Cholesterol and heart disease: Where is the science?

The Anti-Coronary Club

In 1957 one of the first studies testing the idea that substituting polyunsaturated fat for saturated fat in the diet would lower cholesterol and protect against heart attacks was launched in New York. The results of this study have foreshadowed the results of just about all the cutting-cholesterol-reduces-heart-disease studies since.

This study is one of my all-time favorites, because it was the first to show what every study has shown since: Subjects on such diets do reduce so-called risk factors, but they don’t reduce fatal outcomes. And as with all studies since, the researchers focused on the reduction of risk factors and not what really counts: whether the subjects live or die.

Dr. Norman Jollife, Director of the New York City Health Department, became convinced that the hefty intake of saturated fat common at that time was one of the driving forces in the development of coronary heart disease. He recruited about 1100 male subjects into a group he styled as the Anti-Coronary Club.

The subjects, some overweight, some not, followed what Dr. Jollife called the Prudent Diet. A similar group of men, who followed their regular diet, joined the study and acted as the controls.

A basic nutritional principal of the study diet is to provide approximately equal quantities of the three types of fats: saturated, polyunsaturated and monounsaturated. Beef, mutton or pork are limited to four meals per week, with the remaining meals comprised of poultry and fish, the latter consumed a minimum of four meals weekly. Butter and hydrogenated shortenings are replaced by high P/S ratio margarines and a minimum of one ounce of vegetable oil daily. Ice cream and hard cheeses are avoided. The diet contains about 30 to 33 percent of total calories as fat with a ration of polyunsaturated to saturated fatty acids of 1.25-1.50 to 1.

The overweight subjects were placed on a diet averaging 1,600 calories and containing 19 percent of the total calories as fat. When weight reduction was completed, this diet was changed to the standard study diet by the addition of one ounce of vegetable oil plus additional calories when needed from bread, nuts, fruits, and vegetables.

Subjects consumed this Prudent Diet for several years. And cholesterol levels fell fairly markedly.

Figure_1 Anti-Coronary Club paper

As you can see from the above graph, there was quite the difference in cholesterol levels between the study group and the control group. It’s interesting to note that the starting cholesterol levels for both groups was in the 250-260 mg/dl range, levels that would give today’s cardiologists hives. But those were normal cholesterol levels back then before the low-cholesterol frenzy settled in on us.

Over the course of the study, the members of the Anti-Coronary Club seemed to do well. Much better than Dr. Jollife, who died a few years into the study. But his colleagues took over and saw the study to its end.

Along the way, the researchers released interim results that caught the attention of the press.

The New York Times published an article on the study in 1962 and another in 1964. Both presented the studies as showing major health improvements in the intervention group following the Prudent Diet.

In February 1966, the paper at the top of this post appeared in the American Journal of Public Health. The article authored by Dr. Jollife’s colleagues was glowing in its description of the wonders of the Prudent Diet.

Then the Journal of the American Medical Association published a second paper on the results of the Anti-Coronary Club members and their Prudent Diet that wasn’t quite so glowing, though you wouldn’t know it by reading the abstract. This paper, Effect of the Anti-Coronary Club Program on Coronary Heart Disease Risk-Factor Status, written by the same authors as the previous paper, continued to put on a happy face about the long-term outcome of the study. But reading the actual paper instead of just the abstract reveals some statistics that don’t paint quite such a pretty picture.

Take a look at the abstract, paying particular attention to the part I’ve highlighted in yellow.

Abstract Anti-Coronary Club Program

 

The yellow is an example of how the so-called science of these kinds of studies have been presented since.

You’ll notice how the authors play up the reduction in risk factors in the first highlighted sentence. The second highlighted sentence points out that not only are risk factors reduced but morbidity is reduced as well.

What does this mean?

Morbidity is a measure of the state of health as contrasted with mortality, which means death. So if morbidity is lower, as the abstract reports, that means the health of the group in question is better. In this case, the abstract refers specifically to those subjects who developed heart disease and what the authors are saying is that those on the Prudent Diet had fewer symptoms and weathered the disease better than those on the standard diet.

Which sounds great, but that isn’t the whole story.

