Clearing the confusion around saturated fat, cholesterol, paleo & keto with Dr Michelle McMacken

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In Episode 37 I sit down for the second time with Dr Michelle McMacken (previous guest on Episode 2) to talk about where the science lies in terms of eating for longevity.

Dr Michelle McMacken Plant Proof Podcast Cholesterol Saturated Fat Plant Based Vegan

We talk about a plethora of fascinating topics including:

  • Michelle’s project with Bellevue Hospital which is now offering out-patients with chronic disease the option of participating in a plant based food program
  • Where the science lies in terms of saturated fat & cholesterol and their contributions to disease
  • The particular type of fat & cholesterol we need to be worried about when it comes to atherosclerosis (narrowing of our arteries) and cardiovascular disease
  • Sources of healthy fats
  • The Paleo & Keto diets and where the science sits in terms of these diets being helpful or harmful from a longevity & disease point of view
  • What Type 2 diabetes is and helpful nutritional information for managing and reversing this disease
  • and much much more

This is an absolute cracker of an episode, one of my favourites so far in terms of breaking down the science, clearing the confusion and helping us all understand what we should be eating more of and what we should be eating less of.  Grab a pen and paper…you’re going to want to take notes and more than likely listen 2-3 times!

To connect with Michelle you can find her on Instagram @veg_md – I strongly suggest following her page as she often posts really helpful information directly from the many lifestyle medicine conferences she attends and speaks at.

Extra information from Michelle on Cholesterol & Saturated Fats:

Following our episode Michelle kindly sent through a summary of cholesterol for the show notes which you can find below:

Non-HDL cholesterol = total cholesterol minus HDL cholesterol. This includes not just LDL, but all of the other atherogenic lipoproteins, including intermediate-density lipoprotein (IDL) and very-low-density lipoprotein (VLDL).
Both non-HDL cholesterol and total cholesterol-to-HDL ratio are considered by many to be better predictors of cardiovascular risk than LDL cholesterol alone, based on numerous studies.
However, simply raising HDL via diet or drugs, and thus altering the non-HDL cholesterol and total cholesterol-to-HDL ratio in an apparent “favorable” direction without lowering LDL, has not necessarily been shown to improve cardiovascular outcomes. In contrast, altering the non-HDL cholesterol and total cholesterol-to-HDL ratio in a favorable direction by lowering LDL has been shown in countless observational and randomized trials to be highly protective against cardiovascular disease.
This is in part because HDL function (eg, its efflux capacity, or ability to remove excess cholesterol from tissues and return it to the liver to be excreted in bile) appears to be more important than HDL quantity when it comes to cardiovascular risk. Moreover, HDL can become dysfunctional and pro-inflammatory in situations of oxidative (cellular) stress. For example, saturated fats, which are known to raise HDL, also have been shown to render HDL more inflammatory and atherogenic.
Check out the references summarized below:
Consumption of a saturated fat reduces the anti-inflammatory potential of HDL and impairs arterial endothelial function. In contrast, the anti-inflammatory activity of HDL improves after consumption of polyunsaturated fat.
From the above review of the scientific, epidemiological and clinical data, it becomes apparent that HDL functionality plays a much more important role in atheroprotection than circulating HDL-C levels. Plasma HDL constitutes a heterogeneous group of particles with diverse structure and biological activity, and very high HDL-C levels are not invariably protective but rather, under certain conditions, may actually become pro-inflammatory. HDL functionality is dependent upon genetic, environmental, and lifestyle factors and may be modified in several disease states. HDL cholesterol efflux capacity from macrophages is a key metric of HDL functionality and exhibits a strong inverse association with both carotid intima media thickness and the likelihood of angiographic CAD, independent of the HDL-C level.
Recent research has demonstrated that cholesterol efflux capacity may play an important protective role in atherogenesis and clinical ASCVD. It appears that the CEC of HDL particles may be more important than the absolute HDL-C level for atheroprotection. This finding may help explain the overall negative results seen in the trials of pharmacologic agents aimed at increasing the absolute level of HDL-C. Multiple studies have demonstrated that CEC inversely correlates with adverse ASCVD events, even after adjustment for traditional cardiovascular risk factors, including HDL-C. Although CEC has shown promise as a biomarker, more studies are needed to determine if CEC has any clinical utility as a prognostic tool or as a therapeutic target to reduce ASCVD.
Michelle McMacken, MD
Assistant Professor of Medicine, NYU School of Medicine
Director, Bellevue Hospital Weight Management Program
Internal Medicine, Plant-Based Nutrition, and Lifestyle Medicine
Twitter & Instagram @Veg_MD

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