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Why does Dale Bredesen recommend limiting Saturated Fat?

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  • Why does Dale Bredesen recommend limiting Saturated Fat?

    In his RECODE protocol Dale Bredesen recommends a low-carb high-fat ketogenic diet, but then he says to limit saturated fat. I wasn't able to find the rationale for that recommendation, unless he's subscribing to the SFAs-cause-heart-disease theory and is extending that theory to include vascular dementia. But that theory never had any good evidence behind it and the recent PURE study couldn't find any connection between SFAs in the diet and heart disease.

    Given that Dr Brewer has attended Dale's training course, can he shed any light on Dale's reasoning?

  • #2
    I was not able to get confirmation of my understanding. But my impression was similar; that he was yielding to previous interpretations that saturated fats should be avoided. He seems to focus on the cognitive impairment science and just adopt the Functional Medicine interpretation of everything else. His wife is a Functional primary care doc. And the IFM runs his training seminars.

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    • #3
      What fats are good then? I thought saturated was best.

      Comment


      • #4
        Robin,

        You may be aware of the big disagreement between the Keto and the Vegan camps on which diet is best. The thing is that people can differ enough in their genetics to make it difficult to determine without having a genetic test along with an understanding of their current metabolism. HMGCR and PPAR alpha are examples of genes which deal with saturated fat metabolism, and some people process saturated fat better than others. One other thing of interest in the Keto camp now is for those whose lipids go through the roof when they eat a LOT of saturated fat. Some people say that it is a "natural" reaction, but others say not so fast given the understanding of how lipids affect cardiovascular disease for instance. I have heard that people who present with those very high lipid levels are able to significantly moderate the increase by changing from saturated fat to mono-unsaturated fat. So, drown in olive oil instead of that big steak every night.

        Comment


        • #5
          I went from a vegan diet that gave me an A1C of 4.9 but raised blood glucose fasting and after some carbs ... and my lipids were messed up...switched to a low carb high fat diet and added niacin and high vitamin c and other supplements and my lipids are optimal but my a1c has risen to 5.8 and FBG to 110 at times. So do I go back to vegan with grains and fruits and veggies to fix my a1c and risk messing up my lipids? It’s like I need two different diets for two totally different issues.

          Comment


          • #6
            That's really counter-intuitive. Are you saying your blood sugar and A1c drop when you eat carbs & go back up when you stop eating carbs?

            Comment


            • Robin
              Robin commented
              Editing a comment
              No, what I am surprised about is that my new low carb, high fat diet along with niacin totally corrected all my lipid panel including my Lp(a)...which is what I came to Prev Med for in the first place. So, I'm thrilled. But, I just got a new reading 11 months into this new lifestyle change and my A1c has risen to 5.8 from 4.9 at my initial tests back in January. My insulin measured 3 (u/ml) at the same blood draw and my FBG was 91. So it said my estimated average was 119 for the A1C. This confuses me obviously because I do everything I can to eat very low low carbs (no sugars) drink lots of water, exercise....all that good stuff. Almost a full point raise in A1C. All of my other markers tested in the optimal ranges.

            • Stuart M
              Stuart M commented
              Editing a comment
              Robin, niacin has been known to increase blood sugar somewhat. That probably accounts for the increase in your A1c, which is a small price to pay for all the other benefits of niacin. Certainly not as bad as the side effects of statins.

            • Joe Reilly
              Joe Reilly commented
              Editing a comment
              I agree with Stuart. To determine if your body is paying any price for the increased A1c, get an HS CRP. The inflammation marker. If that is low, then you’re paying no price for the slight increase in A1c.

          • #7
            Originally posted by Stuart M View Post
            In his RECODE protocol Dale Bredesen recommends a low-carb high-fat ketogenic diet, but then he says to limit saturated fat. I wasn't able to find the rationale for that recommendation, unless he's subscribing to the SFAs-cause-heart-disease theory and is extending that theory to include vascular dementia. But that theory never had any good evidence behind it and the recent PURE study couldn't find any connection between SFAs in the diet and heart disease.

            Given that Dr Brewer has attended Dale's training course, can he shed any light on Dale's reasoning?
            I don't know the thinking on saturated fat today - whether it is inflammatory or not, but fairly recently there were studies that showed saturated fat was inflammatory. As Dr Bredesen is dealing with patients who have a multitude of diseases, I would imagine he stresses a low inflammatory diet. Also, many of these people likely have a leaky gut and until it is healed, it is probably a good idea to limit saturated fat.