If you dig into the body of the paper, you’ll find some troubling statistics. In the study group–the ones who followed the Prudent Diet–there were 26 subjects who died during the study, while only six subjects died from the control group. It gets even worse when you look at heart disease, the very problem this diet was designed to prevent.

Eight subjects from the Anti-Coronary Club died of heart attacks, but not a single member of the control group died of heart disease.

These statistics are not easy to find. Below are the highlighted sections containing the above stats. You can see for yourself how hidden these devastating statistics are. They are on two different pages of the paper, so it takes some real digging to tease these numbers out.

Text_1 Anti-Coronary Club paper

 

Text_2 Anti-Coronary Club paper

Letting these numbers recede into the background while touting the reduction in risk factors has become the protocol adopted by many papers subsequently published.

The Anti-Coronary Club paper was the first, but many similar papers have followed in its footsteps. In the years since, various funding agencies have spent hundreds of millions of dollars on studies trying to show that reducing cholesterol brings about good things. What these kinds of studies often hide in the fine print is that reducing these risk factors doesn’t really make people live longer.

And this type of obfuscation annoys me to no end.  I’m always happy to discourse about it to anyone who will listen and I recently did so on camera with Dr. Maryanne Demasi of Australia’s ABC network.

Most of the readers of this blog have probably seen the two Catalyst episodes that recently ran and went viral. If not, click on the links to see Heart of the Matter Part 1 and Heart of the Matter Part 2.

I was interview extensively for these programs, and, due to time constraints, a lot of the interview was left on the cutting room floor.

Here is some of that footage, specifically dealing with these cholesterol studies and their outcomes. And in it, me, doing my best to bite my tongue to keep it civil.

If you’ve read The Protein Power LifePlan, you’ll notice in the background of the shot the giant Cave Bear skull I wrote about in the opening paragraphs.

In case you’re wondering what book I was reading about the creation of the atomic bomb, it was Richard Rhodes The Making of the Atomic Bomb.  If you want to read about how science is really supposed to be done, and learn something of the gripping history of that time and even a bit of physics, grab a copy.  You won’t be disappointed.

If you would like to see the extra material from the other people interviewed for these Catalyst shows, take a look this Special Edition of the Heart of the Matter.

This series of shows has created a firestorm in Australia with the statinators coming unglued.  It’s been great fun to participate.

 

Monthly Book Reviews

Reading_recommendations

I have been writing a series of book reviews each month that I email to subscribers. If you're interested and want to get on the list, sign up here (or above where it says Get free email alerts in the upper right). I'll send you an email notice of all new blog posts plus all my monthly book reviews. Also, you will get a link to all the previous month's book reviews I've sent. Hope to see you aboard.

Powered by ConvertKit

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

70 thoughts on “Cholesterol and heart disease: Where is the science?

  1. In Australia we have a program called Media Watch on our Govt funded TV station, they basically go through any news reports in popular media and shred it to bits showing how much crap is in it, and this show basically convinced me to give up watching the news back in the mid-90’s.

    Anyhoo, tonight they are apparently doing an investigation into the Catalyst programs from the last couple weeks, will be interesting to see how it stacks up to their scrutiny. Will follow it tonight and post the results on the page where I send people who call BS on my high fat/cholesterol/meaty ways:

    http://highsteaks.com/forum/health-nutrition-and-science/myths-cholesterol-statins-saturated-fat-and-heart-disease-52.0.html

    FWIW I’m sitting here watching your extended interview with a plate of nothing but fatty lamb chops covered in butter, staving of an imminent heart attack…

  2. Hello from Finland!

    I really don’t like advertising in general, but this time I think I’m gonna ask whether you’d like to read my recent article: http://180degreehealth.com/2013/08/thyroid-hormones-heart-disease/

    In the article, I suggest that thyroid hormones are one important factor related to CVD, and that they might be much more important than “safa/pufa intake” or “cholesterol levels”. 🙂

    ——-
    Re: this article

    The Anti-Coronary Club study is very interesting. It’s an open trial so it’s results are not included in meta-analyses… But the results are similar to Rose Corn-Oil trial and some other studies so maybe there are some mechanisms causing those problems seen in the results…

    For some reasons, many other studies haven’t found similar effects from vegetable facts.

