresser:  So you don’t need to belabor this, but it’s really important to point out because I think it's something that people who are less familiar with research may not have thought of. So okay, so you chose total and CHT mortality, and I believe you ended up with 10 RCTs?

Zoë Harcombe:  Yeah. So the original six and then the Women’s Health Initiative, DART, STARS, and the Minnesota Coronary Survey, pull them all together, there’s no difference in all-cause mortality. There’s no difference in coronary heart disease mortality. Again, there was a significant reduction in cholesterol in the interventions that did not meet any difference in coronary heart disease mortality or all-cause mortality.

So essentially, all we did by adding in the former recent studies was that we increased the number of people studied quite dramatically. It came up into the tens of thousands, not least because the women’s health initiative alone brings along tens of thousands of people to the party. And of course it then became more female than male because of all the women in the Women’s Health Initiative. But we still in those 10 only ended up with one study including both men and women that would be a primary prevention study, so people who had not already had a heart attack, and that was of course the Minnesota Coronary Survey. And this in itself found no significant results at the time of publication and of course we then had that brilliant paper where … it should be on the tip of my tongue, the person who went back to look at this, Christopher, I’m thinking. You know the person I mean, who went back to look at the Minnesota Coronary Survey and also went back to look at the Sydney.

Chris Kresser:  Was it Hibbeln?

Zoë Harcombe:  No.

Chris Kresser:  No that’s Joseph Hibbeln and Christopher, they’re both the guys who have done a lot of the critique of the polyunsaturated fat research, or am I thinking of someone different?

Zoë Harcombe:  Oh, I’ll be kicking myself and don’t worry. Stick it in your show notes. But it’s a very well-known team that went back to look at both of those studies and even thought there was no evidence found against the dietary intervention at the time, they found that there was some unpublished data. And it just made it even more robust that we had been demonizing fat at the time. So all the RCTs as of 2016, and there haven’t been any since, and there’s still no more evidence than we had at the time the guidelines were introduced.

Chris Kresser:  Wow, it’s just, it’s really kind of remarkable, actually. And it’s again just going back to this idea that a lot of this evidence is really based on a house of cards. And as an example of the fallibility of these guidelines, the US in 2015 for the first time removed their advisory that we should not be eating dietary cholesterol. Because they finally acknowledged the cholesterol in the diet does not have any relationship with heart disease. And that was kind of like a pretty major thing that just, like, slipped through.

There weren’t really big announcements or any fanfare around that. Like, “Hey, everybody, we’ve been really wrong about this for the last 30 or 40 years and we just want to bring that to your attention.” And I even remember reading editorials written by scientists who were kind of still anti-saturated fat and cholesterol, and were saying things like, “We can’t really make too much of this because the public is going to lose faith in our ability to guide them with diet.” And I have a sense that the same thing is going to happen with saturated fat in the next few years. And maybe already people know this, but they're just not willing to do it yet because if they do, people will absolutely lose faith in the diet guidelines.

Zoë Harcombe:  Yeah, and they need to.

Chris Kresser:  Yeah.

Zoë Harcombe:  I mean, let’s face it, they need to lose faith. The best thing that they could do, the dietary guideline committees, would be to come out and say, “Guys, we were wrong. I’m sorry, we were wrong. And we’re going to get it right from now on.” And that would be the only way that we would start having trust in them again. But all this surreptitious slipping things out, then slipping things in, anyone who’s working in this field is just finding this completely unprofessional and noncredible.

 Why Dietary Guidelines Don’t Work

Chris Kresser:  I mean, this is a whole other discussion, but it’s worth pointing out that the idea of top-down, one-size-fits-all dietary guidelines that will apply to everyone is really not consistent with our understanding, our modern understanding of human biology, biochemistry, and physiology. And I think that this, the whole idea of dietary guidelines that would apply to everyone needs to just die. Because that has led to this reductionist approach, which one researcher calls nutritionism, I like that idea, which is that a nutrient is a nutrient is a nutrient no matter what it's found in.

Saturated fat in candy or pizza or junk food will have the same impact as saturated fat found in a steak or another whole food. And it’s led to this extreme focus on macronutrients and isolated food components rather than looking at the whole context of the diet. And that's starting to change slowly. There have been some pretty good studies in the last couple years. There was one, I’m sure you know which one I mean. It was looking mostly at weight loss and they compared, they designed a study that was comparing the effects of a healthier low-carb versus a healthier low-fat diet. And they found that both were actually pretty effective compared to the standard junk food diet that most people eat.

And we need more studies like that, and if we let go of this kind of one-size-fits-all approach, we might actually be able to start looking at the context of foods we’re eating, and then where maybe one person does need to eat more fat and fewer carbs and another person might do better eating a little bit less fat and more carbs from whole foods relative to that other person. So to me that’s one of the biggest assumptions behind the dietary guidelines that’s not mentioned.

Zoë Harcombe:  Yeah, that was the Gardner study, wasn’t it?

Chris Kresser:  Yeah.

Zoë Harcombe:  I corresponded that enough.

Chris Kresser:  Yes, the Gardner study.

Zoë Harcombe:  Yeah, very good study, yeah.

 The Epidemiological Evidence

Chris Kresser:  So let's just briefly touch on epidemiological evidence. I mean, there’s so many issues with observational nutrition studies. I don't know if you saw John Ioannidis’s recent review. It was published in JAMA and I’m going to pull up a couple choice … It was called “The Challenge of Reforming Nutritional Epidemiological Research.” And I’m going to read the first two sentences because they’re classic Ioannidis in how pithy and direct they are. It says, “Some nutrition scientists and much of the public often consider epidemiologic associations of nutritional factors to represent causal effects that can inform public health policy and guidelines. However, the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles. The field needs radical reform.”

Zoë Harcombe:  Oh, I couldn’t agree more. I just couldn’t agree, I mean, I had the privilege of seeing John present at the Food for Thought conference in Zurich, which was arranged by the British Medical Journal and Swiss Re, a reinsurance company, and he gave the, I guess you’d call it the keynote, after-dinner speech by videoconference into the conference hall where we were in Zurich. And it was uncomfortable, shall we say, for some of the audience.

Chris Kresser:  I could imagine. In an audience full of nutritional epidemiologists, probably didn’t like what he had to say.

Zoë Harcombe:  Yeah, largely. I mean, I sat near Nina Teicholz, and we were absolutely loving it. But I won’t mention any names, but a couple of nutritional epidemiologists did walk out.

Chris Kresser:  Yeah, yeah, I’m not surprised. It’s hard to consider, and there are ways that nutritional epidemiology can be done better. We can have more advanced data collection methods and an application of Bradford Hill criteria, which you mentioned, to increase the chance that the relationship between variables is causal. But the way it is now … there’s another critique that I love by Archer and he says, “For results to be scientific, data must be, number one, independently observable. Number two, measurable. Number three, falsifiable, Number four, valid, and number five, reliable. And these criteria distinguish scientific research from mere data collection and pseudoscience.”

And when you look at nutritional epidemiology, they do not satisfy those basic criteria for science because they're relying on data collection methods like food frequency questionnaires, which are just a joke. I mean, they’ve been so thoroughly debunked as a reliable way of assessing what someone is eating. We know that human memory is not an accurate reproduction of past events. It’s just basically a highly edited anecdote regarding what we ate. And we know that these approaches that are used to assess what people are eating in these studies are really not accurate and not reliable and don't fulfill the basic criteria of science.

So, I mean, we could talk a lot more about the problems with epidemiology, but I think let's, given the time constraint, let's just go on and talk with those caveats, those huge caveats. What did the epidemiological evidence suggest if it had been included in the original analysis that you looked at and then also since then?

Zoë Harcombe:  So we covered in some depth at the time that essentially it was just the Seven Countries Study that found anything. None of the six studies found anything against total fat, and then just the Seven Countries Study alone found something against saturated fat. When you bring the epidemiology up to date, and I actually did it, I had to do it in a different way in the fourth part of the PhD because they didn’t have data on current epidemiology and total mortality or coronary heart disease mortality. So there was going to be nothing that I could actually update the original studies with.

So I had to look at different measures of looking at any relationship that I could find with deaths and total fat or deaths and saturated fat separately. Of course they’re not interventions anymore. So you are into just this epidemiological base of looking at the fat intake in different regions or in different studies. So it was slightly different to the other three that were looked at, and they were completely different studies, and probably studies therefore that are less well known to people. They were certainly less well known to me. So things like the Ireland-Boston study, Kushi, the US Health Professionals, Lipid Research study that’s very well known. The Pietinen Finnish counts study, a UK health survey by a couple of people called Boniface and Tefft. She’s not very well known, this new heart study, and then the Gardner Japanese study, which is probably not too badly known within the field. And when you separate it out, look in it, coronary heart disease deaths, so we couldn’t get the total mortality anymore.

But we could at least get the heart deaths and align those to either the total fat, where it was examined, or the saturated fat. There was, again, no significant difference for coronary heart disease deaths and total fat or saturated fat consumption. We were back to a limitation of the pooled studies from those seven that I’ve mentioned being almost entirely male. So 94 percent of the people involved in those studies were male. They were at least mostly healthy. Almost all of them had not already had a heart attack, but there was still no relationship for coronary heart disease deaths and total or saturated fat. So there was then a fifth paper that I published with the BJSM that wrapped up the four studies.

So it went through essentially what we’ve gone through now, which is, what did I do, looking at RCTs then, RCTs now, epidemiology then, epidemiology now? What was found? What wasn't found, which was far, far more. And then an era that I suggest we’ll probably be heading into quite soon was to put what I’d looked at in context of other meta-analyses that had been done. Because I’m a PhD researcher, I was not straight out of finishing my degree. But I’m still just a PhD researcher looking at this evidence fresh in a systematic way.

A number of other people have also looked at the data in this field either for mortality or for events or for interventions or for epidemiology. And I therefore wanted to look at what everybody else had done to say have I found something different. Has everybody found this? Because you have to do that. You can’t come to the end of your PhD and say, “I find if I might drop the toast buttered 100 times out of 100 it falls on the butter on the floor,” if everybody else has found more (audio cuts out 59:06) it doesn’t fall with the butter on the floor. You’ve got to put your own research in context.

Chris Kresser:  That’s another core principle of science. Shapiro, an epidemiologist, said, “We should never forget that good science is skeptical science, and science works by experiments that can be repeated. When they’re repeated they must give the same answer.” So this is another core principle. So what did you find when you looked at these other meta-analyses?

Zoë Harcombe:  So the main ones that were pulled together, and there’s a great table in the paper five, which is one from 2016. I think it's called “Dietary fat guidelines have no evidence base: Where next for public health nutritional advice?”

Chris Kresser:  That’s a pretty straightforward title.

Zoë Harcombe:  Yeah, it is pretty straightforward, actually yeah.

Chris Kresser:  Not beating around the bush.

Zoë Harcombe:  They’re pretty good, actually. They help you with titles. So they come up with catchy ones.

Chris Kresser:  Yeah.

Zoë Harcombe:  And I then went through, for example, I got the tape in front of me, so you’ve got Skeaff and Miller from 2009 who looked at RCTs and epidemiological studies. And they looked at mortality and events for total fat. You’ve got a fairly well-known study with Siri Tarino and colleagues from 2010 looking at epidemiology of fatal and nonfatal coronary heart disease and cardiovascular disease. Mozaffarian, who I had the pleasure of meeting in Zurich over the summer, and his paper looking at just events, not mortality. We might come back to that one. And then of course you’ve got the two well-known Hooper studies, that’s the Cochrane research, which should be the gold standard, but we can take a bit of a better look at that one. And then you’ve got Schwing, Jacqueline, Hoffman from 2014, RCTs, and my own study. And then of course you’ve got the Chowdhury study that looked very interestingly at the four different types of fats, saturated fat, monounsaturated fat, polyunsaturated fat, and they included trans fats in their research looking at coronary disease for both randomized controlled trials and epidemiological studies.

Chris Kresser:  Right, and I’d like to read the conclusion of that one: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Zoë Harcombe:  Here, here.

Chris Kresser:  So that was the Chowdhury, and then, so there were, I think, 39 total reports.

Zoë Harcombe:  Yeah, 35 non-significant. And we don’t shout that often enough.

Chris Kresser:  Yeah.

Zoë Harcombe:  If you stop—and I’ve done this for a Welsh TV program that I was working on—we went to Cardiff, which is the capital city of Wales, and we walked down the main street in Wales and we said to people, “What do you think about fat? What do you think about fruit?” And people would tell you, “We need to eat five a day and fat is bad for us.” So people have got the messages. But what we’re not telling them is when you actually look at all the evidence, 35 out of 39 results were non-significant. No findings. And that has to be the most significant thing that has been found, that we didn't find much. Why don’t we look at that more often? That’s so more powerful to me than the four findings. And if we just whiz through those. In the Chowdhury study that you mentioned, the one finding that they did make was against trans fats, and I don’t think you or I would give them any argument over that one.

Chris Kresser:  No.

Zoë Harcombe:  Mozaffarian, I really liked him in Zurich. But I was involved in a paper that critiqued his 2010 study which said, “You should replace saturated fats and polyunsaturated fats because there’s an impact on CHD events.” And our paper criticized that paper for excluding two studies that were not favorable to polyunsaturated fats, which was the Rose corn oil study and also the Sydney Diet Heart Study. And including, and it’s all bad studies, the Finnish Mental Hospital Study, which was not randomized, not controlled, crossover trial. I mean, just the worst possible trial to try and slip in to pretend it’s an RCT. So we critiqued that paper. I like to think he wouldn't publish that paper if he had the opportunity tomorrow. I can't speak for him, that wasn't right.

And that’s, of course, exactly what the Sax paper did last year, the American Heart Association paper. Again left out two unfavorable studies, the same two. Included the Finnish Mental Hospital Study, they shouldn't have done. And so basically, there were only two findings, and they boil down to one because it was the same research team, Hooper and the Cochrane team, working out of the east of England in the UK. One paper was from 2011 and the other was from 2015. And among 11 known findings for CVD, mortality, total mortality by modified fat, reduced fat, any kind of variation of fat, the only finding they could come up with was for CVD events when they looked at all RCTs for saturated fat reduction intervention. And we can get into that.

Chris Kresser:  Yeah, I mean, I think we can stop here at least in terms of the actual studies because it's, just to review what we've discussed, the randomized controlled trials that have been done since the late 1970s to today have not supported the idea that saturated fat increases the risk of death from heart disease, or any cause. The epidemiological evidence that has been done throughout that period does not support that hypothesis either. And even if it did, we'd still have all of the issues that epidemiological research, that make it problematic, like the healthy user bias and inaccurate methods of data collection, small risk ratios.

We talked about that earlier, how the increase in relative risk is so low that it doesn't really meet the threshold for assuming a causal relationship in any kind of epidemiology outside of nutrition, and even in nutrition 20 or 30 years ago. Other people who've meta-analyzed these data have come to a similar, if not the same, conclusion as you did in your research and your PhD thesis. And I just want to highlight something that you said about how the Finnish study, which is really not a good study at all, has been included in a number of analyses. And you might wonder why that would happen if the researcher is aware of its limitations and that it's not a valid study to draw any inferences from on this topic, why would it be included?

And again I’d like to turn to a John Ioannidis quote, and he says, “Consequently, meta-analyses become weighted averages of expert opinions. In an inverse sequence, instead of carefully conducting primary studies informing guidelines, expert-driven guidelines shaped by advocates dictate what primary studies should report.”

Zoë Harcombe:  Yeah.

Chris Kresser:  Doesn’t that sum it up?

Zoë Harcombe:  He’s so brilliant, isn’t he?

Chris Kresser:  So in other words, we start out with, the way that science should proceed is by doing experiments, and then if any guidelines are made, to make them based on these objective experiments. But the way it actually happens, a lot is we start out with a certain agenda and then we design studies that will return results that support that agenda. And anyone who's worked with data in any capacity knows how easy that is to do.

Zoë Harcombe:  Yeah.

Chris Kresser:  And it's not even conscious all the time. This is where confirmation bias comes in. It’s very difficult to guard against. I have to, and I’m not 100 percent, I’m not saying I’m 100 percent successful. But I can watch even myself. If I go and look for research on a particular topic and I have a certain idea, it's very easy to just skip the studies that don't support that idea. And that happens among scientists. It's a real cognitive bias that is very difficult to guard against. And I think it has a huge effect on research.

Here's another quote, this is from Casazza: “Confirmation bias may prevent us from seeking data that might refute propositions we have already intuitively accepted as true, because they seem obvious. For example, the value of realistic weight loss goals. Moreover, we may be swayed by persuasive yet fallacious arguments.” So again I come back to psychology. It's a real … we’re human beings doing this work, right? All researchers and scientists are not infallible. They’re human beings as well. Many of them have their own ideas and preferences about diet and nutrition. They’ve been influenced by many of the same things that we as laypeople or myself have been influenced by. And it really, really does affect the outcomes of this research.

Zoë Harcombe:  Yeah, yeah. I would agree with you. I mean I went in with a vegetarian, fat is bad, carbs are good bias. I am aware that I was so shocked by the things that I found when I started researching in this field, even before the PhD, you do then get quite skeptical and quite angry. And I now almost trust nothing. So every week I’m taking a paper from any kind of field, though mostly typically nutrition, and the low-carb study was one that I did recently, and then there was a weight loss drug that came out. And then I looked at red meat, the evidence because that was topical for something. And when I’m going in, I just assume that there’s going to be errors, and I’ve yet to find a published paper that doesn’t have something that you can point out as being really quite seriously wrong or disingenuous or open to interpretation.

Chris Kresser:  Yeah.

Zoë Harcombe:  I mean it’s really shocking. I saw on Twitter just a couple of days ago a guy, an academic, got so fed up with all the emails that you do get saying, “Oh, I really enjoyed this paper. Please can you write some papers for us.” Because papers are big spinners for the journals. He got so fed up with all these spam emails that he made up a complete nonsense study using Latin words that made something look really impressive, but it was basically saying something like, “If you do this with excrement, this happens.” I mean it was just, it really was, he was really taking the mickey and it got through peer review and he put it on Twitter. And he said, “I’m delighted to say that my complete nonsense article has just been published by this complete nonsense journal.”

Chris Kresser:  Yeah, and I’ve heard other experiments like that that have been done where a lot of stuff like that has made it through peer review. And there have been a lot of critiques of peer review and why it’s broken and the links to the money in the research industry. Marcia Angell, who I mentioned earlier, in the context of the relative risk who was the former editor of New England Journal of Medicine, has famously said that some, I’m going to paraphrase, but “I now no longer think we can believe any published research,” is basically what she said.

So yeah, I mean, I think it doesn't mean that research is not valuable. It doesn't mean that we have to just become, I think you can go too far with this where we just say, “Oh, forget it. There’s no point in even trying. Let’s just discount all research equally.” Because there are differences in the quality of research and there are still studies that are done well even if they're not done perfectly. And it's the best tool that we have, that we’ve discovered today to try to answer some of these questions, at least on a population-wide scale.

