In episode 529 of Sigma Nutrition Radio, we discuss all things related to cholesterol, atherosclerosis, heart disease, and dietary fat. The discussion extensively covers the impact of LDL cholesterol and ApoB on atherosclerotic plaque progression, cardiovascular events, and the benefits of early LDL lowering interventions, particularly through the use of PCSK9 inhibitors alongside statins.

We address misconceptions prevalent in the low-carb and carnivore communities, dissect claims regarding saturated fats, and elucidate why atherosclerosis predominantly affects arteries and not veins. The episode sheds light on the nuanced mechanisms of cholesterol metabolism, the significance of different lipid particles, and the limited dietary impact on LP(a) levels.

Comprehensive evidence-based insights and practical recommendations for dietary patterns and cardiovascular health interventions are provided, offering clarity on these complex topics.

Note: This discussion is hosted by Simon Hill, and originally appeared as an episode of The Proof podcast.

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• Episode with Professor Chris Packard

Timestamps:

• 07:19 Understanding Cholesterol and Lipoproteins
• 14:35 The Role of ApoB in Cardiovascular Risk
• 25:10 Atherogenic Lipoproteins and Their Impact
• 37:42 Causal Pathways and Biomarkers in Heart Disease
• 47:02 Understanding Residual Risk and Triglycerides
• 49:46 Paul Saladino’s Claims on LDL and Metabolic Health
• 01:03:01 Addressing Concerns About Lowering Cholesterol
• 01:16:16 The Importance of Early Intervention in Cholesterol Management
• 01:23:36 The Future of Cholesterol Management and Gene Editing
• 01:28:24 Atherosclerosis in Arteries vs. Veins
• 01:36:08 Dietary Interventions to Lower ApoB Levels
• 01:47:55 Modifying Keto Diet for Better Health Outcomes
• 01:56:33 Plant-Based Diets and Fat Consumption
• 02:05:10 Understanding Lp(a) and Its Impact on Health

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The consumption of red meat, specifically the distinction between unprocessed and processed varieties, has been a subject of considerable debate in nutritional science and public health. There is a fair amount of confusion and lack of clarity surrounding this issue.

While the harmful effects of processed meat are well-documented and less controversial, the evidence concerning unprocessed red meat is less consistent. This inconsistency often leads to a gray area in scientific discussions and public perception. In examining unprocessed red meat, we encounter a spectrum of claims, including minimal evidence of harm, context of overall diet and mechanistic concerns.

Epidemiological evidence shows varied health outcomes related to red meat consumption across different populations. These variations underline the importance of defining and measuring “high” and “low” intake levels accurately in research.

The challenges in nutrition research, including methodological flaws in meta-analyses and the rapid dissemination of simplified study results, can impact public health recommendations. Misinterpretations can arise from comparisons within narrow intake ranges or from studies failing to specify absolute intake levels.

This podcast episode’s goal is to clarify existing evidence, acknowledge areas needing further research, and explore why this topic is significant in the broader context of nutrition science, aiming to equip healthcare professionals with the knowledge needed to make nuanced and effective dietary recommendations.

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• 01:00 Introduction to the issue
• 03:16 Processed vs. unprocessed red meat
• 05:54 Health guidelines and recommendations
• 06:56 Epidemiological evidence and dose thresholds
• 09:55 Biological mechanisms and plausibility
• 21:00 Criticisms and misinterpretations in research
• 40:42 Substitution analyses and dietary patterns
• 46:37 Mendelian randomization and genetic studies
• 56:31 Effect modifiers and confounders
• 01:13:18 Key Ideas Segment (Premium-only)

Hypertension, commonly known as high blood pressure, is a silent yet prevalent health issue that affects millions of people worldwide. Often going unnoticed until significant damage has been done, hypertension can lead to severe cardiovascular complications if not properly managed.