            Comment


            • #8
              I have the same perspective. Here's what I think. The major criticism I have with Dr. Bredesen's program is the fact that he did better at including concepts than he did on weeding them out. When I take Bredesen patients, we always end up going down a lot of "bunny trails". Given the desperation of the typical patient & family with cognitive decline, they want to pursue to the end everything they see mentioned. Unfortunately that often tempts them to lose focus on some of the harder- but more important - priorities, like IR. I think this thing on avoiding SFAs is one of those issues. Patients focus on avoiding these & drop focus on carbs & measurement of ketosis. I don't think he looked hard enough at the literature re: SFAs.

              Comment


              • #9
                This is a very controversial issue. But what if some SFAs in the diet could be the cause of insulin resistance as proposed in this paper : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572653/ ?
                what is the actual cause of beta cell death?
                I believe that the mechanism that leads to IR and T2D is not yet well understood.
                Large amounts of fats in the diet somehow don't seem natural. People came out of Africa, not Greenland!

                Comment


                • #10
                  Originally posted by oketz View Post
                  This is a very controversial issue. But what if some SFAs in the diet could be the cause of insulin resistance as proposed in this paper : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572653/ ?
                  what is the actual cause of beta cell death?
                  I believe that the mechanism that leads to IR and T2D is not yet well understood.
                  Large amounts of fats in the diet somehow don't seem natural. People came out of Africa, not Greenland!
                  Two problems I see with the study are:
                  1) It includes both saturated fatty acids and transfatty acids.
                  2) It doesn't mention whether it controlled for carbohydrates.

                  There are studies on 2 sides of this issue - fats and carbs. High carb, low fat seems to work and high fat, low carb seems to work. IMO it is the high fat, high carb diet that causes most of the problems. Another issue usually ignored is leaky gut, which aggravates the problem with saturated fats.

                  Comment


                  • #11
                    Thanks, Rich! Low fat, high carb seems to work for me especially if I burn the quick sugar in the blood within an hour after meals. I also try to have only 1 meal every other day. Yet the mechanism of beta cell death is still a mistery to me. I have also singled out the 3 villains: rice, potato and cassava.

                    Comment


                    • #12
                      Originally posted by oketz View Post
                      Thanks, Rich! Low fat, high carb seems to work for me especially if I burn the quick sugar in the blood within an hour after meals. I also try to have only 1 meal every other day. Yet the mechanism of beta cell death is still a mistery to me. I have also singled out the 3 villains: rice, potato and cassava.
                      Have you read Blood Sugar 101 or gone to the web site? I know she discusses beta cells. but I'm not sure to what extent.

                      Comment


                      • #13
                        I ted to agree with Rich's comment about high fat/high carb diets seeming to be the bigger issue. How much of that is just high calorie content & obesity? I don't know. But I do think that's one of the reasons you can lose weight on a low fat-diet; plant-based low fat diets are usually low calorie.

                        Comment


                        • Robin
                          Robin commented
                          Editing a comment
                          Yes and you are hungry most of the time.

                      • #14
                        The PURE study - the largest study of diet and heart disease ever - could find no evidence that saturated fat was correlated with cardiovascular disease. While a positive correlation does not by itself prove causation, lack of correlation is pretty much proof of a lack of causation.

                        https://www.thelancet.com/journals/l...252-3/fulltext

                        Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

                        Background

                        The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

                        Methods

                        The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering. Findings

                        During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], p trend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vsquintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], p trend<0·0001; saturated fat, HR 0·86 [0·76–0·99], p trend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], p trend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], p trend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], p trend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

                        Interpretation

                        High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

                        ___________________________________

                        So to summarise, if you want to die sooner then eat a low-fat carbohydrate-rich diet - the very one promoted by the vegan gurus.

                        Comment


                        • sthubbar
                          sthubbar commented
                          Editing a comment
                          Stuart, how does this fit with the observation that the all long lived populations get the bulk of their calories from starches?

                        • David
                          David commented
                          Editing a comment
                          sthubbar. The big criticism I have heard of the Blue Zones concept is that it zeros in on what the dietary patterns of them are and ignores the strong religious and social norms that promote health. The blue zones have very strong community and social ties. It is just as likely that the social structure is what is causing the long life as it is the diet.

                        • sthubbar
                          sthubbar commented
                          Editing a comment
                          David, this seems odd. Why are there no low carb communities with the type of social structure that promotes longevity?
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