 Conclusions about Saturated Fat

So I want to close by just kind of going through some conclusions here. One, we’ve talked throughout that the evidence against total saturated fat is incredibly weak, if not nonexistent. But something we touched on briefly but I want to highlight here is that even if saturated fat were harmful, you have to consider the source of it in the diet. Get away from this reductionist approach where we think that saturated fat coming in different forms is going to have the identical effect. Because we don’t eat nutrients. We eat foods that have nutrients in them.

 And I love how in your paper you pointed out that pizza, desserts, candy, potato chips, pasta, tortillas, burritos, and tacos accounted for 33 percent of saturated fat consumed in the diets of US citizens. A further 24.5 percent was unaccounted for and collated as “all other food categories,” which is almost certainly processed food. And so as a result, only 43 percent of saturated fat came from natural foods like dairy products, nuts and seeds, and burgers and sausages. Although I'm guessing that the burgers and sausages had highly processed buns and sugary ketchup and other stuff on them too. So how can we even look at those things as being anywhere remotely similar, much less the same?

Zoë Harcombe:  Yeah. I mean I actually took out the processed meat in that section. So I got the natural foods listed down to cheese, nut butter, nuts, and seeds. And collectively together they accounted for 20.8 percent of saturated fat intake. But then I actually made the point it would’ve been ideal for the unprocessed chicken, beef, and eggs to have been separated from the processed meals because they always just lump them together. And they will always put, whenever there’s a study damning red meat, particularly in the US, it will always include hamburgers, which they are very firmly processed food in the UK, but for some reason seems to be considered as some sort of Paleo food in America.

Chris Kresser:  Right, right.

Zoë Harcombe:  And meat-type dishes, or something, which might be a curry.

Chris Kresser:  KFC.

Zoë Harcombe:  Yeah, exactly, Kentucky Fried Chicken.

Chris Kresser:  That’s the way most people eat chicken, KFC or chicken nuggets at McDonald’s. There’s your chicken.

Zoë Harcombe:  Absolutely, yeah. Or maybe a curry takeaway ready meal that you pop in the microwave and if it's got a couple of percent of meat in it, you’ve done well. You bought a more expensive one than the average, which doesn’t even bother putting the meat in.

Chris Kresser:  I mean, I’m … yeah, go ahead.

Zoë Harcombe:  No, and that’s the crazy thing because I want us to be able to have heated agreement. I don’t want to be fighting anyone out there. The whole world is much better if we get on and we’re in harmony than when we’re fighting over anything, whether that’s territory or politics or nutrition or anything else. So I would love for us to find a way forward. And I think there could be a way forward by saying, “Guys, can we have a heated agreement that we can demonize processed food?”

And I know there’s industry conflicts all over the place and we have to expose the industry conflicts with the guidelines set in committee in the UK, they are completely dominated by the processed food industry and grocery retail. I mean, it’s just horrific. If somehow we could get the conflicts out of setting health guidelines, which please, for goodness’ sake, must be objective. We must tell people honestly what is healthy. Not tell them what the food industry wants them to believe is healthy. That’s got to be step one.

Chris Kresser:  Absolutely.

Zoë Harcombe:  If we can get all of that nonsense out, surely then we could agree that real food has got to be better than processed food. And there might be some debate what’s real food. But if it’s found in a field, it’s found growing on a tree, it’s found in the natural environment … I said to my niece when she was five years old, fish swim in sea, fish fingers don’t. Breaded fish.

Chris Kresser:  If it comes in a bag or box, you probably shouldn’t be eating it.

Zoë Harcombe:  Yeah.

Chris Kresser:  I mean, of course, there are exceptions. Butter usually comes in a box, but yeah, that’s a general guideline, right?

Zoë Harcombe:  Yeah, we know what real food is. It’s the best-quality meat, eggs, dairy products, fish you can get a hold of, it’s vegetables, seeds, nuts, fruits in season. There will be some debate over legumes and whole grains and how recently they’ve been part of our consideration set, and I agree with your point, there’s not one diet fits all because some people just cannot tolerate grains and legumes and fibrous products, suffering from irritable bowel syndrome or celiac or other digestive conditions. But somewhere within that real food, total consideration set, surely we ought to be able to set some principles that people can follow that are not based on advice from the processed food industry.

Chris Kresser:  Absolutely, and I mean, I've said this so many times that Sean Croxton, who used to write in the health space, he came up with a diet advice that was JERF, he called it. J-E-R-F, just eat real food, which is, like, look, okay, we can debate about is it better, like you said, whole grains or legumes, in or out, saturated fat higher or lower, carbs higher or lower within this context of a whole-foods diet. But is there any doubt that if everyone ate real foods, we would decrease the burden of chronic disease and early mortality by something like 60 to 80 percent? I mean, I have no doubt of that.

And that’s again where this reductionist focus on nutrients completely isolated from the context of the foods that they come in has been such a disservice. Because imagine if we spent the last 30 or 40 years just hammering home the message that eating real, whole, nutrient-dense foods is really, like, if you want to simplify it for public health, like, that's the message. Don't even worry about those other finer points. And we would not, well there's a whole other discussion about whether people will actually follow that advice if you give it to them and given the influence of our brains with highly rewarding and palatable foods in the food industry and all of that. But there's no doubt that if people really did follow that advice, we probably wouldn't even be having this discussion right now.

The other thing about that is it is possible at least in theory to, like, if we really wanted to answer the question of is saturated fat harmful, the way we would need to do that is we would need to take two groups and they would both have to have the same baseline healthy diet that we’re talking about. Just eating real, whole foods, right? And then in one group, they would eat more saturated fat. And then we would, this is to be a randomized controlled trial, we’d lock them up in a metabolic ward so that we could control all of the variables that we know can influence health, or at least most of them, and then we’d follow them for about 15 or 20 years and see what happens. And the problem is that's never going to be done. I mean, that study would be hundreds of millions of dollars, if not billions, and no, Coca-Cola's not going to pay for it, right? I mean none of the, no drug company is going to pay for that study. So unfortunately, that study is unlikely to ever happen.

Zoë Harcombe:  Yeah, but “just eat real food” would work as a message until.

Chris Kresser:  Exactly.

Zoë Harcombe:  Yeah.

Chris Kresser:  Just eat real food, and then we can use other mechanistic studies and other lines of evidence and maybe even shorter trials to try to answer some of the finer points. And those trials should also include individual, should also pay attention to individual factors or genetic or non-genetic factors that might bear on the answer to that question, so that we don't then extrapolate the findings to everybody instead of just one group of people, for example. We know there are genetic polymorphisms that make some people hyper-responders to saturated fat and that can lead to an increase in LDL particle number. And the clinical significance of that is still controversial and debatable. But we know pretty certainly that that does happen.

So, but then if you were to extrapolate those results to someone that didn't have those genetic polymorphisms, that would not be a valid inference. So yeah, it’s just disappointing that, I mean, we know this and yet we still go on doing the same things over and over again. And I have to throw in one last Ioannidis quote which—from that more recent, or I think from one of his previous papers, and I'm going to paraphrase this one because I don't, let me see if I can find it—yeah, “Definitive solutions won’t come from another million observational papers or small randomized trials.” In other words, that was from a paper he wrote called “Implausible Results in Human Nutrition Research.” So in other words, doing the same thing over and over and expecting a different result is the definition of insanity, right?

Zoë Harcombe:  Absolutely.

Chris Kresser:  So, Zoë, thank you so much for joining me, and I know we went a little long, everybody, but I hope you enjoyed it and got a lot out of it. And I just, I wanted to have one podcast that we could direct people to to really answer this question and look at all the evidence on saturated fat in particular and its relationship with mortality and heart disease mortality. And I think we didn't cover everything, but I think we did a pretty good job of getting the most of it out there. So thank you so much.

Zoë Harcombe:  Oh, thank you. Can I just add one thing, because I think we just about completely nailed everything.

Chris Kresser:  Please, of course. Yeah.

Zoë Harcombe:  When we ran through the 39 results and found that only four were significant, and we dismissed Mozaffarian and we agreed with Chowdhury, and then the two Hooper results, which were just on the CBD events, we can actually put those to bed as well because aside from the fact that they’re events and they’re not mortality and we both agree that mortality is best, the thing that you have to then look at is why did Hooper find something different to all the other people? And when I went in detail, Hooper had actually managed to include four studies which involved only 646 people that were not about cardiovascular disease. And she’d asked the study authors if they happened to have data on cardiovascular disease events. So this was non-peer-reviewed data. That was the first thing.

When, and I owe Dr. Trudi Deakin in the UK, I always credit her for this finding, she spotted in the Hooper paper that when Hooper actually did as she should do, the sensitivity test on that one single finding, it was no longer significant. So the test that had to be done was not just which studies intended to reduce saturated fat or which studies actually did reduce saturated fat.

Chris Kresser:  A key distinction there.

Zoë Harcombe:  That’s really, really important, yeah. So Trudi looked at this and found that it is declared in the paper, but it’s tucked away on sort of page 158, or something.

Chris Kresser:  Right.

Zoë Harcombe:  That when the ones that were tested did actually reduce saturated fat only were included, there was no statistical significance and it was not generalizable because again in the whole of the evidence that was looked at by Hooper in either of those two papers, there was no single study of healthy men and women. But I think sensitivity tests apart from non-peer-reviewed data and apart from events, I think we can actually put that one to bed as well. So when you do that, because that’s the one that the other sites still try to hang onto. That’s the one that came up in the Professor Noakes trial when that’s down there for him as an expert witness. They tried to wave that in front of us and said, “Oh, see saturated fat is bad.”

Chris Kresser:  Right.

Zoë Harcombe:  So we hit them back with an, “Oh, no it isn’t.”

Chris Kresser:  What’s the data?

Zoë Harcombe:  Yeah, we kind of went in on the data. So there just is no evidence, and knowing the facts about fat, it would make no sense if there were.

Chris Kresser:  Exactly. And that reminds me of the recent low-carb study which you and I both critiqued on our blogs. It wasn’t a low-carb study. The people were eating something like 40 percent of calories is carbohydrate, not to mention the fact that they reported a calorie intake that was basically at starvation level, which would invalidate the entire data set. So you don't even need to go any further. I mean we did, but, like, that would've been enough, right? And all it takes is one major error like that, and it casts doubt on the entire data set and makes any kind of inferences that you would draw from it invalid. And I don't think people understand that enough.

Zoë Harcombe:  Yeah, I think critiques, I think the word you used there was quite polite. Actually, I think we both annihilated that study.

Chris Kresser:  Yeah, well it was.

Zoë Harcombe:  And a few other people as well, Nina Teicholz and Georgia Ede.

Chris Kresser:  Several, yeah. I mean, it was frankly like shooting fish in a barrel.

Zoë Harcombe:  Yeah, it wasn’t hard, that one, was it?

Chris Kresser:  Yeah, it was not hard. I’m just actually kind of shocked that that kind of study makes it through peer review and gets published, given all of those issues. So anyways, yes, thank you so much for doing all of the work that you do, Zoë. It’s such a pleasure to meet you, virtually, at least, and to be able to really just concisely and comprehensively go through all of these deficiencies in the evidence and to just make it clear for people that this, despite the fact that they've heard this probably for 30 or 40 years, depending on how old they are, and despite the fact that it still forms the basis of our dietary guidelines, there really is no evidence to support it.

Zoë Harcombe:  Yep.

Chris Kresser:  Fantastic. Well, where can people find more about your work, Zoë?

Zoë Harcombe:  Just ZoeHarcombe.com. So my surname is H-a-r-c-o-m-b-e. So that’s ZoeHarcombe.com. And as I say, I blog every week. That’s my sort of business model. So if anyone wants to sign up and get the newsletter, there is lots of stuff on open view. But if you do that, then you support what I do and you help me to stay independent because I don’t take any money from anyone for anything in any circumstance.

Chris Kresser:  Key. Absolutely.

Zoë Harcombe:  I just work away and come up with what I want to find. And I know some people are on the email list who are quite fans of whole grains, for example. And I know every time I write a newsletter saying I looked at this whole grains study and it really didn’t stack up, I know that I’m upsetting some people who are subscribing, but I have to go with where the evidence takes me and I have to report as I find. So that’s what I do.

Chris Kresser:  Yeah, yeah. I’m disappointing my readers all the time with my opinions and it’s important, I think, to stay true to what the data is showing and be as objective as possible about it. You’re one of the few people that I do follow regularly. I love reading your stuff, so everyone who’s listening to this, go check out the blog. It’s one of the most thorough and insightful sources on all of these topics that we discussed today.

And Zoë, we didn’t get a chance to go into much detail on red meat above and beyond its saturated fat content, which as we know is less than its polyunsaturated fat content. But Zoë has recently tackled that, the evidence behind red meat being associated with high risk of heart disease and death. And i'd really recommend checking that out too, because that's another persistent myth that continues to this day.

Zoë Harcombe:  Indeed.

Chris Kresser:  Okay, everybody, thanks for listening. Continue to send in your questions at chriskresser.com/podcastquestion, and we’ll talk to you next time.

The post RHR: The Truth about Saturated Fat, with Zoё Harcombe appeared first on Chris Kresser.

Source: http://chriskresser.com September 25, 2018 at 07:12PM

[fataziraphale]

Viktor Week Day 1: Food

For @viktorweek! Set after the Barcelona GPF! Viktor and Yuuri move to Saint Petersburg and pay Yakov a visit! Yay!

TW for fat shaming, talk of dieting and weight loss, and of characters dealing with weight issues. Everyone ends up fat and happy in the end tho bc... come on, I wrote this. Me. Look at my url.

Anyway, Viktor + food is maybe the most important thing in my whole life and I hope you all enjoy him as much as I do

“Oh my god.”

Yakov Feltsman let out a huff of air that Yuuri recognized well: it was the long-suffering sigh a man would inevitably release after spending more than five minutes with Viktor Nikiforov. Yuuri would know. He’d spent the last nine months living with the guy, and had exhaled that sigh approximately ten quintillion times.

But he’d never sighed at Viktor for the reason Yakov was now. Yakov’s eyes weren’t locked on Viktor’s face, incredulously reflecting on some inane, nonsensical, or vaguely culturally insensitive comment Viktor had just made. No, Yakov was sighing at a very different part of Viktor entirely: namely, the chubby pot belly that had settled comfortably around the skater’s middle, one that most certainly had not been there nine months before.

Yuuri bit his lip. He didn’t want Viktor to get self-conscious. Not about this.

Yakov, apparently, had no such reservations. “Oh my fucking god,” he said. “Vitya, you’ve gotten fat.”

No matter how well Viktor tried to mask it behind heart-shaped smiles, Yuuri knew his fiancé could get pretty anxious about his weight. It was only understandable, after all—Yuuri knew better than anyone just how much pressure was placed on figure skaters to be willowy and lean, rather than his own natural body type of squishy plush rotund. But slowly, over the past few months in Japan, Viktor had learned how to drop the masks he always wore in favor of letting his true self out, of speaking honestly and smiling earnestly and being comfortable in his own, newly pudgy skin. Yuuri didn’t want Yakov to ruin all that.

But Viktor just looked his coach in the eye and smiled. “What can I say? Japanese food is super yummy! Have you ever had katsudon? You need to try it! Yuri’s dad makes the most delicious pork, oh my god, my mouth is watering just thinking about—”

“I’ve had katsudon,” said Yakov curtly. “Yuratchka made it for me and Lilia after Rostelecom. But Jesus, Vitya, it’s not that good.”

“That’s because you haven’t had the katsudon at Yutopia yet~” Viktor grinned. “Just wait until you try it! You’ll be singing a different tune, or I haven’t won five world championship gold medals and five GPF gold medals and an Olympic—”

“I’m familiar with the fact that you’re a decorated athlete, Vitya. Stop bragging! Do you want to come in, or do I have to drag you by your ridiculous hair?!”

Viktor twirled into Yakov’s house as if he were doing a skating spin, graceful and controlled. Yuuri awkwardly sidled in through the door after him.

Yakov closed his front door and followed Viktor into, predictably, the kitchen. Viktor’s head had disappeared completely into one of Yakov’s cabinets. If Viktor were a dog (Yuuri hadn’t entirely ruled out the possibility that he was), his tail would have been wagging, hard.

“Ooooooh! You have Alenka! Mmm… chocolate sounds good right about now…”

Yakov stood behind him, arms crossed. “So when are you planning to lose it?”

“Huh?” Viktor emerged from the cabinet, ripping open a chocolate bar. He took a casual bite. “My haircut? I can grow it out if you want… I wouldn’t mind having long hair again, actually. If you meant when am I going to lose it, as in start balding, I might have to run up to the room you’ve prepared for me and start sulking for—”

“The weight. The extra fifty pounds.”

“Sixty-four!”

“Yeah. When are you going to lose it so you can skate.”

Viktor nibbled on chocolate. Yuuri’s heart beat a little bit faster. “Yuuri is a fat figure skater.”

To his intense discomfort, Yakov’s eyes strayed to Yuuri’s belly then, as round and soft as the first day Viktor had arrived at Yutopia (oh, all right—if he was being honest with himself, it was even rounder and softer). “I can see that. I do have eyes. But Yuuri is not my athlete, so I don’t get a say in what he does or doesn’t do with his body.” He looked back at Viktor, who was already ripping open his second bar of chocolate. “But you’re my athlete, Vitya. And I don’t coach fat figure skaters.”

For a moment, the only sound in the room was Viktor’s attempt to open the bar of chocolate. It was taking him a lot more time than the first one had. In fact, it took so long that he got pretty frustrated, struggling and scrabbling desperately at the packaging. Tears prickled in his eyes. He threw the chocolate down onto the counter unopened. Then he ran.

“Viktor!” Yuuri cried. Part of him wanted to go after his fiancé, to comfort him, to assure him he was loved—but another, more foreign fragment of Yuuri took control instead, one that was fiery and volatile. “HEY!”

Yakov looked a little startled. “Da?”

“How dare you say that kind of thing to Viktor? There’s nothing wrong with being fat, or skating fat, or Viktor’s weight at all! So he likes Japanese food! I’m glad he’s been eating a lot of it! I’m glad he’s been doing something that makes him really happy for once in his life!”

To Yuuri’s immense surprise, Yakov snorted at that. “It’s not just Japanese food. Didn’t you see the fucking beeline he made for my chocolate? Vitya’s been a food addict since the day he was born. It doesn’t matter if it’s katsudon or beef stroganoff.”

Yuuri blinked. “Really? But… he was so thin when I met him.”

“Because I’m a damn good coach!! Do you know how difficult it was to keep him from stuffing his face with every single piece of food he came in contact with? Do you know how many different diet plans I had to write up—how many times I had to increase his exercise regimen just to keep up with all the crap he was eating—how many times I had to literally grab food out of his fucking hands?!!”

“So…” Gears began to turn in Yuuri’s head, one at a time. “So that’s why he went crazy with katsudon. Because it was the first time in his life no one had been around to tell him not to.”

“I’ll say. And from the looks of you, you could use a real coach to tell you what not to eat as well.”