Mechanistically, the causes of hypertension are complex, involving both genetic and lifestyle factors. The management of hypertension presents multifaceted challenges, encompassing both pharmaceutical treatments and lifestyle modifications.

From a prevention and management standpoint, understanding the interplay between genetics and lifestyle is crucial. This raises several important questions…

• To what extent do genetic factors contribute to hypertension risk compared to lifestyle choices, and how does this interaction influence disease progression?
• What role does lifestyle play in managing hypertension, and is there evidence supporting the influence of specific dietary patterns and nutrients, particularly sodium and potassium, on blood pressure control?
• How do exercise and physical activity impact blood pressure, and what types of exercise are most beneficial for individuals with or at risk of hypertension?
• What are the main categories of antihypertensive medications, and how do these drugs work to lower blood pressure?
• What are the potential side effects, and how should clinicians decide on the best treatment approach for individual patients?

In this episode, we are joined by Dr. Mohammed Alo, a board-certified cardiologist and internal medicine specialist, who will help us understand the intricacies of hypertension and how it can be effectively controlled.

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• dralo.net/
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Timestamps:

• 03:28 Dr. Alo’s Background and Expertise
• 08:40 Understanding Blood Pressure and Its Implications
• 10:26 Causes and Diagnosis of High Blood Pressure
• 12:42 Lifestyle Modifications and Treatment Options
• 30:26 Medications for Blood Pressure Management
• 38:34 Combination Therapy and Patient Variability
• 43:11 Debunking Myths About Sodium and Blood Pressure
• 57:29 Exercise and Lifestyle Interventions

Food science and behavior are intimately connected. One critical but often overlooked facet of this connection is food texture and its substantial impact on eating behavior and energy intake.

Food texture encompasses characteristics such as hardness and structure. It categorizes food into liquids, semi-solids, and solids, each with a wide range of textures—from dry and crispy to elastic and more substantial. This classification deeply affects how we consume food. The time it takes to chew and swallow a food item can vary greatly based on its texture.

Different textures can also influence the speed at which satiety signals are triggered. Eating rate is a highly individual trait, stable over time, and consistent across different contexts. Some people are naturally slower eaters, while others consume food quickly. This variance can have significant implications for energy intake and body weight.

In this episode, Dr. Marlou Lasschuijt, an assistant professor in the Sensory Science and Eating Behaviour group at Wageningen University, discusses the above topics and their implications.

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• The Restructure Project
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• 00:14 Introduction
• 00:47 Dr. Lasschuijt’s Research Focus
• 04:23 Understanding Food Texture and Eating Behavior
• 06:37 Impact of Food Texture on Satiation and Eating Rate
• 16:55 Applications and Innovations in Food Science
• 18:31 Unanswered Questions
• 25:34 Practical Recommendations
• 27:00 Current and Upcoming Research Projects

Cholesterol-lowering medications, particularly statins, play a pivotal role in reducing low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) concentrations, which are causal markers in atherosclerosis development. The efficacy of these medications is well-documented, with numerous clinical trials demonstrating substantial benefits in reducing cardiovascular events and improving overall mortality rates.

Despite the robust evidence supporting the benefits of cholesterol-lowering medications, there are various misconceptions and misunderstandings regarding their use. One common myth is that these drugs are unnecessary for those without overt cardiovascular symptoms, ignoring the preventative benefits for at-risk individuals.

Concerns about side effects, such as muscle pain, liver damage, and cognitive impairment, are often exaggerated. While side effects are possible, they are typically mild and manageable. Regular monitoring and adjustments by healthcare providers can help mitigate any adverse effects, ensuring that the benefits of reducing LDL-C and apoB far outweigh the risks.

In this episode, preventative cardiologist Dr. Paddy Barrett discusses the different types of lipid-lowering medications, their mechanisms of action, the side effects that may occur, and the misconceptions about the drugs that are unfortunately widespread.