Under any other circumstances, Yuuri would have been mortified, and would have quietly crawled into a hole to live out the rest of his fat life in solitude and never bother anyone again. Now that Viktor’s happiness was at stake, all he felt was a burning, righteous frustration. “Viktor is a real coach, Yakov. He’s the best coach I’ve ever had! Sure, he—has no idea how to coach figure skating. Like, at all. But he showed me that I can be a skater without starving myself to get there! He’s given me so much confidence to be happy and myself, and I don’t see why you can’t do the same for him!”

Yakov considered this. “His weight is going to go up further. You realize this.”

“I don’t care if he gains another 300 pounds. Food makes him happy. I’m not taking that away from him.”

Yakov opened his mouth to respond, but was interrupted by a soft and pudgy form padding its way idly back into the kitchen. Viktor’s arms were taken up by an enormous tin of cookies, one of them peeking out from between his lips as he munched. “Found this in the medicine cabinet. Your hiding places are too easy.”

Yakov took a deep breath. “Don’t eat too many, Vitya. You’ll spoil your dinner.”

“Mm? Dinner?” Vitya lifted his knee to balance the tin on it, performing a shaky juggling act in order to whip off the lid and select another cookie. “What’s for dinner? Are you cooking something healthy and un-yummy to teach me the proper value of nutrition?” He worked hard to keep his voice level, but then, Viktor had never been a very good actor. It trembled almost as much as his raised knee did.

“I’m treating you to stroganoff at that place you like,” said Yakov. “Eat as much as you want—I’ll even pay for vodka—but for God’s sake keep your clothes on. I heard what happened at the Cup of China. If you embarrass me in in my own city, I swear to God you’ll never walk a—”

“As much as I want?” Victor’s voice cracked. The tin of cookies crashed to the floor. “I… don’t have to lose weight to skate for you?”

Yakov sighed that long-suffering sigh. “No. I want you to be happy, Vitya. I was hoping that light eyes I’ve seen recently was coming from you being engaged to Katsuki, and not from your own ridiculous gluttony, but… well, we can’t all have everything we want.”

Viktor just stared at him. And then his eyes filled with tears. And then he threw himself at Yakov, encasing his coach in the biggest hug Yuuri had ever seen (other than the ones Viktor usually gave him). “AAAAAAAAAAAAAAAAAA THANK YOU THANK YOU THANK YOU THANK YOU THANK YOU THANK YOU”

“Food addict,” grumbled Yakov, stiffly hugging him back.

Viktor just laughed, relief shining in every inch of his features. “Says you! You’ve been an alcoholic for eighty years!”

“I’m not an alcoholic. I’m Russian.”

“You drink enough vodka to kill a horse! Or a really, really fat guy!”

“And I CAN’T have been an alcoholic for eighty years, I WAS ONLY FUCKING BORN IN NINETEEN FOURTY-FIVE YOU PIECE OF ABSOLUTE SHIT”

Viktor was laughing. Yuuri smiled at him, and Viktor beamed back, even as he bent deftly towards the floor to pick up one of the cookies there. Holding a chubby finger to his lips, he popped the cookie into his mouth.

For his part, all this human interaction had left Yuuri exhausted. He was just looking forward to tonight, when he could snuggle up to Viktor, rest his head gently on his fiancé’s fat tummy, and dream of katsudon in peace.

[shapesnnsizes]

RHR: The Truth about Saturated Fat, with Zoё Harcombe

In this episode, we discuss:

Why you need to eat fat

Why the Paleo diet template makes sense

Where these misguided ideas about fat came from

The Seven Countries Study

Zoё Harcombe’s research on fat

Why you should be skeptical of some news headlines

Why dietary guidelines don’t work

The epidemiological evidence

Conclusions about saturated fat

Show notes:

The Obesity Epidemic: What Caused It? How Can We Stop It?, by Zoё Harcombe

“Evidence from Randomised Controlled Trials Did Not Support the Introduction of Dietary Fat Guidelines in 1977 and 1983: A Systematic Review and Meta-Analysis,” by Zoё Harcombe

“The Nitrate and Nitrite Myth: Another Reason Not to Fear Bacon,” by Chris Kresser

USDA Food Composition Databases

“Re-evaluation of the Traditional Diet-Heart Hypothesis: Analysis of Recovered Data from Minnesota Coronary Experiment (1968–73),” by Christopher Ramsden

“The Challenge of Reforming Nutritional Epidemiologic Research,” by John Ioannidis

[smart_track_player url="http://traffic.libsyn.com/thehealthyskeptic/RHR_-_The_Truth_about_Saturated_Fat_with_Zo_Harcombe.mp3" title="RHR: The Truth about Saturated Fat, with Zoё Harcombe" artist="Chris Kresser" ]

Hey, everybody, Chris Kresser here. For the past 50 years we’ve been told that eating meat, saturated fat, and cholesterol is unhealthy. Recently, a growing number of people are turning to a vegetarian or vegan diet with the goal of improving their health.

But is it really true that meat and fat are bad for us? And are vegetarian and vegan diets a good choice for optimizing health and extending lifespan? If not, what is the optimal human diet? Join me on the Joe Rogan Experience on Thursday, September 27th, as I debate these questions with vegan doctor Joel Kahn. You can tune in live at 12 noon Pacific Time at JoeRogan.live. That’s J-o-e-r-o-g-a-n.live, or you can catch the recording at podcasts.joerogan.net, on YouTube, or in iTunes or Stitcher.

If you’d like to receive updates about the debate, including links to the recording and new articles and information I’ve prepared on this topic, go to Kresser.co/Rogan. That’s Kresser.co/Rogan and put your email in the box.

Okay, now onto the show.

Welcome to another episode of Revolution Health Radio. This week I'm very excited to welcome Dr. Zoë Harcombe as the guest on the podcast.

Dr. Harcombe is a Cambridge University graduate with a BA and MA in economics and math. Zoë enjoyed a successful career in blue-chip organizations before leaving corporate life in 2008 to pursue her passion. Her early career involved international roles and management consultancy, manufacturing, and marketing in global organizations from FMCG to telecoms before specializing in personnel and organization. At the peak of her career, Zoë was vice president for human resources for Europe, Middle East, and Africa. Having written three books between 2004 and 2007 while being head of people, Zoë left employment to research obesity full time. This culminated in the publication in 2010 of The Obesity Epidemic: What Caused It? How Can We Stop It?

Zoë returned to full-time education in 2012 to complete a PhD in public health nutrition, which was awarded in March 2016. Her PhD thesis was entitled “An Examination of the Randomised Controlled Trial and Epidemiological Evidence for the Introduction of Dietary Fat Recommendations in 1977 and 1983: A Systematic Review and Meta-Analysis.” A number of peer-reviewed articles have emanated from this work, and the first was the 64th most impactful paper in any discipline in the year 2015. Zoë lives with her husband and rescue animals in the Welsh countryside surrounded by food, a.k.a. sheep, hens, and cows.

Now I'm really excited to talk with Zoë because she recently published a paper critiquing the U.S. dietary guidelines and the U.K. dietary guidelines for the lack of evidence behind their recommendation against eating saturated fat or limiting it to less than 10 percent of calories in the diet. And she, as I just suggested with her bio, has probably spent more time looking at this than anybody else. She wrote her PhD thesis, as the title suggests, on the evidence, or lack of evidence, rather, behind the dietary guidelines around total fat and saturated fat. And she went all the way back to the late 70s and early 80s to look at the studies that were used to create the original dietary guidelines. And then the second half of her paper looked at all of the research that has been published since then through 2016.

And as we’ll discuss in the show, the conclusion is that the dietary guidelines never really had any meaningful evidence behind them to justify restricting saturated fat back in the late 70s and the early 80s. And the same is true today in 2018. So I hope you enjoy this interview as much as I did, and let's dive in.

Chris Kresser:  Zoë, it is such a pleasure to have you on the show. We were just chatting before the show, and I can't believe we haven't connected by now. We walk in many of the same circles, and I’ve followed your work for some time. So I'm really, really grateful that you’re able to join us.

Zoë Harcombe:  Oh, I thank you so much for having me. I’ve just followed you for so long and your “nitrates in bacon” is my just absolute go-to blog. Stop, people, worrying about bacon.

Chris Kresser:  All right. Well, we’re going to talk a lot more about that and there’s so many things we could talk about today. But the main reason that I wanted to have you on the show is to talk about your recent paper critiquing the dietary guidelines both in the U.S. and in the U.K. related to total fat and particularly saturated fat. And everyone who’s listening to this knows that for many, many years, really, I guess about 40 years now, right? It goes back to about 40, 41 years now, we've been told that fat in general, although that's maybe slightly changing in the public perception recently and even in some of the dietary guidelines that fat in general is bad, and particularly saturated fat is terrible.

But as we’re going to discuss in the show, your research has shown that that's maybe not what the evidence actually says. So before we dive into that, why don’t you tell everyone a little bit about your background and how you came to this work.

Zoë Harcombe:  Okay, I’ll do a really quick one because I know you’re not sort of a three-hour podcast man. So I’ll give you a composite history. First fascination came when I was studying at Cambridge University in the late 80s, early 90s and started seeing obesity growing around me. And it was just a fascination to me because it's the last thing that people want to be. People do not want to be overweight, let alone obese, and it was just starting to explode and had already exploded in the U.S. And I was just fascinated.

So I wanted to understand, why do we have an obesity epidemic? When you start looking at why, you go back to looking at when, and you can't help but see, particularly on the U.S. graph, that it just takes off like an airplane at about 1976 to 1980, that pivot point in the NHANES data. And of course, therefore, you go back to look at that period of time. Did anything particularly happen? Did we suddenly start eating 10,000 calories a day and sitting around on our backsides? Well, actually, no we didn't.

Did you grow up hearing that saturated fat would give you a heart attack? You’re not alone. Check out this episode of RHR for an in-depth look at the science surrounding saturated fat with researcher and author Zoё Harcombe. 

And the UK data was particularly interesting. We seem to be eating fewer calories nowadays than we did back in the 1970s, when we were much slimmer. Barely any obesity in the UK by about 1972. And you then start looking at an event called the dietary guidelines, which came in with the Senator McGovern committee in 1977, and of course these were then embedded in the US Dietary Guidelines for Americans in 1980 and then every five years since. And there is debate.

There are people who will say the introduction of the dietary guidelines has nothing to do with the rise in obesity and type 2 diabetes and more beta conditions related to diet and lifestyle. But it at least needs to be looked at. I mean, I say it coincided with the epidemics in obesity and diabetes, and we need to therefore explore was that a coincidence or was it a factor that was material in the changes in our health. And I am one of the people who thinks it is material and that our shift to basing our meals on starchy foods, grains, fruits, vegetables, largely carbohydrates, being encouraged to consume as high as 60 percent of our diet in the form of carbohydrate, the one macronutrient we don’t actually need, I do think it has made a difference. And I’m not alone in that view.

And then of course you look at guidelines and say, well, what were they about? And of course, they were about restricting total fat to no more than 30 percent of calories and saturated fat to no more than 10 percent. And because they were only three things that we ate and because protein is in everything other than sucrose and oil, so it tends to be fairly constant in any natural diet, and the peer study showed this beautifully, nice evidence for this, protein tends to stay constant around 15 percent. So as soon as you set the fat guideline, you’ve automatically set a carbohydrate intake minimum of 55 percent. And that’s what we did.

So I wanted to understand why did we set that total fat guideline. If that was the thing that started everything, why did we do that? And did we get it right or did we get it wrong?

Chris Kresser:  So you have a BA and an MA from Cambridge in economics and math, and then in 2016 you got a PhD in public health nutrition. And what I find really fascinating is what you … tell us a little bit about your PhD thesis.

Zoë Harcombe:  Yeah, so the PhD thesis was using the relatively modern techniques, and they have been around since the 1970s, but we’re really using them a lot now. And that’s the systematic review and meta-analysis. And when we pulled together evidence from randomized controlled trials, ideally, if not from cohort studies, it’s considered to be the pinnacle of the evidence that we could examine. So I approached looking at the dietary fat guidelines in four ways. And one was to say, what was the RCT evidence at the time available to the committee? Had they looked at it back in …

Chris Kresser:  That’s “randomized controlled trials,” for those who are not familiar.

Zoë Harcombe:  Yes. Yeah, so the randomized controlled trial evidence available to the US committee in 1977, and then the UK committee deliberated in 1983, and that allowed one more study available to the UK committee that wasn't available to the US committee, and that was the Woodhill Sydney Diet Heart Study. And also to look at the epidemiological evidence available, had the committee chosen to look it at the time the guidelines were set? So that was the first two papers, the first half of the PhD. And then the second half was to bring it up to date and to say if the committees were deliberating again today and they had all the RCT, randomized controlled trial, evidence available and all the epidemiological evidence available we have today, what would the conclusions be, looking at it in an up-to-date scenario. And that was the four parts.

Chris Kresser:  Yeah, so you’ve spent, how many years did it take for you to get your PhD?

Zoë Harcombe:  Yeah, three and a half. I did it full time. I just decided to stop everything else I was doing and do it full time. And as anyone who’s ever done one meta-analysis knows, to try and do four …

Chris Kresser:  Yeah, that’s a lot of work. But the upshot here is that you have a PhD in public health nutrition. You spent the better part of four years examining the evidence base for the last 40 years connecting fat and saturated fat to health and disease. And this is exactly why I wanted to have you on the show to talk about this topic because it's one thing if you have a kind of armchair critic who's cherry picking one or two studies to make their point, which often happens on the internet, right?

Zoë Harcombe:  Yes.

Chris Kresser:  It's another thing to have someone who's trained at the level that you've been trained at who spent four years objectively looking at this evidence and then publishing on it and showing where it doesn’t add up. So let's dive into that now.

I want to start by talking about some basics because I think they’re really important. I love how you did this in your recent dietary guidelines paper. Just a few facts about fat that maybe not everyone is aware of or has thought about much.

Zoë Harcombe:  Okay, so I shared these in conference presentations and I was really pleased that when I did this, there’s peer-reviewed study. They didn’t get edited out because I thought they might be a bit chatty, if you know what I mean, for a peer-reviewed paper.

Chris Kresser:  Yeah, yeah.

Zoë Harcombe:  But I actually had a couple of nice comments in the margin of people saying, “Oh, good point, I hadn’t thought about that.”

Chris Kresser:  Yeah, yeah. I had the same reaction.

Why You Need to Eat Fat

Zoë Harcombe:  Oh, thank you. So the most important one is that we must consume fat. Human beings must consume fat. We die without consuming dietary fat. We must consume essential fatty acids, that’s why they’re called essential.

“Essential” in nutrition means something that we must consume, not just something that the body needs. And of course we have the fat-soluble vitamins A, D, E, and K, and they come in foods with fat. And they need fat to be absorbed. So that’s pretty vital. When people demonize fat to the extent that they do, they always give the impression that we could get away without eating this stuff. And we couldn’t. I don’t know how quickly we’d die, but we would. So we need it.

Number two, again, that people seem to realize particularly when they demonize saturated fat is that every single food that contains fat, and it’s actually quite difficult to find a food that doesn't contain fat, sucrose doesn’t. But not much else doesn’t. So every food that contains fat contains all three fats. That’s:

Saturated fat

Monounsaturated fat

Polyunsaturated fat

And only the proportions vary. So again, people talk as if we can avoid saturated fat and only eat unsaturated fat, and that is completely impossible unless you're in a lab and you’re trying to create single fats. It is impossible if you’re going to eat food, which I recommend that all people do.

And then the other interesting factoid, I love playing around on the USDA all foods database and just looking at things that add up and things that don’t add up. And it was a real surprise to me when I first started looking at foods that when it comes to food groups, there is only one food group that has more saturated than unsaturated fat, and that is dairy products. So your struggle to find a meat, and I have not yet found one, that has more saturated than unsaturated fat, typically the main fat in meat is monounsaturated fat. And that goes for lamb or steak or chicken.

Chris Kresser:  Even pork.

Zoë Harcombe:  Absolutely. And therefore lard, which I just love, because people just think lard is pure disgusting.

Chris Kresser:  Saturated fat, yeah.

Zoë Harcombe:  Saturated fat.

Chris Kresser:  If you were to put lard or coconut oil together, people would say lard would be the unhealthy choice from a saturated fat perspective. But of course, coconut oil is 97 percent saturated, I think.

Zoë Harcombe:  Yes.

Chris Kresser:  Something like that.

Zoë Harcombe:  And lard is 39 percent.

Chris Kresser:  Right.

Zoë Harcombe:  So nowhere near as bad. And that’s not saying that saturated fat is worse than unsaturated fat. It’s just stating a nutritional fact. The only food group that has more is dairy products. And then of course you’re getting to, “Well, are dairy products bad for us?” And it’s really difficult to think that they are when you look at the nutritional profile of dairy products and the bone nutrients calcium, phosphorus, vitamin D. Look at any profile of any dairy product and you can’t help but think …

Chris Kresser:  And the evidence.

Zoë Harcombe:  Yes.

Chris Kresser:  I mean there’s a ton of evidence suggesting that full-fat, but not nonfat or low-fat dairy are beneficial for both cardiovascular and metabolic health. And there was actually a new study recently published, I’m not sure if you saw it. I am less persuaded by it. Or you mentioned it, the PURE Study.

Zoë Harcombe:  Oh, yes.

Chris Kresser:  Because it has within-country or between-country comparisons, which I think we’ll be talking about later, is problematic. That was an issue with the Seven Countries Study. But it does align with many of the other studies that have been done on this topic previously, showing that when people eat more full-fat dairy, that's associated with lower body weight, with lower blood sugar and better glycemic control, and with lower risk of heart disease based on cardiovascular markers. And that's actually the reason that the full-fat dairy works better than the low-fat or the nonfat dairy in that regard because some of the nutrients that are thought to be beneficial for cardiovascular and metabolic health are in the fat.

Zoë Harcombe:  Yes, amazing.

Chris Kresser:  So if you take out the fat, you take out the benefit.

Zoë Harcombe:  Yeah, yeah.

Chris Kresser:  Yeah.

Zoë Harcombe:  Absolutely, I’m a huge fan of dairy, personally.

Chris Kresser:  Me too. I mean, of course if someone is lactose intolerant or they’re intolerant of the proteins, it needs to be avoided. But for people who are not, what I always say is at least the evidence that we have suggests that it's healthy when it's well tolerated by the individual.

Zoë Harcombe:  Yes.

Why the Paleo Diet Template Makes Sense

Chris Kresser:  So given this, given that fat is essential, that all foods contain all fats and that saturated fat is not even the highest percentage of fat in any food except for dairy, this leads us to some pretty interesting conclusions. You mentioned in your paper, which I loved, and I loved that they kept it in here too, it’s illogical that the same natural food would be both helpful and harmful. Like you can't eat a steak and eat it so that you're only eating the unsaturated fats and not the saturated fats.

Zoë Harcombe:  Yeah, yeah. There’s no other way of putting that. It just, it doesn’t make sense. Whether your belief system is in God or nature, food is provided around us on this planet, and it makes no sense that in that same food that we need to thrive and survive, something has been put that is trying to kill us at the same time as all the things being there that are trying to save us and enable us to live. And we’ve evolved of course over—I’m reading Sapiens at the moment, so there’s an argument over our heritage—but, I mean, we’ve certainly been around potentially since Australopithecus, Lucy, two-and-a-half, maybe three-and-a-half million years ago. And we’ve done pretty well eating anything we can forage or hunt around us.

Chris Kresser:  That’s right.

Zoë Harcombe:  The idea that they came up with in the last 40 years that this stuff is trying to kill us, it’s just so stupid.

Chris Kresser:  It doesn’t add up at all.

Zoë Harcombe:  Yeah.

Chris Kresser:  It doesn’t add up. So another example you used which I love because it really turns nutrition-dominant paradigm ideas on their head is the olive oil versus pork chop example. Tell us about that.

Zoë Harcombe:  Yeah. So I have a little postcard that I leave on the chairs at conferences, as well, so there’ll be many around the world. And I put up a picture of a sirloin steak, mackerel, olive oil, and mention the pork chop. And a couple of interesting, fun factoids. One is that the mackerel has twice the total fat and one-and-a-half times the saturated fat as the sirloin steak, which isn’t a problem because both of them are great foods. But of course we’re told not to have red meat and we’re told not to have oily fish. So that’s illogical.

And then olive oil has 14 percent saturated fat versus a typical pork chop might be only sort of one to two grams, but then people say, “Oh, you wouldn't consume 100 grams of olive oil.” No, but a tablespoon of olive oil has more saturated fat than a 100-gram pork chop. And again, we can make a mockery of nutritional advice when you know something about food.

Chris Kresser:  Yeah, I mean, and it’s easy to see how you could have a salad, if you have a big salad with a couple tablespoons of olive oil and dressing versus a 200-gram pork chop, you’re still eating more saturated fat there.

Where These Misguided Ideas about Saturated Fat Came From

So, I mean, this is so obvious when you look at it this way, and it makes you wonder, how did we get the idea that saturated fat is bad in the first place? I know there are some political and social roots of this, and feel free to talk a little bit about that if you want. But in particular, how did this arise from the evidence? What was your sense of that as you did your PhD and looked deeply at all of this?

Zoë Harcombe:  Yeah, so one of the most important chapters in the PhD is the review of the literature. And you go back in the review of the literature, and of course in this topic area, you’ve got to go back to the Russian pathologists in the early part of the 19th century, when they noticed the cholesterol deposits in the arteries of the autopsies that they were doing. So they started to hypothesize, had these cholesterol deposits actually caused the death of this relatively young person that they were performing an autopsy on, and could they come to any conclusions about those sort of cholesterol stores of fatty deposits?

And many people know this, it’s been said in conference presentations, that at the time they then started experiments on rabbits, feeding them foods containing cholesterol, feeding them purified cholesterol, to try to see if they could mimic the impact that they thought food might be having on the human body. And of course, as some people have worked out, rabbits are herbivores and the only foods that contained artery cholesterol are foods of animal origins. No exception. So you find dietary cholesterol only in meat, fish, eggs, and dairy, which are things that rabbits can't tolerate.

Chris Kresser:  Yeah, it’s strange. In a certain way, this almost supports what we were just saying. Eat a species-appropriate diet. The message there is not “don’t eat cholesterol.” It’s “don’t feed cholesterol to an animal that’s not supposed to eat it and don’t feed humans foods that we’re not supposed to eat.”

Zoë Harcombe:  Absolutely. And very interesting. When they fed purified cholesterol not in animal foods to the rabbits, they didn’t have any problems. And when they fed cholesterol foods to dogs, they didn’t have any problems because dogs are omnivores.

The Seven Countries Study

So we then wind forward to the 1950s, and Ancel Keys gets a bit of a bad rap in our world. I like to look on him in quite a more balanced way because he did some brilliant work, like the research starvation experiment. But he did kind of fall by the wayside a little bit on the fat thing.

So his first exploration was with the Russian experiments in mind to try to see if dietary cholesterol impacted blood cholesterol. And he concluded it did not, and he never deviated from that view. And the best quotation I found on that was from the 1954 symposium on atherosclerosis, and he said, “Cholesterol in food has no impact on either cholesterol in the blood or the development of atherosclerosis in man.” Which was brilliant because he had actually exonerated animal foods. But he didn't make that connection at the time. Maybe his nutritional knowledge just wasn't good enough and he just hadn't quite worked out, “If I’m finding nothing when I’m feeding human subjects,” because you could do that then with ethics, “human subjects massive amounts of dietary cholesterol via loads of animal products, they don’t develop any blood cholesterol problems and they don’t develop any signs of atherosclerosis,” he should’ve concluded, “I therefore just exonerated what I’ve been feeding them.” Which would be:

Eggs

Cheese

Meat

Possibly fish

But most likely meat, cheese, and eggs. But he didn’t. For some reason he was convinced that fat was the bad guy. If it wasn’t cholesterol in food, then it had to be fat in food. And yet again, having given his human subjects animal foods, he should’ve said, “What are the macronutrients in those animal foods? Okay, so it’s fat and protein. Dairy products have got a little, little bit of carbohydrate, but essentially what I've just fed them is fat and protein. So I should turn my attention to the one thing I haven't fed them, which is carbohydrate.” But he didn't do that.

So he was convinced that total fat was the problem, and of course we then had the Mount Sinai presentation in 1953, which gave us that famous Six Countries Graph, which has nothing to do with the Seven Countries Study. And then of course there were a number of countries that he'd left out. And Yerushalmy and Hilleboe found this out and unfortunately published a little bit too late, in 1957, saying, “Hey, hang on, you left out all of these other countries. And if you put them all on there it looks a bit like a spider scatter, that the pattern has gone. But the Seven Countries Study had already started in 1956. And Keys seemed pretty determined that he was going to come to the end of the Seven Countries Study and find fat guilty.

Now interestingly, and this is not terribly widely known, he could not find anything against total fat. So when, as part of my PhD, I pulled the epidemiological studies that were available at the time the guidelines were introduced, and of course the Seven Countries Study was one of those, and you’ve got Framingham and Honolulu, Puerto Rico, the London bank and bus study, and the Western Electric study being the others, none of those six found any relationship between coronary heart disease and total fat. So Keys acted. He went in with the total fat hypothesis. He accepted that it was not total fat. Now he had spent so much time and money on this study, he needed to find something. And he could find an association between saturated fat in the different cohorts, and coronary heart disease in the different cohorts. But at the same time he claimed, and this is in the summary paper, “I found no issue with weight, obesity, I found no issue with sedentary behavior activity, I found no issue with smoking.”

So things that we now know he was wrong about, we give him the benefit of the doubt on the one thing that he did find, which was saturated fat. And the other five peer studies, the ones I’ve just mentioned, did not find anything against saturated fat. And of course, they were all in country studies. So they were right, they were in community studies.

So you take Framingham. It’s a small town, it’s looking at people who eat a certain level of total fat or saturated fat versus people who don’t. So you’ve got all the other factors, or many of them, constant. You’ve got the same GDP, the same politics, the same community, the same access to healthcare. Go to Japan in the 1950s versus the US in the 1950s, you’re comparing efficiently.

Chris Kresser:  Completely different.

Zoë Harcombe:  Exactly.

Chris Kresser:  Not even apples and oranges. We’re not even in fruit category there. I just want to pause here and just highlight this for people who are less familiar with research and methodologies. What Zoë’s saying is that if you … the problem with comparing groups of people between countries is that there's so many factors that vary from country to country and lifestyle, physical activity, the type of foods they eat. Saturated fat comes in lots of different types of food. So what kinds of foods are people eating in the US versus in Japan, where saturated fat would be found in totally different type of food? So comparing between countries just makes the possibility of confounding factors and all of the other issues of epidemiological research, it just amplifies them and makes them even more likely. So typically, especially today, those between-country studies are often discounted or taken with a large grain of salt because it's so hard to control for factors even within the population, much less between different populations.

Zoë Harcombe:  Absolutely. Absolutely yes.

Chris Kresser:  Okay, so, I mean, this is … the crazy thing to me about this, Zoë, and I'm sure this struck you at many intervals throughout your PhD, is just how much of a house of cards the whole evidence base is behind the idea that saturated fat is bad for us. There’s this illusory truth fallacy that we were chatting about before we hit the record button, as well, which is the idea that if you hear something repeated enough times, you just start to believe that it's true, whether it has any basis in fact or not. And we think maybe that researchers and scientists are immune to this illusion. But the fact is, they’re not.

John Ioannides, one of the most famous epidemiologists in the world, one of my favorite quotes of his is, “Claimed research findings may often be simply accurate measures of the prevailing bias.” So, I mean, that sums it. He has all these pithy quotes that just sum it up in, like, 10 words. Which basically means that once you have a certain idea and it's out there because of groupthink and confirmation bias, that idea will often just be perpetuated, even if it was never based in fact in the first place. Because someone will link to that original study that turned out to be erroneous as proof, then someone does a later study and you link to that second study. And then it just becomes a chain of references that all point back to that original study that then it was later shown to be invalid. So it's crazy to me that 40 years of dietary policy has been based on such flimsy evidence.

Zoë Harcombe:  I should declare my own bias, actually, going in, because up until 2010 I’d been a vegetarian for about 20 years. Then my own bias going in was that fat was bad, saturated fat was bad, saturated fat equaled animal fat, which of course I now know absolutely that it doesn’t. All fats are in all foods, especially coconut oil, which is purely vegan. And I believed what I’d been taught at school, that we should be eating low-fat foods and healthy whole grains and plenty of fruit and vegetables. And I believed it too. And I was at a dinner party just a couple of weeks ago, and there were a couple of young people who were engaged and full of life and full of news and full of opinions.

And as we sat down to dinner, they were reliably informing me and my husband that they didn’t eat much meat because it was full of saturated fat, which of course it isn’t, and saturated fat is bad for you, which of course it isn’t. And I said, “You guys work in the finance industry. How did you pick up, how did you become authorities on dietary fat at your tender young years?” We had done a superb marketing job on fat and cholesterol worldwide and people have fallen for it.

Chris Kresser:  Absolutely. Yeah, yeah, and it’s deep. It’s really a form of conditioning. At least, I’m not sure what’s happening with with kids now, but I grew up certainly at a time where butter and eggs and all those foods were really demonized. And it becomes kind of part of your cultural conditioning, and it's so deeply hardwired in the brain, it can be really hard to let go of it. I, as my listeners know, I was a macrobiotic vegan at one point. So I took it about as far as you could go.

Zoë Harcombe:  Wow.

Chris Kresser:  And I remember in high school, I was an athlete and the whole carb loading paradigm. I was eating, like, bagels with nothing on them, like dry bagels and breakfast cereal with nonfat milk for breakfast, and eating pasta and pancakes before my basketball games because the thinking was that would be good for athletic performance and also good for my health.

So I can be pretty extreme when I go for something. I took it to the extreme and when I started to figure out, I mean, it took a very serious chronic illness for me to snap out of that. And even with that, I remember when I was first starting to eat more fat, I had this distinct feeling, like I was doing something wrong or I should do it behind closed doors, or that something bad was going to happen to me. And it took quite a while for that to unwind. So I think there’s that kind of deeper psychological influence happening here too.

Zoë Harcombe:  I’ve read your stuff on that. You write so, like it just happened yesterday. I mean you just describe it, and you just did it then. I could see you running around the track with your bagel. It sort of stays in your mind, doesn’t it, how we felt and what we thought we were doing when we did all of that stuff.

Zoё Harcombe’s Research on Fat

Chris Kresser:  Absolutely. So let's talk a little bit more. Let’s kind of dive in with a little more of a fine-toothed comb on your thesis and your review of the RCTs from 1977, the randomized controlled trials. Which again, if we’re looking at a hierarchy of evidence, it's not that RCTs are perfect or they don't have potential issues, but certainly when compared to epidemiological issues and all of the problems there, which we’ll discuss a little later, they are more reliable. So what did you find in your review of RCTs related to saturated fat and either death from all causes and death from heart disease?

Zoë Harcombe:  So this paper came out in February 2015, and it went nuts. And if you Google it, it was front page in New Zealand and in the UK papers. And I spent the whole day when it came out. The phone was ringing the second I put it on in the morning and it was the BBC, could I come in? And I ended up doing about 20 or 30 interviews that day, just back to back. And it just went nuts. So I think it went nuts because it was the unique part of the PhD that was looking at the evidence at the time. And so people were picking up on the idea that we’ve been eating low fat for 40 years and the evidence wasn’t there at the time to back up the call to do that.

So the major findings from that paper were first of all that there were only six studies, six randomized controlled trials that were available to the UK committee. Only five were available to the US committee, and they’ll be pretty well-known to people. It’s like the Rose corn oil, olive oil trial, the low-fat diet; the Leren Oslo Diet-Heart Study; the MRC soybean study; the Sydney Diet Heart Study; and the LA Vet study. And you pull all of those together, there is no difference whatsoever. Not even to just leak the significance, it was actually the exact same number of deaths in the controlled side as in the intervention side. There was no significant difference in coronary heart disease mortality, it wasn’t quite an identical number, but it was something like 221 versus 219, or something. It was so close. It was virtually identical, again.

A really interesting finding, and this just massively undermined the diet–heart hypothesis and was not a finding that we expected to come across. It just came out. We were able to measure the … Across the polled studies, there was a significant difference in cholesterol being lowered in the intervention studies. But of course that made no difference whatsoever between mortality or coronary heart disease mortality. And I then went on to try to understand why it may have been the case that cholesterol had been lowered by the intervention and not made any difference to health benefits apart from the fact that cholesterol is not bad for us. But why didn’t intervention diets lower cholesterol?

And I think it’s because the main intervention was to swap out saturated fat and to swap in polyunsaturated fat. And a lot of the polyunsaturated fats that they were putting in, corn oil, soybean oil, vegetable oils, contain plant sterols. And plant sterol is effectively plant cholesterol, and it competes in the human gut with the human cholesterol and it replaces it, to an extent. So if you take plant sterols in margarines or spreads or in vegetable oils or indeed in some grain plant products, or some people take them from tablets from the health food shop, which is a really crazy … they will replace your own cholesterol to an extent and lower your blood cholesterol. But I’ve looked at the evidence for the end outcomes on heart disease. I’ve got another paper on that that was published in an editorial, and that shows that actually the overall benefit is not there. It’s actually overall harm of administering plant sterols in the end outcomes of heart disease.

But I think that’s why they lowered cholesterol and perhaps the studies weren’t long enough for the harm from that replacement to actually manifest itself in a difference in outcomes. And I would then expect the interventions to have more deaths from heart disease and more deaths therefore from all-cause mortality.

One of the other really big aspects I think that grabbed the media is the point that we made at the end of the paper, saying that these six studies, when he pulled them together, amounted for fewer than two-and-a-half thousand men, not one single woman had been studied, and not one of those men was healthy. They had all had a heart attack already.

Why You Should Be Skeptical of Some News Headlines

Chris Kresser:  So this is just really key here. You cannot generalize, even if the results were consistent across all these studies, which they weren’t, implicating … Or it sounds like they were consistent in the opposite direction that people thought they were. But even if they had implicated saturated fat as increasing total and CHD mortality, coronary heart disease, that would only be applicable to men.

Zoë Harcombe:  Sick.

Chris Kresser:  With pre-existing, yeah, sick men.

Zoë Harcombe:  Yeah.

Chris Kresser:  Not women and not men that are not sick.

Zoë Harcombe:  Yeah, absolutely, yeah. And interestingly not one study called for change, and studies at the time were far more ethical, I think, than they are today. Far less media orientated, far less trying to get a press release. They would just say things how they were. And a couple of them were a bit nervous about potential toxicity of the fish oil that we’d administered, and they’re the ones that were a bit worried about … the corn oil study had more deaths in the intervention group, and said, “We’re worried about the potential harm from the fish oil intervention.” And the low-fat diet study, the last sentence of that study just cracks me up. It just says, “A low-fat diet has no place in the treatment of myocardial infarction,” which is heart attack.

Chris Kresser:  It's interesting to me what you just said that how much the, both the reporting on studies has changed in the media and also even the way that researchers talk about their findings themselves to the media. I think I was reading an article in Science that was published in 1993, and they were talking about relative risks, which we can get into more detail when we talk about epidemiological evidence. But this is the percentage increase in risk from a given intervention, and they were outside of nutrition, still today in any other field, epidemiologists would consider anything below a 200 to 400 percent increase in risk to be indistinguishable from noise, meaning they would consider anything less than a 200 percent increase in risk to be not significant statistically. And in this article, Marcia Angell, who is a former editor of the New England Journal of Medicine, was quoted as saying that, “They typically didn't really accept a paper unless it had a relative risk ratio of over three for nutrition.” And that just blew me away because today, like IARC's panel about red meat and processed meat causing increased risk of cancer, the percentage increase is 18 percent.

Zoë Harcombe:  Yeah.

Chris Kresser:  That’s not even remotely close to the 200 percent which is the lower end of the threshold. And yet the media headlines are not saying indistinguishable increase in risk observed in people eating more red meat. They come out and just claim causality. They say, “Red meat and eating red meat and processed meat is going to kill you.”

Zoë Harcombe:  And as Bradford Hill would say, “There’s nine criteria and that double is just one of them.”

Chris Kresser:  Yeah.

Zoë Harcombe:  “So hit the double and then you can look at the other eight.” But none of them hit the double, none today get anywhere close.

Chris Kresser:  Nowhere near and yet, and I think this is partly an artifact of the world we live in, just with, like, proliferation of the internet and so many headlines. Everyone's vying to get attention and so you have to … a headline that said, almost insignificant increase in risk observed in people who eat more red meat than other people. But of course there are other diet and lifestyle factors that we’re not considering. That's not to make a good headline, right? Nobody’s going to click on that. And so people want the flashy, clickbait headline saying low-carb diet will shorten your lifespan or eating red meat will give you a heart attack. Even though I would hope that the researchers themselves somewhere deep down know that that’s a gross exaggeration of their findings.

Zoë Harcombe:  Yeah.

Chris Kresser:  And as for the media, I guess it’s just that we don’t have science journalists anymore.

Zoë Harcombe:  We don’t. I do a note every Monday where I look at a paper from the previous week and dissect it. And you can tell, mostly the ones that get into the media have had a press release. And if you look at the press release and you look at the media article, the media have just taken the press release almost verbatim. The press release provides a couple of quotes, they end up in every single article. Completely lazy journalism. Occasionally they might call in the UK me or Dr. Aseem Malhotra or Dr. Malcolm Kendrick and just say, “Do you want to give an opposing quote?” and occasionally they’ll stick it in.

Mostly they’ll just run off the press release, and the researchers should be challenging the press release. I mean, our paper in February 2015 was press released, and I remember having a few toings and froings because I wanted it to be scientific. It’s a big enough claim in itself to say we only studied two-and-a-half thousand sick men, and then we introduced these guidelines for 250 million Americans and 50 million Brits. That’s okay, enough. We don’t need to sensationalize it anymore than that.

Chris Kresser:  Absolutely.

Zoë Harcombe:  So I tried to get it down to the facts that we found and not to put any spin on them.