Timestamps:

• 00:14 Introduction
• 03:26 Dr. Barrett’s Background
• 04:50 What is “Lipid Lowering”?
• 05:30 Overview of Lipids and Atherosclerosis
• 09:58 Setting Targets for Lipid Levels
• 15:52 Medications for Lowering LDL and ApoB
• 20:12 Statins: Types, Effects, and Side Effects
• 35:38 Addressing Concerns and Misconceptions
• 42:47 Future of Lipid Lowering Therapies

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• drpaddybarrett.com
• Dr. Barrett’s Substack
• Book: Heart. An Owner’s Guide
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When aiming for healthy aging and reducing chronic disease risk over the lifecourse, exercise, specifically a combination of resistance training and cardiorespiratory fitness, has a fundamental role to play. In addition it can mitigate age-related declines and support independence in later years.

A strong evidence base exists showing the benefits of increased strength and cardiorespiratory fitness on a range of important outcomes related to lifespan and healthspan. But some intriguing questions remain, such as:

• How strong is strong enough?
• At what point do we maximize the benefits of exercise?
• How “fit” do we need to be?
• Is simple participation enough or do we need a true training adaptation?
• How can this actually be implemented in practice so that it is doable?

In this episode, Dr. Jordan Feigenbaum shares his insights on this topic and offers advice on how we can increase our probability of a long healthspan, through exercise interventions.

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• Barbell Medicine

Timestamps:

• 04:40 Dr. Feigenbaum’s Journey and Barbell Medicine’s Mission
• 05:57 Defining and Achieving Healthy Aging
• 10:37 The Impact of Exercise on Health and Longevity
• 28:52 Strength Training: How Much is Enough?
• 38:43 Muscle Mass vs. Strength: What Matters More for Health?
• 47:18 The Paradox of Muscle Mass vs. Strength
• 49:05 Designing an Effective Strength Training Program
• 01:01:27 Cardiorespiratory Fitness: Importance and Assessment
• 01:06:19 Optimizing Cardio Training: Intensity and Volume

Contemporary society is witnessing a growing interest in, and embracing of, plant-based diets. Numerous athletes are now gravitating towards such dietary choices, motivated by concerns for health, performance or ethics. Consequently, coaches, nutritionists, and other fitness experts find themselves increasingly tasked with guiding athletes who adhere to plant-based diets. For coaches and trainers, understanding the possible impacts of these dietary preferences on athletes’ objectives is paramount, as is devising dietary plans that optimize their performance. This episode discusses the scientific and practical aspects of supporting athletes who have adopted a vegetarian lifestyle and diet.

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• Go to episode page - See related episodes
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The Food Frequency Questionnaire (FFQ) stands as a cornerstone in nutritional research, offering valuable insights into dietary patterns and habits over a specified period. Despite its widespread use and established utility, the FFQ has not been immune to criticism, much of which arises from a misunderstanding of its purpose and inherent limitations.

At its core, the FFQ is designed to assess the frequency and quantity of food consumption, aiming to capture long-term dietary behaviors rather than precise intake levels. Researchers employ it to investigate relationships between diet and various health outcomes, such as chronic diseases or nutritional deficiencies.

However, critics argue that its reliance on self-reported data introduces biases and inaccuracies, leading to potential misestimation of nutrient intake. Additionally, some detractors question the FFQ’s ability to capture sporadic or infrequent dietary choices accurately.

Yet, it’s crucial to recognize that the FFQ serves a specific purpose within the realm of nutrition research. While there are no doubt limitations, its strength lies in its ability to capture habitual dietary behaviors over an extended period. Moreover, researchers employ various strategies, such as validation studies and data adjustment techniques, to enhance the FFQ’s reliability and validity.

In this episode, world-leading nutrition epidemiologist Dr. Deirdre Tobias discusses the development of the FFQ, the key concepts that are crucial to understand, common criticisms of the FFQ, and how we should evaluate the utility of this tool.

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