Chris Kresser:  Yeah. Yeah, to your credit, I mean, that's so hard to do in this crazy media environment that we live in now. And to be fair, there are definitely researchers that make an effort to do that. And you still will see that in reports where, I was reading one on, I can't remember what it was, but it actually stood out to me because I don't see it as often as I do. I was impressed by both at what the researchers were saying and that the author of the article. Because they went out of their way to say this is just an association or correlation. It doesn't prove causality, and here are the reasons why it might not be a causal relationship, and why we need more research. But my sense of that is it's almost like when you watch, if you see a commercial for a drug and then you have like the 20 seconds of side effects after the 10 seconds of the commercial. People have heard that so many times they just kind of tune that out and they’re only really still paying attention to the headline.

Zoë Harcombe:  Yeah.

Chris Kresser:  So let’s talk. So you went back, you reviewed the RCTs from the late 70s that were responsible for creating dietary guidelines that, as you said, applied to hundreds of millions of people around the world and probably affected many more even just by osmosis. Those ideas becoming firmly entrenched in industrialized society, even if they weren’t part of formal dietary guidelines. And then you went back and analyzed all of the research that had been done from, was it from the late 70s to 2016?

Zoë Harcombe:  Yes, so we then took it up to date. And I actually said in the recent paper that’s just been published by the BJSM, the one on is saturated fat a nutrient of concern, and that’s because the USDA is now looking at it again for the next dietary guidelines. And I actually put in that paper that the day that the paper is saying there was no evidence at the time came out, I was astonished that Public Health England came out almost immediately on the day. I said, “Okay, so maybe there wasn’t evidence at the time, but we’ve got plenty of evidence today.”

Chris Kresser:  Right.

Zoë Harcombe:  I was surprised that they were prepared to concede. I thought they said, “No, no, no, this is ridiculous. The Seven Countries Study was marvelous and that’s all we need. And we can ignore everything else.” But they didn’t. They said, “Okay, there was no evidence, but there is plenty nowadays.” And of course it takes so long to get papers published that with my supervisory team, we’d already moved on to the next step, which was looking at the evidence available today. So we had that paper pretty much ready to go. And of course you keep in the original six studies, then you just add in any other randomized controlled trials that have looked at coronary heart disease, mortality, and total mortality. Those were our two outcome criteria so we wouldn’t lose some RCTs that only looked at events, for example. But then that then brought in the Women’s Health Initiative, the DART study, the STARS study, and the very well-known Minnesota Coronary Survey study.

Chris Kresser:  Zoë, before we go on I want to pause there. Let’s talk about why you chose total and coronary mortality as an endpoint and why that's important—to focus on the mortality endpoints versus just the events.

Zoë Harcombe:  Yeah, I’ve got to credit Dr. Malcolm Kendrick with this, and I am such a Dr. Malcolm Kendrick fan, it’s just not true.

Chris Kresser:  Yeah, me too.

Zoë Harcombe:  And I just remember, I mean, I’m fortunate enough to know him and consider him a friend and to meet him on occasions. And just every time I meet with him he says stuff and I'm just, why is this not just the only thing that’s being taught in medical school because it’s so sensible? So he’ll say, “I can guarantee that you won’t die from heart disease by pushing you off a cliff.” And it just, it then sticks in your head. Okay, so the important thing is total mortality because there is no point to reducing heart disease if you increase deaths of something else. So all this stuff going on with statins. Oh, we think we can reduce some events. We could have a whole different program on statins. But would there be any point in making any benefit anyway, even if they could, if they, for example, as they might do, increase your risk of cancer or dementia or mind health, etc., etc.? So it has to be total mortality. The only thing that matters is are you going to help people to live longer, to die later?

Chris Kresser:  Absolutely.

Zoë Harcombe:  That’s what we’re trying to do with health interventions. And so we’ve got to have all-cause mortality in there and then we’ve got to have heart disease mortality and not just events. Because that’s where the dietary fat guidelines came about. They were issued in the name of trying to stop deaths, particularly in men at the time, younger men at the time, from coronary heart disease. So if they’re not going to achieve that, then they’re not even going to achieve what they were introduced for. So why on earth were they introduced?

Chris Kresser:  Yeah, thanks for clarifying, and sorry to interrupt. But I'm banging on this drum all the time. I just want to make sure that people understand it because it's a crucial distinction. You frequently see headlines like “XYZ intervention reduces the risk of heart attack by 20 percent,” which again, as we just said, in an epidemiological study, that's meaningless. We can’t distinguish that from chance anyways.

But even if it's an RCT, then the first thing I’d do is go look at the table to see if they even measured total mortality. Which previously, that was less common. It’s more common now, I'm finding. But then when you look at total mortality, there is often no difference. So that’s where the disease substitution is happening that you were just talking about. The risk of death.

Zoë Harcombe:  A bit of gossip. Malcolm Kendrick wants to die from a heart attack.

Chris Kresser:  Rather than cancer?

Zoë Harcombe:  Exactly. Rather than cancer.

Chris Kresser:  Yeah, that’s what I tell people too.

Zoë Harcombe:  Yeah, he doesn’t want to go early, don’t get me wrong. He probably wants to go at sort of 98 drinking a glass of red wine, playing with his grandchildren when he gets them.

Chris Kresser:  Yeah. You just have a heart attack in your sleep overnight. You don’t wake up one morning. That sounds a lot better to me than dementia or Alzheimer’s or cancer.

Zoë Harcombe:  Yeah.

Chris Kresser:  So you don’t need to belabor this, but it’s really important to point out because I think it's something that people who are less familiar with research may not have thought of. So okay, so you chose total and CHT mortality, and I believe you ended up with 10 RCTs?

Zoë Harcombe:  Yeah. So the original six and then the Women’s Health Initiative, DART, STARS, and the Minnesota Coronary Survey, pull them all together, there’s no difference in all-cause mortality. There’s no difference in coronary heart disease mortality. Again, there was a significant reduction in cholesterol in the interventions that did not meet any difference in coronary heart disease mortality or all-cause mortality.

So essentially, all we did by adding in the former recent studies was that we increased the number of people studied quite dramatically. It came up into the tens of thousands, not least because the women’s health initiative alone brings along tens of thousands of people to the party. And of course it then became more female than male because of all the women in the Women’s Health Initiative. But we still in those 10 only ended up with one study including both men and women that would be a primary prevention study, so people who had not already had a heart attack, and that was of course the Minnesota Coronary Survey. And this in itself found no significant results at the time of publication and of course we then had that brilliant paper where … it should be on the tip of my tongue, the person who went back to look at this, Christopher, I’m thinking. You know the person I mean, who went back to look at the Minnesota Coronary Survey and also went back to look at the Sydney.

Chris Kresser:  Was it Hibbeln?

Zoë Harcombe:  No.

Chris Kresser:  No that’s Joseph Hibbeln and Christopher, they’re both the guys who have done a lot of the critique of the polyunsaturated fat research, or am I thinking of someone different?

Zoë Harcombe:  Oh, I’ll be kicking myself and don’t worry. Stick it in your show notes. But it’s a very well-known team that went back to look at both of those studies and even thought there was no evidence found against the dietary intervention at the time, they found that there was some unpublished data. And it just made it even more robust that we had been demonizing fat at the time. So all the RCTs as of 2016, and there haven’t been any since, and there’s still no more evidence than we had at the time the guidelines were introduced.

Chris Kresser:  Wow, it’s just, it’s really kind of remarkable, actually. And it’s again just going back to this idea that a lot of this evidence is really based on a house of cards. And as an example of the fallibility of these guidelines, the US in 2015 for the first time removed their advisory that we should not be eating dietary cholesterol. Because they finally acknowledged the cholesterol in the diet does not have any relationship with heart disease. And that was kind of like a pretty major thing that just, like, slipped through.

There weren’t really big announcements or any fanfare around that. Like, “Hey, everybody, we’ve been really wrong about this for the last 30 or 40 years and we just want to bring that to your attention.” And I even remember reading editorials written by scientists who were kind of still anti-saturated fat and cholesterol, and were saying things like, “We can’t really make too much of this because the public is going to lose faith in our ability to guide them with diet.” And I have a sense that the same thing is going to happen with saturated fat in the next few years. And maybe already people know this, but they're just not willing to do it yet because if they do, people will absolutely lose faith in the diet guidelines.

Zoë Harcombe:  Yeah, and they need to.

Chris Kresser:  Yeah.

Zoë Harcombe:  I mean, let’s face it, they need to lose faith. The best thing that they could do, the dietary guideline committees, would be to come out and say, “Guys, we were wrong. I’m sorry, we were wrong. And we’re going to get it right from now on.” And that would be the only way that we would start having trust in them again. But all this surreptitious slipping things out, then slipping things in, anyone who’s working in this field is just finding this completely unprofessional and noncredible.

 Why Dietary Guidelines Don’t Work

Chris Kresser:  I mean, this is a whole other discussion, but it’s worth pointing out that the idea of top-down, one-size-fits-all dietary guidelines that will apply to everyone is really not consistent with our understanding, our modern understanding of human biology, biochemistry, and physiology. And I think that this, the whole idea of dietary guidelines that would apply to everyone needs to just die. Because that has led to this reductionist approach, which one researcher calls nutritionism, I like that idea, which is that a nutrient is a nutrient is a nutrient no matter what it's found in.

Saturated fat in candy or pizza or junk food will have the same impact as saturated fat found in a steak or another whole food. And it’s led to this extreme focus on macronutrients and isolated food components rather than looking at the whole context of the diet. And that's starting to change slowly. There have been some pretty good studies in the last couple years. There was one, I’m sure you know which one I mean. It was looking mostly at weight loss and they compared, they designed a study that was comparing the effects of a healthier low-carb versus a healthier low-fat diet. And they found that both were actually pretty effective compared to the standard junk food diet that most people eat.

And we need more studies like that, and if we let go of this kind of one-size-fits-all approach, we might actually be able to start looking at the context of foods we’re eating, and then where maybe one person does need to eat more fat and fewer carbs and another person might do better eating a little bit less fat and more carbs from whole foods relative to that other person. So to me that’s one of the biggest assumptions behind the dietary guidelines that’s not mentioned.

Zoë Harcombe:  Yeah, that was the Gardner study, wasn’t it?

Chris Kresser:  Yeah.

Zoë Harcombe:  I corresponded that enough.

Chris Kresser:  Yes, the Gardner study.

Zoë Harcombe:  Yeah, very good study, yeah.

 The Epidemiological Evidence

Chris Kresser:  So let's just briefly touch on epidemiological evidence. I mean, there’s so many issues with observational nutrition studies. I don't know if you saw John Ioannidis’s recent review. It was published in JAMA and I’m going to pull up a couple choice … It was called “The Challenge of Reforming Nutritional Epidemiological Research.” And I’m going to read the first two sentences because they’re classic Ioannidis in how pithy and direct they are. It says, “Some nutrition scientists and much of the public often consider epidemiologic associations of nutritional factors to represent causal effects that can inform public health policy and guidelines. However, the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles. The field needs radical reform.”

Zoë Harcombe:  Oh, I couldn’t agree more. I just couldn’t agree, I mean, I had the privilege of seeing John present at the Food for Thought conference in Zurich, which was arranged by the British Medical Journal and Swiss Re, a reinsurance company, and he gave the, I guess you’d call it the keynote, after-dinner speech by videoconference into the conference hall where we were in Zurich. And it was uncomfortable, shall we say, for some of the audience.

Chris Kresser:  I could imagine. In an audience full of nutritional epidemiologists, probably didn’t like what he had to say.

Zoë Harcombe:  Yeah, largely. I mean, I sat near Nina Teicholz, and we were absolutely loving it. But I won’t mention any names, but a couple of nutritional epidemiologists did walk out.

Chris Kresser:  Yeah, yeah, I’m not surprised. It’s hard to consider, and there are ways that nutritional epidemiology can be done better. We can have more advanced data collection methods and an application of Bradford Hill criteria, which you mentioned, to increase the chance that the relationship between variables is causal. But the way it is now … there’s another critique that I love by Archer and he says, “For results to be scientific, data must be, number one, independently observable. Number two, measurable. Number three, falsifiable, Number four, valid, and number five, reliable. And these criteria distinguish scientific research from mere data collection and pseudoscience.”

And when you look at nutritional epidemiology, they do not satisfy those basic criteria for science because they're relying on data collection methods like food frequency questionnaires, which are just a joke. I mean, they’ve been so thoroughly debunked as a reliable way of assessing what someone is eating. We know that human memory is not an accurate reproduction of past events. It’s just basically a highly edited anecdote regarding what we ate. And we know that these approaches that are used to assess what people are eating in these studies are really not accurate and not reliable and don't fulfill the basic criteria of science.

So, I mean, we could talk a lot more about the problems with epidemiology, but I think let's, given the time constraint, let's just go on and talk with those caveats, those huge caveats. What did the epidemiological evidence suggest if it had been included in the original analysis that you looked at and then also since then?

Zoë Harcombe:  So we covered in some depth at the time that essentially it was just the Seven Countries Study that found anything. None of the six studies found anything against total fat, and then just the Seven Countries Study alone found something against saturated fat. When you bring the epidemiology up to date, and I actually did it, I had to do it in a different way in the fourth part of the PhD because they didn’t have data on current epidemiology and total mortality or coronary heart disease mortality. So there was going to be nothing that I could actually update the original studies with.

So I had to look at different measures of looking at any relationship that I could find with deaths and total fat or deaths and saturated fat separately. Of course they’re not interventions anymore. So you are into just this epidemiological base of looking at the fat intake in different regions or in different studies. So it was slightly different to the other three that were looked at, and they were completely different studies, and probably studies therefore that are less well known to people. They were certainly less well known to me. So things like the Ireland-Boston study, Kushi, the US Health Professionals, Lipid Research study that’s very well known. The Pietinen Finnish counts study, a UK health survey by a couple of people called Boniface and Tefft. She’s not very well known, this new heart study, and then the Gardner Japanese study, which is probably not too badly known within the field. And when you separate it out, look in it, coronary heart disease deaths, so we couldn’t get the total mortality anymore.

But we could at least get the heart deaths and align those to either the total fat, where it was examined, or the saturated fat. There was, again, no significant difference for coronary heart disease deaths and total fat or saturated fat consumption. We were back to a limitation of the pooled studies from those seven that I’ve mentioned being almost entirely male. So 94 percent of the people involved in those studies were male. They were at least mostly healthy. Almost all of them had not already had a heart attack, but there was still no relationship for coronary heart disease deaths and total or saturated fat. So there was then a fifth paper that I published with the BJSM that wrapped up the four studies.

So it went through essentially what we’ve gone through now, which is, what did I do, looking at RCTs then, RCTs now, epidemiology then, epidemiology now? What was found? What wasn't found, which was far, far more. And then an era that I suggest we’ll probably be heading into quite soon was to put what I’d looked at in context of other meta-analyses that had been done. Because I’m a PhD researcher, I was not straight out of finishing my degree. But I’m still just a PhD researcher looking at this evidence fresh in a systematic way.

A number of other people have also looked at the data in this field either for mortality or for events or for interventions or for epidemiology. And I therefore wanted to look at what everybody else had done to say have I found something different. Has everybody found this? Because you have to do that. You can’t come to the end of your PhD and say, “I find if I might drop the toast buttered 100 times out of 100 it falls on the butter on the floor,” if everybody else has found more (audio cuts out 59:06) it doesn’t fall with the butter on the floor. You’ve got to put your own research in context.

Chris Kresser:  That’s another core principle of science. Shapiro, an epidemiologist, said, “We should never forget that good science is skeptical science, and science works by experiments that can be repeated. When they’re repeated they must give the same answer.” So this is another core principle. So what did you find when you looked at these other meta-analyses?

Zoë Harcombe:  So the main ones that were pulled together, and there’s a great table in the paper five, which is one from 2016. I think it's called “Dietary fat guidelines have no evidence base: Where next for public health nutritional advice?”

Chris Kresser:  That’s a pretty straightforward title.

Zoë Harcombe:  Yeah, it is pretty straightforward, actually yeah.

Chris Kresser:  Not beating around the bush.

Zoë Harcombe:  They’re pretty good, actually. They help you with titles. So they come up with catchy ones.

Chris Kresser:  Yeah.

Zoë Harcombe:  And I then went through, for example, I got the tape in front of me, so you’ve got Skeaff and Miller from 2009 who looked at RCTs and epidemiological studies. And they looked at mortality and events for total fat. You’ve got a fairly well-known study with Siri Tarino and colleagues from 2010 looking at epidemiology of fatal and nonfatal coronary heart disease and cardiovascular disease. Mozaffarian, who I had the pleasure of meeting in Zurich over the summer, and his paper looking at just events, not mortality. We might come back to that one. And then of course you’ve got the two well-known Hooper studies, that’s the Cochrane research, which should be the gold standard, but we can take a bit of a better look at that one. And then you’ve got Schwing, Jacqueline, Hoffman from 2014, RCTs, and my own study. And then of course you’ve got the Chowdhury study that looked very interestingly at the four different types of fats, saturated fat, monounsaturated fat, polyunsaturated fat, and they included trans fats in their research looking at coronary disease for both randomized controlled trials and epidemiological studies.

Chris Kresser:  Right, and I’d like to read the conclusion of that one: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Zoë Harcombe:  Here, here.

Chris Kresser:  So that was the Chowdhury, and then, so there were, I think, 39 total reports.

Zoë Harcombe:  Yeah, 35 non-significant. And we don’t shout that often enough.

Chris Kresser:  Yeah.

Zoë Harcombe:  If you stop—and I’ve done this for a Welsh TV program that I was working on—we went to Cardiff, which is the capital city of Wales, and we walked down the main street in Wales and we said to people, “What do you think about fat? What do you think about fruit?” And people would tell you, “We need to eat five a day and fat is bad for us.” So people have got the messages. But what we’re not telling them is when you actually look at all the evidence, 35 out of 39 results were non-significant. No findings. And that has to be the most significant thing that has been found, that we didn't find much. Why don’t we look at that more often? That’s so more powerful to me than the four findings. And if we just whiz through those. In the Chowdhury study that you mentioned, the one finding that they did make was against trans fats, and I don’t think you or I would give them any argument over that one.

Chris Kresser:  No.

Zoë Harcombe:  Mozaffarian, I really liked him in Zurich. But I was involved in a paper that critiqued his 2010 study which said, “You should replace saturated fats and polyunsaturated fats because there’s an impact on CHD events.” And our paper criticized that paper for excluding two studies that were not favorable to polyunsaturated fats, which was the Rose corn oil study and also the Sydney Diet Heart Study. And including, and it’s all bad studies, the Finnish Mental Hospital Study, which was not randomized, not controlled, crossover trial. I mean, just the worst possible trial to try and slip in to pretend it’s an RCT. So we critiqued that paper. I like to think he wouldn't publish that paper if he had the opportunity tomorrow. I can't speak for him, that wasn't right.

And that’s, of course, exactly what the Sax paper did last year, the American Heart Association paper. Again left out two unfavorable studies, the same two. Included the Finnish Mental Hospital Study, they shouldn't have done. And so basically, there were only two findings, and they boil down to one because it was the same research team, Hooper and the Cochrane team, working out of the east of England in the UK. One paper was from 2011 and the other was from 2015. And among 11 known findings for CVD, mortality, total mortality by modified fat, reduced fat, any kind of variation of fat, the only finding they could come up with was for CVD events when they looked at all RCTs for saturated fat reduction intervention. And we can get into that.

Chris Kresser:  Yeah, I mean, I think we can stop here at least in terms of the actual studies because it's, just to review what we've discussed, the randomized controlled trials that have been done since the late 1970s to today have not supported the idea that saturated fat increases the risk of death from heart disease, or any cause. The epidemiological evidence that has been done throughout that period does not support that hypothesis either. And even if it did, we'd still have all of the issues that epidemiological research, that make it problematic, like the healthy user bias and inaccurate methods of data collection, small risk ratios.

We talked about that earlier, how the increase in relative risk is so low that it doesn't really meet the threshold for assuming a causal relationship in any kind of epidemiology outside of nutrition, and even in nutrition 20 or 30 years ago. Other people who've meta-analyzed these data have come to a similar, if not the same, conclusion as you did in your research and your PhD thesis. And I just want to highlight something that you said about how the Finnish study, which is really not a good study at all, has been included in a number of analyses. And you might wonder why that would happen if the researcher is aware of its limitations and that it's not a valid study to draw any inferences from on this topic, why would it be included?

And again I’d like to turn to a John Ioannidis quote, and he says, “Consequently, meta-analyses become weighted averages of expert opinions. In an inverse sequence, instead of carefully conducting primary studies informing guidelines, expert-driven guidelines shaped by advocates dictate what primary studies should report.”

Zoë Harcombe:  Yeah.

Chris Kresser:  Doesn’t that sum it up?

Zoë Harcombe:  He’s so brilliant, isn’t he?

Chris Kresser:  So in other words, we start out with, the way that science should proceed is by doing experiments, and then if any guidelines are made, to make them based on these objective experiments. But the way it actually happens, a lot is we start out with a certain agenda and then we design studies that will return results that support that agenda. And anyone who's worked with data in any capacity knows how easy that is to do.

Zoë Harcombe:  Yeah.

Chris Kresser:  And it's not even conscious all the time. This is where confirmation bias comes in. It’s very difficult to guard against. I have to, and I’m not 100 percent, I’m not saying I’m 100 percent successful. But I can watch even myself. If I go and look for research on a particular topic and I have a certain idea, it's very easy to just skip the studies that don't support that idea. And that happens among scientists. It's a real cognitive bias that is very difficult to guard against. And I think it has a huge effect on research.

Here's another quote, this is from Casazza: “Confirmation bias may prevent us from seeking data that might refute propositions we have already intuitively accepted as true, because they seem obvious. For example, the value of realistic weight loss goals. Moreover, we may be swayed by persuasive yet fallacious arguments.” So again I come back to psychology. It's a real … we’re human beings doing this work, right? All researchers and scientists are not infallible. They’re human beings as well. Many of them have their own ideas and preferences about diet and nutrition. They’ve been influenced by many of the same things that we as laypeople or myself have been influenced by. And it really, really does affect the outcomes of this research.

Zoë Harcombe:  Yeah, yeah. I would agree with you. I mean I went in with a vegetarian, fat is bad, carbs are good bias. I am aware that I was so shocked by the things that I found when I started researching in this field, even before the PhD, you do then get quite skeptical and quite angry. And I now almost trust nothing. So every week I’m taking a paper from any kind of field, though mostly typically nutrition, and the low-carb study was one that I did recently, and then there was a weight loss drug that came out. And then I looked at red meat, the evidence because that was topical for something. And when I’m going in, I just assume that there’s going to be errors, and I’ve yet to find a published paper that doesn’t have something that you can point out as being really quite seriously wrong or disingenuous or open to interpretation.

Chris Kresser:  Yeah.

Zoë Harcombe:  I mean it’s really shocking. I saw on Twitter just a couple of days ago a guy, an academic, got so fed up with all the emails that you do get saying, “Oh, I really enjoyed this paper. Please can you write some papers for us.” Because papers are big spinners for the journals. He got so fed up with all these spam emails that he made up a complete nonsense study using Latin words that made something look really impressive, but it was basically saying something like, “If you do this with excrement, this happens.” I mean it was just, it really was, he was really taking the mickey and it got through peer review and he put it on Twitter. And he said, “I’m delighted to say that my complete nonsense article has just been published by this complete nonsense journal.”

Chris Kresser:  Yeah, and I’ve heard other experiments like that that have been done where a lot of stuff like that has made it through peer review. And there have been a lot of critiques of peer review and why it’s broken and the links to the money in the research industry. Marcia Angell, who I mentioned earlier, in the context of the relative risk who was the former editor of New England Journal of Medicine, has famously said that some, I’m going to paraphrase, but “I now no longer think we can believe any published research,” is basically what she said.

So yeah, I mean, I think it doesn't mean that research is not valuable. It doesn't mean that we have to just become, I think you can go too far with this where we just say, “Oh, forget it. There’s no point in even trying. Let’s just discount all research equally.” Because there are differences in the quality of research and there are still studies that are done well even if they're not done perfectly. And it's the best tool that we have, that we’ve discovered today to try to answer some of these questions, at least on a population-wide scale.

 Conclusions about Saturated Fat

So I want to close by just kind of going through some conclusions here. One, we’ve talked throughout that the evidence against total saturated fat is incredibly weak, if not nonexistent. But something we touched on briefly but I want to highlight here is that even if saturated fat were harmful, you have to consider the source of it in the diet. Get away from this reductionist approach where we think that saturated fat coming in different forms is going to have the identical effect. Because we don’t eat nutrients. We eat foods that have nutrients in them.

 And I love how in your paper you pointed out that pizza, desserts, candy, potato chips, pasta, tortillas, burritos, and tacos accounted for 33 percent of saturated fat consumed in the diets of US citizens. A further 24.5 percent was unaccounted for and collated as “all other food categories,” which is almost certainly processed food. And so as a result, only 43 percent of saturated fat came from natural foods like dairy products, nuts and seeds, and burgers and sausages. Although I'm guessing that the burgers and sausages had highly processed buns and sugary ketchup and other stuff on them too. So how can we even look at those things as being anywhere remotely similar, much less the same?

Zoë Harcombe:  Yeah. I mean I actually took out the processed meat in that section. So I got the natural foods listed down to cheese, nut butter, nuts, and seeds. And collectively together they accounted for 20.8 percent of saturated fat intake. But then I actually made the point it would’ve been ideal for the unprocessed chicken, beef, and eggs to have been separated from the processed meals because they always just lump them together. And they will always put, whenever there’s a study damning red meat, particularly in the US, it will always include hamburgers, which they are very firmly processed food in the UK, but for some reason seems to be considered as some sort of Paleo food in America.

Chris Kresser:  Right, right.

Zoë Harcombe:  And meat-type dishes, or something, which might be a curry.

Chris Kresser:  KFC.

Zoë Harcombe:  Yeah, exactly, Kentucky Fried Chicken.

Chris Kresser:  That’s the way most people eat chicken, KFC or chicken nuggets at McDonald’s. There’s your chicken.

Zoë Harcombe:  Absolutely, yeah. Or maybe a curry takeaway ready meal that you pop in the microwave and if it's got a couple of percent of meat in it, you’ve done well. You bought a more expensive one than the average, which doesn’t even bother putting the meat in.

Chris Kresser:  I mean, I’m … yeah, go ahead.

Zoë Harcombe:  No, and that’s the crazy thing because I want us to be able to have heated agreement. I don’t want to be fighting anyone out there. The whole world is much better if we get on and we’re in harmony than when we’re fighting over anything, whether that’s territory or politics or nutrition or anything else. So I would love for us to find a way forward. And I think there could be a way forward by saying, “Guys, can we have a heated agreement that we can demonize processed food?”

And I know there’s industry conflicts all over the place and we have to expose the industry conflicts with the guidelines set in committee in the UK, they are completely dominated by the processed food industry and grocery retail. I mean, it’s just horrific. If somehow we could get the conflicts out of setting health guidelines, which please, for goodness’ sake, must be objective. We must tell people honestly what is healthy. Not tell them what the food industry wants them to believe is healthy. That’s got to be step one.

Chris Kresser:  Absolutely.

Zoë Harcombe:  If we can get all of that nonsense out, surely then we could agree that real food has got to be better than processed food. And there might be some debate what’s real food. But if it’s found in a field, it’s found growing on a tree, it’s found in the natural environment … I said to my niece when she was five years old, fish swim in sea, fish fingers don’t. Breaded fish.

Chris Kresser:  If it comes in a bag or box, you probably shouldn’t be eating it.

Zoë Harcombe:  Yeah.

Chris Kresser:  I mean, of course, there are exceptions. Butter usually comes in a box, but yeah, that’s a general guideline, right?

Zoë Harcombe:  Yeah, we know what real food is. It’s the best-quality meat, eggs, dairy products, fish you can get a hold of, it’s vegetables, seeds, nuts, fruits in season. There will be some debate over legumes and whole grains and how recently they’ve been part of our consideration set, and I agree with your point, there’s not one diet fits all because some people just cannot tolerate grains and legumes and fibrous products, suffering from irritable bowel syndrome or celiac or other digestive conditions. But somewhere within that real food, total consideration set, surely we ought to be able to set some principles that people can follow that are not based on advice from the processed food industry.

Chris Kresser:  Absolutely, and I mean, I've said this so many times that Sean Croxton, who used to write in the health space, he came up with a diet advice that was JERF, he called it. J-E-R-F, just eat real food, which is, like, look, okay, we can debate about is it better, like you said, whole grains or legumes, in or out, saturated fat higher or lower, carbs higher or lower within this context of a whole-foods diet. But is there any doubt that if everyone ate real foods, we would decrease the burden of chronic disease and early mortality by something like 60 to 80 percent? I mean, I have no doubt of that.

And that’s again where this reductionist focus on nutrients completely isolated from the context of the foods that they come in has been such a disservice. Because imagine if we spent the last 30 or 40 years just hammering home the message that eating real, whole, nutrient-dense foods is really, like, if you want to simplify it for public health, like, that's the message. Don't even worry about those other finer points. And we would not, well there's a whole other discussion about whether people will actually follow that advice if you give it to them and given the influence of our brains with highly rewarding and palatable foods in the food industry and all of that. But there's no doubt that if people really did follow that advice, we probably wouldn't even be having this discussion right now.

The other thing about that is it is possible at least in theory to, like, if we really wanted to answer the question of is saturated fat harmful, the way we would need to do that is we would need to take two groups and they would both have to have the same baseline healthy diet that we’re talking about. Just eating real, whole foods, right? And then in one group, they would eat more saturated fat. And then we would, this is to be a randomized controlled trial, we’d lock them up in a metabolic ward so that we could control all of the variables that we know can influence health, or at least most of them, and then we’d follow them for about 15 or 20 years and see what happens. And the problem is that's never going to be done. I mean, that study would be hundreds of millions of dollars, if not billions, and no, Coca-Cola's not going to pay for it, right? I mean none of the, no drug company is going to pay for that study. So unfortunately, that study is unlikely to ever happen.

Zoë Harcombe:  Yeah, but “just eat real food” would work as a message until.

Chris Kresser:  Exactly.

Zoë Harcombe:  Yeah.

Chris Kresser:  Just eat real food, and then we can use other mechanistic studies and other lines of evidence and maybe even shorter trials to try to answer some of the finer points. And those trials should also include individual, should also pay attention to individual factors or genetic or non-genetic factors that might bear on the answer to that question, so that we don't then extrapolate the findings to everybody instead of just one group of people, for example. We know there are genetic polymorphisms that make some people hyper-responders to saturated fat and that can lead to an increase in LDL particle number. And the clinical significance of that is still controversial and debatable. But we know pretty certainly that that does happen.

So, but then if you were to extrapolate those results to someone that didn't have those genetic polymorphisms, that would not be a valid inference. So yeah, it’s just disappointing that, I mean, we know this and yet we still go on doing the same things over and over again. And I have to throw in one last Ioannidis quote which—from that more recent, or I think from one of his previous papers, and I'm going to paraphrase this one because I don't, let me see if I can find it—yeah, “Definitive solutions won’t come from another million observational papers or small randomized trials.” In other words, that was from a paper he wrote called “Implausible Results in Human Nutrition Research.” So in other words, doing the same thing over and over and expecting a different result is the definition of insanity, right?

Zoë Harcombe:  Absolutely.

Chris Kresser:  So, Zoë, thank you so much for joining me, and I know we went a little long, everybody, but I hope you enjoyed it and got a lot out of it. And I just, I wanted to have one podcast that we could direct people to to really answer this question and look at all the evidence on saturated fat in particular and its relationship with mortality and heart disease mortality. And I think we didn't cover everything, but I think we did a pretty good job of getting the most of it out there. So thank you so much.

Zoë Harcombe:  Oh, thank you. Can I just add one thing, because I think we just about completely nailed everything.

Chris Kresser:  Please, of course. Yeah.

Zoë Harcombe:  When we ran through the 39 results and found that only four were significant, and we dismissed Mozaffarian and we agreed with Chowdhury, and then the two Hooper results, which were just on the CBD events, we can actually put those to bed as well because aside from the fact that they’re events and they’re not mortality and we both agree that mortality is best, the thing that you have to then look at is why did Hooper find something different to all the other people? And when I went in detail, Hooper had actually managed to include four studies which involved only 646 people that were not about cardiovascular disease. And she’d asked the study authors if they happened to have data on cardiovascular disease events. So this was non-peer-reviewed data. That was the first thing.

When, and I owe Dr. Trudi Deakin in the UK, I always credit her for this finding, she spotted in the Hooper paper that when Hooper actually did as she should do, the sensitivity test on that one single finding, it was no longer significant. So the test that had to be done was not just which studies intended to reduce saturated fat or which studies actually did reduce saturated fat.

Chris Kresser:  A key distinction there.

Zoë Harcombe:  That’s really, really important, yeah. So Trudi looked at this and found that it is declared in the paper, but it’s tucked away on sort of page 158, or something.

Chris Kresser:  Right.

Zoë Harcombe:  That when the ones that were tested did actually reduce saturated fat only were included, there was no statistical significance and it was not generalizable because again in the whole of the evidence that was looked at by Hooper in either of those two papers, there was no single study of healthy men and women. But I think sensitivity tests apart from non-peer-reviewed data and apart from events, I think we can actually put that one to bed as well. So when you do that, because that’s the one that the other sites still try to hang onto. That’s the one that came up in the Professor Noakes trial when that’s down there for him as an expert witness. They tried to wave that in front of us and said, “Oh, see saturated fat is bad.”

Chris Kresser:  Right.

Zoë Harcombe:  So we hit them back with an, “Oh, no it isn’t.”

Chris Kresser:  What’s the data?

Zoë Harcombe:  Yeah, we kind of went in on the data. So there just is no evidence, and knowing the facts about fat, it would make no sense if there were.

Chris Kresser:  Exactly. And that reminds me of the recent low-carb study which you and I both critiqued on our blogs. It wasn’t a low-carb study. The people were eating something like 40 percent of calories is carbohydrate, not to mention the fact that they reported a calorie intake that was basically at starvation level, which would invalidate the entire data set. So you don't even need to go any further. I mean we did, but, like, that would've been enough, right? And all it takes is one major error like that, and it casts doubt on the entire data set and makes any kind of inferences that you would draw from it invalid. And I don't think people understand that enough.

Zoë Harcombe:  Yeah, I think critiques, I think the word you used there was quite polite. Actually, I think we both annihilated that study.

Chris Kresser:  Yeah, well it was.

Zoë Harcombe:  And a few other people as well, Nina Teicholz and Georgia Ede.

Chris Kresser:  Several, yeah. I mean, it was frankly like shooting fish in a barrel.

Zoë Harcombe:  Yeah, it wasn’t hard, that one, was it?

Chris Kresser:  Yeah, it was not hard. I’m just actually kind of shocked that that kind of study makes it through peer review and gets published, given all of those issues. So anyways, yes, thank you so much for doing all of the work that you do, Zoë. It’s such a pleasure to meet you, virtually, at least, and to be able to really just concisely and comprehensively go through all of these deficiencies in the evidence and to just make it clear for people that this, despite the fact that they've heard this probably for 30 or 40 years, depending on how old they are, and despite the fact that it still forms the basis of our dietary guidelines, there really is no evidence to support it.

Zoë Harcombe:  Yep.

Chris Kresser:  Fantastic. Well, where can people find more about your work, Zoë?

Zoë Harcombe:  Just ZoeHarcombe.com. So my surname is H-a-r-c-o-m-b-e. So that’s ZoeHarcombe.com. And as I say, I blog every week. That’s my sort of business model. So if anyone wants to sign up and get the newsletter, there is lots of stuff on open view. But if you do that, then you support what I do and you help me to stay independent because I don’t take any money from anyone for anything in any circumstance.

Chris Kresser:  Key. Absolutely.

Zoë Harcombe:  I just work away and come up with what I want to find. And I know some people are on the email list who are quite fans of whole grains, for example. And I know every time I write a newsletter saying I looked at this whole grains study and it really didn’t stack up, I know that I’m upsetting some people who are subscribing, but I have to go with where the evidence takes me and I have to report as I find. So that’s what I do.

Chris Kresser:  Yeah, yeah. I’m disappointing my readers all the time with my opinions and it’s important, I think, to stay true to what the data is showing and be as objective as possible about it. You’re one of the few people that I do follow regularly. I love reading your stuff, so everyone who’s listening to this, go check out the blog. It’s one of the most thorough and insightful sources on all of these topics that we discussed today.

And Zoë, we didn’t get a chance to go into much detail on red meat above and beyond its saturated fat content, which as we know is less than its polyunsaturated fat content. But Zoë has recently tackled that, the evidence behind red meat being associated with high risk of heart disease and death. And i'd really recommend checking that out too, because that's another persistent myth that continues to this day.

Zoë Harcombe:  Indeed.

Chris Kresser:  Okay, everybody, thanks for listening. Continue to send in your questions at chriskresser.com/podcastquestion, and we’ll talk to you next time.

The post RHR: The Truth about Saturated Fat, with Zoё Harcombe appeared first on Chris Kresser.

[paleorecipecookbook]

Why We Gain Weight—Beyond Carbs, Fat & Protein with Robb Wolf

Diet is always a hot topic in the Paleo and ancestral health community. There are diehard advocates on every side. Today I talk with Robb Wolf about his new book Wired to Eat. We explore how his approach to diet has evolved beyond just choosing the right mix of carbs, fats and protein and why a personalized approach is the key to understanding weight loss.  In this episode we discuss:

The focus of Wired to Eat

The Paleo diet 3.0

Is it really about the food?

Why the concept of “cheating” is harmful

How stress impacts your weight

The right tool for the job: why personalization is key

Show notes:

Wired to Eat: Turn Off Cravings, Rewire Your Appetite for Weight Loss, and Determine the Foods That Work for You by Robb Wolf  [Note: The book has now been released, but readers of ChrisKresser.com can still get the bonus materials mentioned below by emailing the receipt of their purchase of Wired to Eat to wired2eat@gmail.com by March 27th.]

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Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. In this episode, I'm excited to welcome back Robb Wolf, a good friend and colleague. For those of you who don’t know who Rob is (I can't imagine there are that many of you listening to this podcast), but he is a former research biochemist, health expert, and author of New York Times bestseller The Paleo Solution and the eagerly anticipated Wired to Eat, which is his most recent book that we’re going to be discussing today. He has been a review editor for the Journal of Nutrition and Metabolism and Journal of Evolutionary Health. He serves on the board of directors at a specialty health medical clinic in Reno, Nevada, and is a consultant for the Naval Special Warfare Resilience Program. Rob is also a former California State Powerlifting Champion and holds the rank of blue belt in Brazilian jiu jitsu. He lives in Reno, Nevada, with his wife, Nicki, and his daughters, Zoe and Segan. I'm really looking forward to this show because I think Robb is one of the smartest people in the room when it comes to these topics, and if you’ve been around the Paleo Primal Movement for any length of time, you’ll know that Rob has done more to advance these concepts into the mainstream than pretty much anybody else. His most recent book is a deep dive into the mechanisms that lead to overeating and that govern food intake in general, and it goes far beyond protein, carbs, and fat and calorie intake. So, without further ado, let’s hear from Robb Wolf. Chris: Robb Wolf, welcome back. Robb: It has been a while. You’ve been busy. You’ve been busy. Chris: I saw you two days ago, but it has been awhile on the podcast. Robb: You’ve had a lot going, not much grass grows under your feet. Chris: I've had a few things going on but you have as well. You released The Paleo Solution in 2010, and I don’t think you’ve just been sitting on your hands since then, have you? Robb: Not completely, no. Chris: Well, you had a couple of kids along the way. Robb: A couple of kids, permaculture farm, a 90-pound Rhodesian ridgeback, which was almost the end of my and Nicki’s relationship—yeah, we’ve had some fun stuff. Chris: I think you’ve also been doing a little bit, squeezing in a little bit of work in between those major life events. Robb: A little bit. I joined a medical clinic here in Reno several years ago. I'm on the board of directors and those folks did a two-year pilot study with the Reno Police, Reno Fire Department, where they found folks at high risk for type 2 diabetes and cardiovascular disease and that they’ve put these folks on a Paleo-type diet, got them to modify their sleep and exercises as best they could, and based off the changes in their blood work and their health risk assessment, it’s estimated that the pilot study alone saved the city of Reno about $22 million, with a 33:1 return on investment. Chris: Whoa. Robb: Yeah, I was pretty impressed with that. I was like, “Ah, this evolutionary medicine stuff, there might be something to it.” So, I've been fiddling with that. You know this back story. I've been looking at some opportunities to scale this and hopefully take it to the masses, and that has proven to be more challenging to I thought. But amidst all that process, I've learned a lot and it kind of lit a fire under me to write a second book, which is Wired to Eat. Which looks pretty deeply at the neuroregulation of appetite and it still is very much steeped in this ancestral health/evolutionary biology template. But (and you did this in your book—you really tried not to have a one-size-fits-all approach) I may have made the disastrous decision of trying to do something that wasn’t a black-and-white, all-or-nothing recommendation. Chris: Nine steps to weight loss in five minutes with no effort at all, the groundbreaking new approach. Robb: Yeah.

Robb Wolf explains why you shouldn’t use the word “cheat” when you diet

The focus of Wired to Eat

Chris: You're a total geek like I am, and whenever we get together, we like to nerd out and talk about all the research behind this stuff. You’ve done a really deep dive into kind of like the next level, looking at the mechanisms behind food intake and weight regulation, body fat mass, and not just using the same Paleo evolutionary kind of template, but going deeper to look at what is this big mismatch between our genes and our biology and our current food environment really all about. And how is that driving the epidemic of obesity and metabolic disease? For people who have already read The Paleo Solution, which I think is just about everyone listening to this podcast probably, what’s different about Wired to Eat, your most recent book? Robb: That’s a super-good question, good lead in. The big differences that—somewhat indirectly, I talked about this whole discordance idea within The Paleo Solution. We talk about the observations of preindustrial societies and how despite a really aggressive medical presence, like these folks are remarkably healthy, generally free of Western degenerative diseases. I think it’s really interesting, powerful stuff, but it’s maybe a bit far afield for many people, and still we see stuff devolve almost immediately into these macronutrient wars and folks really getting out in the weeds. And so in reading and thinking about this stuff, I started getting this into—and I'm really backing up a little bit, there was a paper a couple of years ago that was looking at brain evolution, and one of its catchy taglines was “the omnivore's real dilemma,” and it made this really strong case about the fundamental kind of forces that forged not just our genetics in the way that we seek out food, but any organism that moves to obtain nutrients, that there’s this basic need to get more than what you spend on the acquisition of trying to get nutrition, basic calories and also vital nutrients and whatnot. This idea really struck me because I'm like, okay, if we’re wired on a really fundamental level to need to eat more and move less to make that equation work—because we can make a super simple accounting. If you spend more money than you make, you're going to end up bankrupt at some point. From an energetics perspective, if you live out in a natural environment and you consistently burn more calories than what you consume, we’re going to have a serious problem. Wild animals, if they find some food, make a kill, and they don’t consult their Fitbit and say, “Oh man, so I just ate 600 calories, so I need to walk or jog or jumping jack for x number of minutes to burn this off.” Typically, it gets some food and then it goes and lays down and rests. This is the only way that that free-living scenario works. Whereas with humans, because of technology and because of culture, we’ve created these massive surpluses in energy, basically in the form of food, but also convenience measures, and so in a way, you could argue that we’ve pushed that optimum forwarding strategy idea to this mega and ultimate winning scenario. It’s like, “Okay, we can burn one calorie a day trying to obtain food.” We literally click Amazon and then AmazonFresh delivers food to your door and then you pop it in the microwave and you're good. We’re so good now at gaming that system that we have been developing chronic degenerative diseases for quite some time—type 2 diabetes, neurodegenerative diseases. And so this perspective on the neuroregulation of appetite, for me, it’s really almost like cutting the Gordian Knot. Is it about carbs? Is it about fat? Well, maybe. Let’s consider the context, but really let’s look at what governs the neuroregulation of appetite, what allows us to, in a free-living scenario—not being locked in a metabolic ward, but in a free-living scenario—to spontaneously eat in a way that doesn’t make us metabolically broke and then sticks us in an early grave. So that’s really the big difference between Wired to Eat and The Paleo Solution. Both of them are super-steeped in this evolutionary biology framework, but in Wired to Eat I'm really looking first at that neuroregulation of appetite story because when you start then unpacking that piece, then carbohydrates take on a certain context. It’s like, oh, cellular carbohydrates from beans and even properly prepared grains and ... Chris: Don’t say beans, or grains! You’re cut. Robb: I know I'm cut. I'm no longer getting the Cordain inheritance package. Chris: Paleo foul. Robb: But you know these things react to our physiology, and perhaps more importantly, they alter the neuroregulation of appetite and they alter our gut microbiome in very different ways than refined flours or added sugars. Everything from sleep to stress, the stress of altered circadian rhythms, inadequate socialization, all of this stuff feeds back into the neuroregulation of appetite. I think that by looking at that, then we can kind of bypass the macronutrient wars because we're able to get to a spot where we could make a pretty defensible argument that, okay, we just need to find a way, whether it's high carb or low carb, that you individually eat within the parameters that keep you healthy, and there may be certain trigger foods that are inappropriate for you. So we're going to consider all that stuff, but it bypasses the macronutrient wars. It integrates things, like, to what degree does insulin play a role in health and disease? To what degree is the calories-out model accurate or inaccurate? If you start with that first-principle story and then kind of work your way forward, a lot of this stuff, for me, gets quite a bit of clarity. It's still a reasonably complex story, but Stephan Guyenet, we just got to hang out with him last this last weekend. He wrote an amazing book, The Hungry Brain. Chris: I just had him on and we just talked all about those mechanisms, so this is a perfect follow-up to that. Robb: Yeah. Stephan gets so much drama and hate mail, and the guy has just been consummately professional. He's always just presented his case, let the research speak for itself. If you've got a better mousetrap, then let's compare those mousetraps and what not. I really credit him with putting this whole topic into a potentially popular context and his treatment of that material is just really nothing short of stunning. To the degree that I have attempted a treatment of some similar material, I hope I can carry his gym bag on that because it has just been a remarkable thing. In the following, I don't want this to be overly self-serving, but I can make a pretty good argument that I think going forward if we're not talking about two things, if we're not talking about inability to personalize nutrition for folks and if we're not starting this conversation around what goes into the neuroregulation of appetite, then I think that the material at hand is not really topical. It's not really relevant to our current understanding of stuff, and again, that's a very self-serving argument given my book is oriented towards the neuroregulation of appetite. But, again, I think we have a pretty defensible spot on that.

The Paleo diet 3.0

Chris: Yeah. I wouldn't say... it may serve you in the sense that you wrote this book but it's actually true. I’ll just step back and summarize a little bit for people who might be a little lost at this point because we’ve covered a lot of ground.   If we think of we can think of Paleo 1.0 and even weight loss 1.0, which was way more focused on quantity, the quantity of the kind of food you're eating, maybe a voluntary calorie restriction, which doesn't, I think we know, turn out to work very well for most people over the long term. And then, that focus may be switched over to quantity of macronutrient, so initially it was low fat but then more recently it's become low carb, maybe that was 1.5 or even 2.0. What we're talking about now I would say is the 3.0 level, whether we're talking about weight loss or even just a Paleo type of approach to diet, which is that yes, the quantity of calories matters, and yes, the quantity of macronutrients may matter and make a difference, but those are not the best entry points. A better entry point is understanding these concepts of how the brain is wired to control food intake and manipulating those wisely. That will in turn affect your intake of calories and your intake of macronutrient, but it will do it in a much more effective way—in a way that can be tailored and personalized for each person’s particular circumstances and need. It's kind of agnostic to the dogma that surrounds any of these approaches—whether we're talking about Paleo, low carb, ketogenic or any of this stuff—because it's kind of like a meta-perspective that incorporates and ties together all of these notions that have been floating around out there for many years. Robb: Yeah. Very well said, much better said than I did. You should probably write a book on this topic. Chris: You brought up Stephan, and we both agree that Stephan is the smartest guy in the room when it comes to this stuff and we've both learned a tremendous amount from him. I've read both Stephan's book and your book. What I would say to people who are thinking about these two books, or looking for a way to think about them, is Stephan’s book is definitely oriented towards the public and even though he's a scientist himself, it is a popular book. So it's not something that you're going to get lost in necessarily if you're not familiar with the science, but it's not a “how-to” book either. It goes pretty deep into the mechanisms and it's an exploration of how we got to where we are, and it does provide some very practical tips along the way. Whereas, Robb, I think your book does a fantastic job of summarizing all of the mechanisms but goes a little bit deeper into the “how,” like how you can actually utilize these various concepts to create an approach that works for you. That makes sense to me because you've always been concerned with practical application, whether it was running a gym or working with the Naval Special Warfare and the specialty health program that you just mentioned. Do you think that's an accurate summary? Robb: Yes, yes. Both gracious and accurate, yes, thank you.

Is it really about the food?

Chris: Cool. One of your perspectives that I appreciate in the book was a kind of different take on the healthy relationship with food. It's kind of a meme that we hear thrown around a lot in the mainstream media and medical establishment. We should have a “healthy relationship with food,” but what the heck does that even mean, really, and what's your take on that? Robb: Oh man, it's one of those things—my mom’s side of the family is from the Deep South, Appleton, Arkansas. My wife is still kind of perplexed at some of the cowboy witticisms that I'll drop every once in awhile, and she's like, “Where do you get this stuff?” It was totally my grandmother's influence, and you just love these almost Mark Twain-esque pithy sentences in this whole “you need a healthy relationship with food,” like there's something that just intuits with that. Oh man, my inner child is happy when I think about this. It just seemed so good, and then over the course of time and working with people, I just … and again, this started off very empirically, and then I started digging in where I saw some problems, but empirically, I'm working with a person and it comes out there are maybe some challenges, so I'm like, “What's going on here?” We’d start having conversations. Well, in one way or another, the individual articulated the following: I'm trying to develop a healthy relationship with food. I have problems eating or I overeat … whatever the deal is, I'm trying to find a healthy relationship with food. Again, on your first blush, you're kind of like, “Okay, that's totally reasonable.” Who could argue with that? We need to be in a good place with our food, but then over the course of time, in working with these folks, it felt like the mating dance of an exotic tropical bird. You’re like, “Man, if I just wiggle my butt, bob my head, and flap my ears in just the right way, it will allow this person to finally have a healthy relationship with food.” And it just never happened. It was calculating the final decimal point of pi. It just kept going and going and going. Then I started asking some questions. Is it really about the food? And so, I would dig and dig and dig, and what I found is that when people are … Mostly people that I've worked with and I wouldn’t say all of them, but these black-and-white universalities I'm getting more and more hesitant to throw out there, but I mean, a very consistent trend. Put it that way, trying to sound somewhat scientific ... A very consistent trend is that when I've interfaced with folks, that they're in a situation where they are endeavoring towards having a healthy relationship with food, almost always somewhere in the past, this individual has suffered some sort of pain. There's been some sort of a traumatic event that could be family, school, or peer group. It could be a variety of things. And for whatever reason, food has become kind of a palliative tool in dealing with that pain, and then that can lead into essentially overeating. Either making more food choices or consistently just overeating to kind of get the satisfaction and the dopamine release associated with eating. And what I've noticed is that a real strong focus on that relationship with food guarantees that the fundamental underlying issues will not be dealt with. We've turned this into a situation of chasing symptoms and not root cause, and it's going to be an unresolvable scenario versus if we can sit down and say, “Okay, I understand that food has kind of become the focus, but I'm going to throw out this suggestion. I'm not saying it's true, but the suggestion is that this really isn't about food. There's something else deeper here going on that food has become kind of a Band-Aid, has become a symptom. Can we talk about and explore this? Maybe work with a therapist and really get some professional eyeballs and ears on this thing.” And when I help people, guide them towards that path, we've had really, really good success. Now, this oftentimes comes on the heels of these people hitting me, crying on me, or hitting me and then crying on me because it puts them into a potentially really defensive state. And again, to your point when you kind of broached this subject, this is the message that comes out of the media and medicine, dietetics, self-help, and self-care, but I'm just starting to think that this is something that literally ensnares and entraps us and distracts us from actually dealing with the root issues that are ultimately going to liberate us out of this scenario.

Why the concept of “cheating” is harmful

Chris: Yeah. I couldn't agree more. I mean, there's often a myopic focus on food and the particulars around food, without looking at the things that influence food intake that are non-food related. And this kind of reminds me of this whole notion—that became really popular in the Paleo world, but also, any other world that is kind of based on the idea of a strict diet rather than just eating what you should eat that's good for you—of cheating. I just absolutely hate this kind of concept of being on this really super-strict diet and then you cheat. Robb: Right. Chris: To me that's just a setup for failure. Can you talk a little bit more about that? Robb: Oh, man. Again, this is one of those things that when I talk about this people get really angry at me. It kind of flies in the face of what's generally being recommended but— Chris: [Crosstalk] … safe space, Robb. Robb: Perfect. I am happy with that. Chris: Not that you're not going to get some email after this. But here and now, I'm not going to get them out of you. Robb: Perfect. Okay. That's all I need for right now. This was again something that I would kind of experience in working with people. I'd sit down and start working with somebody. We're building a relationship, and maybe about 30 seconds into a conversation, the person is like, “So, what do I get to cheat on? Like, what are my cheats?” And initially, I was kind of like, “Okay this is a reasonable question.” I'm kind of suggesting this Paleo-type shtick, and so this person is wondering, will I ever in my life get to eat a chocolate chip cookie again. So, this is a pretty reasonable question. But over the course of time again, I slowly, empirically … this is an observational story ... but I've noticed, these people that really lead with this cheating idea, they were a handful. There was a lot going on with these people. This gets a little out in the weeds, but I know your listeners are pretty deep down, and so I’ll go out in the weeds more so than what I've done in chatting with other folks about this. I'm a student of evolutionary biology. I'm also kind of a student of the roots of words and like really what the meanings of words are. Oftentimes we use them in a very slapdash fashion, and so from this evolutionary biology perspective, we as a primate, all primates have some really intrinsically deeply woven senses of right and wrong and justice. If there is an individual in a group that's being treated poorly, that is immediately understood within the group, and this is true even with New World monkeys. It's really fascinating. This is a deeply conserved thing, and individuals that cheat or inappropriately treat other individuals in a group, they can be ostracized and there can be really profound feelings of shame and guilt, and this is part of what keeps these primate communities woven together. There are ideas of reciprocity, and literally, “I'll scratch your back today, you scratch my back tomorrow. In the process, we're going to delouse each other.” And so, there's this interwoven stuff, so that is a thing that exists and it's real and it's part of the reason why we exist as humans, that human society is what it is. This is part of the fabric, this justice element that we have in right and wrong. But, when we look at the word “cheat,” the Webster's definition of the word cheat is “to take unfair advantage of someone, particularly at their expense.” So, you knew all about that and you're like, okay, take unfair advantage—ha! Whatever way you want to eat, whether it's Paleo, vegan, macrobiotic, or what have you, if you go off the rails from that plan, are you taking an unfair advantage of someone? Is someone suffering because of your choice? No, not at all. It's absolutely ridiculous. But if we attach this terminology of cheating to a process that really isn’t emotional, really isn't victimizing somebody, we still feel the emotional content, the emotional blow of feeling like we cheated on our peer group, that we did something really profoundly bad, and so, we're taking one element of our kind of primate evolutionary history. We're grafting on this inappropriate terminology of cheating and it guarantees that if we do anything other than absolute perfect adherence to a specific plan, that we're now a cheater and we're a failure and we've let down the peer group, we’ve let down ourselves, and so instead of saying, “Well, the next meal, I'll be back on track,” it's like, “Oh, screw it. It's all hookers and cocaine now y’all. I'm going to Krispy Kreme and shutting the place down.” So, this cheating concept, as what I've seen is, it’s really dangerous. It's dangerous from the perspective that it ties a really powerful emotional trigger to a process that is really a non-issue. If you are generally eating pretty well and let's say we eat three meals a day, seven days a week, that's 21 meals, let's say, 18 or 19 of those meals are generally pretty on point two or three of those meals a week kick your heels up, do whatever you want to do, and so long as that “kick your heels up time” doesn't lead into three or four days of the, you know, wacky eating, over-the-top eating, so long as you're not someone like me who has serious gluten issues and, like, you decide to do a gluten binge and you're sick for a week afterwards, we have some caveats with that. But generally, if we're on point and then we “deviate off the norm,” it just doesn't matter. You made this point at the UCSF medical gig just a couple of days ago. Our goal should be to be as resilient as possible. Ideally, we're like a cockroach. We’re almost impossible to kill, and that's a really good place to be, and it's not to say that then you want to adopt horrible eating habits, but it would be really nice to just be as resilient as possible, and the more you play within some certain lines, that help support that resiliency. But then, when we decide to go a little bit outside the norm, it's not cheating. It’s just living. But again, we make, we make some decisions. We understand that there are consequences. If I decide to have a couple of extra NorCal margaritas, I try to have a little earlier in the evening instead of later because I know it disorders my sleep, but sometimes I'm hanging out with friends and that's just this what's going to go down, and I may not feel quite as hundred percent the next day. But that's okay within the bigger context. And so, it's a long, convoluted treatment of my ideas on cheating, and again, it's a pretty hot-button topic for a lot of folks. It really gets them fired up, but I think if people can think through that whole story and then kind of decouple the emotionality from the reality that, “Hey, you don't need to be perfect all the time.” But at the same time, if you go off the rails, you're just one meal away from being back on. Let's not even get into this cheating discussion or any of that.

How stress impacts your weight

Chris: The idea behind your book is a better understanding of the mechanisms that drive eating behavior. And so that's what we're essentially talking about here is that if you understand human psychology, neurobiology, and these mechanisms, you understand that creating a super-strict program and then having this idea of cheats is not in alignment with what we understand about human psychology. It's much more successful to, just as you said, create the ideas that you're changing your diet to something that is going to promote health and well-being in many different ways, and you're not on a diet. You're just changing the way that you eat, and in that context, there really isn't any room for cheat. Cheating doesn't really make sense because who are you cheating and what exactly what are you cheating on? Robb: Right. Chris: It's also important, we can maybe use this as a segue to talk about some of the non-food behaviors that influence food intake and overall health that you talk about in Wired to Eat. There was a question at the symposium that we're both up on stage for the panel with a guy who is really excited and enthusiastic about Paleo, and his question was “Where can I go on vacation that will have a hundred percent-compliant Paleo food?” Are there Paleo retreats and vacation programs? And then he asked me, “Where can I go out to eat that's just like a strict Paleo other than Mission: Heirloom here in Berkeley?” Robb: Right. Chris: And again, those are fair questions. You understand how someone could be thinking that way, especially if they've gotten a lot of benefit from eating that way. But my response is maybe not what he was expecting and I think probably in alignment with what you're talking about now. Robb: Yeah. And your response was great. You're like, “Go on vacation and have fun.” It sounds like madness. Chris: Because it's not all about food is it? Even if it was, you could, you could almost make the argument that having a break and having some time to rest and relax and taking some pressure off would actually, over the long term, make it easier for you to stick with your program. Robb: Right, right. It's just interesting because I've noticed for ages that if I get close to the equator, if I get sun on my skin, if I'm in ocean water in particular, my carb tolerance is amazing, my digestion is phenomenal, my libido is great and everything, and I'm kind of like, “Okay, why do I not live in the water?” But you still have to raise kids and make a living and all that stuff. It's fascinating, but I think there's kind of two pieces to this that I see. One is that you go to an event like that, and it's, like, just get into it, particularly if you're traveling internationally or something like it. Immerse yourself in the culture and try to get as much out of that as you can. And then, the other piece is that when we're out of this really stressful, sometimes monotonous nine-to-five, standard day-to-day living, and we get in that vacation mode, you're oftentimes quite a bit more resilient because your total allostatic load, your total stress load is a lot less, so you kind of get away with a little more fun and kick your heels up a little bit. I think that it's an interesting insight in that. “Okay, if I sleep better and my stress levels are better, that means my digestion is better. Wow! Lo and behold, I eat more carbs but I'm even leaner than what I was home.” We had so many clients that would come back after a vacation in Mexico and they're like, “This Paleo diet’s bonk. I ate tacos, drank margaritas, and I'm leaner than what I was.” And I'm like, “Yeah, but you were sleeping 12 hours a day.” And then they get back in their usual routine, and the tacos plus margaritas plus the stressful routine now ends up being a real problem. But it's a really good learning opportunity that it's like, “Oh, I need to make everyday look a lot more like vacation and then I'll be a lot better off.” And it's like, “Yeah, that's a great insight.” Chris: Yeah, I can't tell you how much. As you know, I treat patients with some pretty significant complex chronic diseases, and that's even true for them or perhaps especially true for them. And one of the key questions that I ask people during the intake process for new patients is, do they feel the same way when they're on vacation? And that actually gives me a kind of a hack for getting a rough sense of how much stress and just their daily routine and behavior and lifestyle is contributing to their condition. Robb: Right. Chris: And I can say that 9.75 times out of 10 they feel better on vacation and their resilience goes up. That's what we're really talking about here, is resilience. Humans should be resilient by nature. A really healthy human being can tolerate a lot of insults basically. That's a sign of health. Health is not being super-fragile to the point where if you deviate even one half-of-one percent from your routine that you fall apart. That's not health. Robb: Yeah. That's sometimes worn as a badge of honor, and it's actually just a target that you've painted on yourself. Evolution is working to remove you.

The right tool for the job: why personalization is key

Chris: Exactly. Thank you. I think these are super-important topics, and I'm glad we're covering them and that you cover them in the book because there's so much more to this than, like you said, protein, fat, and carbohydrates. Not to contradict myself, but there is still a role, of course, for more specific and advanced interventions in certain cases, when people are dealing with more advanced conditions like neurological disease, memory decline, traumatic brain injury, or something like that. I've personally become really fascinated with fasting and ketosis as interventions in these kinds of conditions, especially because the conventional alternatives are either non-existent or sometimes worse than the diseases themselves. Robb:  Right, right. Chris: You covered that a little bit in your book. What have you found in your research and in your self-experimentation, also working with all of these high-level servicemen and women, and other populations that you've been working with? Robb: Yeah. It's interesting. My first real foray into “ancestral eating” was a ketogenic diet. I was super sick. This idea of a low-carb diet removing common gut irritants, and kind of repairing the metabolism got on my radar back in 1998, and it was incredibly profound for me. My whole life before this—and I got sicker and sicker as I went along, and I was the ripe old age of, like, 26 or 27 at this time and I was an absolute mess. But looking back, I had developed some type of an insulin resistance rebound hypoglycemic deal where when I was eating one meal, my current meal, I was thinking about the next meal and when it would go down and what the composition would be because I was terrified of hitting one of these hypoglycemic events because I would get shaky, tunnel vision and just like crazy. And then, when I ate this ketogenic diet, it was like just a switch had been flipped and I had rock-solid energy all day. I could eat. I didn't need to eat. I would go a day without eating or I could eat six meals a day and 6,000 calories. Everything was great at either end of that spectrum. It was incredibly liberating, and it really piqued my interest in this idea of low-carb diets and ketosis and then, by extension, fasting. Unfortunately, what it did also, because this works so well for me, it created a pretty profound confirmation bias where I assumed that this was the one true way for everybody to eat. This was going to be the solution to everyone's ills. If you've got a nail that you need to drive in a wall, a hammer is a really good option, a wrench is a somewhat less good option, and a bandsaw is a worthless option. When you start thinking about appropriate tools for the appropriate situation, there are so many incredible opportunities to use things like ketosis and fasting. I think the neurodegenerative story … I've been pretty geeked out on the autoimmune piece, but I'm finding some things like a fasting mimicking diet instead of continuous ketosis may be very, very beneficial for autoimmune diseases. But these neurodegenerative issues which are intractable, we don't really have much of anything we can do for the vast majority of them. There may be some really legit opportunities there. People have to eat, so there's a certain base level of cost baked in the cake. And so, if we just have them eat differently, eat in a different timing scheme or eat less frequently, or what have you, and we may be able to prevent, reverse, mitigate huge amounts of things like Parkinson's, Alzheimer's, senile dementia, and slowly the mainstream medical scene is kind of warming up to this idea. Ten years ago this was really, you were a heretic and a quack suggesting that there was some therapeutic potential here. I think today, we're finding many many more people open to this, or there is more research that will happen on this topic in the next five years than has occurred in the last 50 years. There are some really powerful opportunities to start implementing this stuff. But at the same time, it's kind of funny because even though … you could argue that within this internet era story, I've maybe been out there beating the drum in favor of low-carb diets and ketosis and fasting longer than just about anybody, but because I'm now in a spot where I'll say, “Man, they’re just the bee's knees for the right situation, but it’s not always the right situation.” Like, a CrossFit games athlete, I've tried to run them low-carb and keto-fueled and I've broken them! There are some people out there that are claiming to be able to do it, and they're doing some targeted ketogenic approaches where you're generally ketonic and will do 50 grams of carbs right before a workout. And so, there's maybe some hacks there, but still, it's not a classic ketogenic diet, and so there is this need for an appropriate tool for the appropriate situation. But man, I get people angry at me. There are groups of people who will say, “You're an idiot for recommending ketosis at all. It's going to kill people.” And then at the same time, you have other folks that are saying, “You're an idiot because everybody should be in ketosis every day all the time.” And I'm kind of like, “How am I wrong in both of these completely different camps?” Whereas actually the reality of things is there's kind of a middle ground that these are legitimately really effective, unfortunately underutilized tools. And like any other tool, you don't use them for everybody every day all the time. Chris: Yeah, I couldn't agree more and have a similar experience. Anyone who has been listening to this show for a while will know that I am a strong believer in an individualized approach and using the right tool for the job. Ketosis and fasting can be incredibly helpful, but they're not for everybody and they're not even for everybody with these conditions. You can't say that it's going to have a hundred percent success rate for someone with Parkinson's, for example. I have two patients with post-concussion syndrome following TBI, and one patient benefited tremendously from fasting and ketosis, and the other patient got significantly worse. So, who knows? There is still a lot we don't understand about this stuff. I think especially if you're someone who is working with patients or clients, you’ve got to let go of any attachment to a particular idea and just be willing to respond to the experiment and respond to what's happening in front of you because if you don’t do that, you're going to, you're going to hurt people. Robb: There are lots of cool nuances there. The person who didn't respond to the ketosis and fasting specifically, maybe ketosis is enough of a stress that it disordered their sleep and now we know that disordered sleep will make these TBIs and post-concussion syndrome issues worse. So maybe that person could benefit from a low-glycemic load, but still carb-inclusive diet, but then we're getting to use pretty aggressively MTC oils, maybe even some ketone salts or something like that and play with that. We've got a rheostat these days. We've got a selector dial where we can still think about this mechanism. Okay, in TBI, we usually see some insulin resistance in the brain. We see some substrate depletion. We've got some membrane depolarization issues, if you really want to auger down really deep, but the ultimate answer is, let's reduce inflammation and provide an alternative fuel substrate, and there is a variety of ways that we can do that. We could fast. We could do nutritional ketosis. We could do what I call a transitional ketosis approach, which is moderate low-glycemic, low-carb intake and then supplement with MCT oils. So, we have a lot of different tools in our toolbox now, and over the course of time, we might be able to get to a spot where we're like, “Okay, your genetics are these, your gut microbiome is this, and so you just suffered a TBI and you're going to be the transitional ketosis that works 98.6 percent of the time.” Until we get to there though, we just need to do a little bit of clinical experimentation. Chris: Yeah, absolutely. And I like your point about nuances. Unfortunately, the wide blogosphere and mainstream media seems to be allergic to nuance and incapable of incorporating it into their thought process. It has to be kind of black and white and oversimplified to get any attention at all. Robb: It's tough because I think there's a little wisdom in that to a degree because you have somebody who is completely unsophisticated in this topic and rightfully so. They're an engineer or a teacher or something, they're not spending all day, you know, talking about this stuff on the internet, and then they have a health problem or they have some sort of a desire to just lose weight or something like that. And then, what do you do? What do you tell this person that’s simple enough to get them moving in the right direction and not overwhelm them with all the details? I think that even though there is … and this is the challenge, how do you keep a general message out there? And we can funnel some people in the front end of this that’s like, largely whole, unprocessed food, go to bed earlier, exercise a little bit. And then, as we move them through this process, then we're like, “Oh, okay, you're doing pretty good, but we have some hang-ups here.” And here's where we need to get more granular and get more detailed. The challenge, though, is that those big-picture, black-and-white stories get written into stone tablets and turned into religious doctrine, and then you can't have any discussion around the nuance like that. That's the bugger. That's the challenge as I see it. Chris: Yeah, no doubt. I mean nuance admittedly is not conducive to getting a big public health message out there. Robb: Right. Chris: And people get overwhelmed with that complexity. But I think for our audience at least, and people who are really paying attention to this stuff, it's important to communicate that. I can't tell you how many—I mean, I can tell you, I have, and you know—how many people I see who come in with these ideas and they're hurting themselves because they're trying so hard to stick with these black-and-white concepts when they just don't match up with their reality. I spend so much time trying to educate people on how to be their own advocate and to observe what's actually happening, do their own experiments, and pay attention to their own responses to things and to use that as their guide. But that's admittedly, to your point, it’s a lot more difficult than just following instructions because you really have to pay attention. And also, I think it's stressful for people to have that level of agency where the decision falls to them rather than to some external authority. Robb: I’ve never thought about it like that. Huh. That's a really good, super-good point. Chris: I know you're kind of a behavior-change geek too, but there's this concept of decision fatigue, right? We only have, we only have a certain amount of mental energy to make decisions throughout the day, and once that's used up, we kind of buckle and we can't. And so, I think for people having to add more decisions that they need to make around their food and diet choices and all of that stuff on top of what they're already existing, decision fatigue is asking a lot. That's why I think programs like Whole30 and Paleo 30-Day Resets are so successful because people don’t have to make those decisions. Robb: Right. Chris: And that's fine for a starting place and for perhaps a first book. Robb: Right. Chris: But then inevitably, you come up against the challenges associated with sticking to that kind of program. There's a place for all of it, you know. Robb: Absolutely. And you know, we saw a little bit of this weekend when Stephan Guyenet did his presentation on his thoughts around the insulin hypothesis. There were some people that needed a hug at the end. They were like, “What the fudge just happened?” And they're like, “So, people can eat whatever they want?” And we're like, “No, no, no, no.” There is this neuroregulation of appetite. There are these other issues, but Stephan was doing a really phenomenal job of keeping it one hundred percent on that topic of “Is insulin the driver of obesity,” and he does a very compelling takedown on that. But man, some folks were … it was like yanked out from under. Chris: Right. And when you've already been through that whole process, it's easy to see it in somebody else, but confusing the mechanism with the effects. If someone says, “Wait a second, how can you be saying that carbs aren't the cause of weight gain because I went on a low-carb diet and I lost weight? Therefore, that makes it impossible that carbs are not the cause, or at least were not in my case.” That doesn't actually follow. There's another argument that makes both of those things that seem like they couldn't be true at the same time true, and of course, that's the argument you're making in your book and Stephan made in his book. But at first glance, it might not even seem possible that those two things could be true. I mean, this stuff requires some thinking at this level, but I think we're at that point now and in this overall discussion that we're having on these topics that it's time to be talking. It's time we’re having this discussion and not just going on with the same old oversimplifications that have gotten people in trouble. Robb: Exactly, and particularly with things like what you're doing with the Kresser Institute and there are so many more coaches and healthcare providers that are now becoming that next layer of interface with people, and so even if the unwashed masses are not really operating at this level of sophistication, definitely health coaches, healthcare providers need to be thinking about that interface of, “Okay, what's our simple heuristic? What’s our simple story to kind of get people in the door, get moving in a good direction?” And then, how do we keep them comfortable with the idea that this may be granular, there may be individual variances? Your wife may react differently than your uncle, and you’re different than both of them. But we have a great opportunity now to start having that nuanced conversation. Chris: Well, Robb, it's always a pleasure to have you on the show. Robb: Thanks, man. Thank you. It was great hanging out with you in real life and great spending a little bit of time with you on the podcast. Chris: Absolutely. So, now this one's in the bag and coming out, when would folks be able to buy this book? Robb: Wired to Eat will be released officially March 21st. That's when it will be in brick-and-mortar stores. Amazon and all the other online book vendors will mail it to folks. It's available for preorder, clearly, before that, and for folks that preorder the book, we have a pretty cool swag bag for folks. [Note: The book has now been released, but readers of ChrisKresser.com can still get the bonus materials mentioned below by emailing the receipt of their purchase of Wired to Eat to wired2eat@gmail.com by March 27th.] If they go to http://ift.tt/2nsScKB, we have a workbook that helps you navigate the 30-Day Reset and the 7-day Carb Test that really helps you to implement the triage process that I have in the book to help you understand where you are on the insulin-resistant, insulin-sensitivity spectrum and kind of plug you in an appropriate place with regards to carbohydrate intake. We have what used to be the first chapter of the book, called “Lies, Damned Lies, and Statistics,” and it is my favorite chapter, but the publishers of the book were already really big, and they're like, “So, you're doing this huge historical treatment of how the food system came to be and where our healthcare system is.” And I'm like, “Yes.” And they said, “It's too much. It's got to go.” And I was like, “Damn it.” But we repurposed it into a downloadable guide, and I'm really proud of that chapter, honestly. There’s some pretty funny stuff in it, and I think it really sets a historical perspective for how did we get here, and then we can start making some thoughts about how to uncouple from that. I also did an interview with Dr. William Cromwell, who's the head of cardiovascular disease research at LabCorp and LipoScience. We got in and talked about what do we see in the basic blood panel, what are the laudable and challenging deficiencies of that, and then what might we want to look at so that we get a more nuanced and a more informed picture of what's going on. He talked about some soon-to-be released stuff like some super-early predictive measures that you can get out of this NMR profile, like this marker called GlycA, which is an inflammatory marker, but my understanding of this is that potentially, we could start seeing predictions of you developing type 2 diabetes 98 percent likelihood within 15 years based off these GlycA readings. It gives you a really early view before we really see any of the classic metabolic symptoms even popping up—before blood pressure increases, before blood glucose goes sideways, before insulin levels start going up. Chris: I know all of that stuff will be super-useful, in particular the interview with Dr. Cromwell. There are some real all-stars in the lipidology world. He is definitely in the top five people you want to be talking about this stuff with. Just quickly before you finish up, what's next? Robb: I'm working with Diana Rogers on a sustainability book, and so we're kind of asking this question, “What is sustainability? What might a sustainable food and medical system really look like?” We're mainly looking at the food with the medicine and food production side clearly has an interface. I'm really excited about that. I love the protein, carbs, fat up to a point, but I've been doing that for a long time and my, I guess, kind of my legacy play at this point is hoping to get folks fired up about where are we going in this overall story of food production and sustainability and the environment. I think it's a natural process. People may start off sick and then they get healthier and they feel good, and then they're like, “Oh, now that I feel good I want abs.” And so they get abs. And then, at the end of that they're like, “Okay, what do I do next?” And I'm like, “Well, we take all this newfangled energy and we funnel this into creating a much better world for our kids and grandkids.” And so, I think it's kind of a natural progression as this ancestral health scene grows and kind of matures, I think we'll see much more interest in it. I feel like the timing on this sustainability-oriented book will be really good, but that'll probably be out in 2018. Chris: Cool. I really look forward to it too. It’s a super-important part of this whole discussion. All right. Again, always a pleasure. Wired to Eat—check it out on Amazon. I look forward to having you back after the sustainability book, if not sooner. Robb: Awesome. Thanks, Chris. Take care.

Source: http://chriskresser.com March 23, 2017 at 10:50PM