    • Thanks for the link. I’ll give it a read.

      Re the veg oil studies. Have you found many that lasted as long as the Anti-Coronary Club study? I didn’t put it up as a model of a great study – I put it up to show how authors are so invested in their hypotheses that they obfuscate the outcome when it doesn’t agree with them.

  3. To play Devil’s Advocate (well, the Devil pays well), I think we have to be aware of more than mortality. Let’s say some diet, for example nothing but tofu and kale for 5 years, reduces mortality but increases serious strokes.

    So on the experimental diet, I’d live longer, but I’d be paralyzed, unable to speak, getting tofu and kale through a plastic tube. Is this what I’d want?

    I think the mortality figures are a good starting point, but we’ll eventually have to dig deeper.

    BTW, When I first became aware of cholesterol levels (and my first test was when I was in my 50s), the cliche was that normal was 200 plus your age. Guess that dates me.

    • Absolutely, we’ve got to think of more than mortality. But mortality is such a hard endpoint that it’s much easier to measure than morbidity, which is subjective. In the Anti-Coronary Club study I suspect the authors even fudged on the morbidity.

      Since higher cholesterol is a marker for longevity in elderly people, the 200 plus your age is probably a pretty good measure, even today.

  4. God bless you Dr. Mike and others like you! Someday the weight of the evidence against the cholesterol hypothesis will finally reach a critical mass and break through all of the propaganda.

    I wondering when someone write a guide on how to talk to one’s brainwashed doctor about all this in a civil manner? I am an extremely healthy 50 year old woman who has always (even in my 20s) had a cholesterol level above 200. All the other ratios are great (triglyclerides, HDL) which have enabled me thus far to slip under the radar, but the day is coming because of my age that someone will start harassing me about my cholesterol and propose a statin drug. Any suggestions?

    • The best conversation you can have with a brainwashed doctor should be short and sweet. It goes like this: Hi, could you please transfer my medical records to the office of Dr.[insert name of a non-brainwashed doctor].

      There is no evidence that statins or lower cholesterol levels benefit women of any age.

      • Finding non-brain-washed doctors can be difficult to impossible, particularly if your insurer is an HMO which provides financial incentives to doctors who (or in other words, penalizes physicians who don’t) prescribe statins once a certain magical cholesterol number is reached.

        A more productive conversation might be–I know you have to prescribe statins in this case, but you should know I’m not intending to take them. Can you respect my point of view and work with me to optimize my health or do I need to find another physician?

        I am fortunate, even with in a highly regimented HMO (Kaiser!), to have a physician who will work with me despite the HMO limitations. I’m OK with him prescribing statins if he feels the need to because of the HMO requirements, as long as he doesn’t give me a hard time about not filling the prescription.

        • I told my pcp to please note in my chart that she’d discussed her concerns with me, recommended a stress test and medication and that I’d declined. I let her know I was ok with a big “non compliant” label and she laughed.

  5. Have cholesterol levels ever been studied across a broad range of healthy people? From what you say here, it sounds like — not.

    I’ve mentioned before, I have hypothyroidism (Hashimoto’s to be specific). Current therapy depends on the TSH level to determine T4 dosage. BUT– In my extensive digging through the Journal of Endocrinology and elsewhere, I uncovered something disturbing:

    TSH levels in euthyroid (normal, healthy) people HAVE NEVER BEEN STUDIED.

    So the ‘target’ TSH level is actually a guess based on results in a subset of hypothyroid (ABNORMAL) patients under treatment. Which is not necessarily the ‘normal’ range in healthy people, thus may not be a valid target for treatment, either. (Witness that the target was recently cranked downward by 400% after 30 years of being … well, wrong. And judging by my own numbers, it’s STILL wrong. I’m no good at all unless TSH is almost entirely suppressed.)

    Likewise: If the *typical range* of cholesterol in normal healthy people has not been established, how do you know what level actually IS abnormal, let alone might need intervention??

    How does this fit with the fundamental medical doctrine of “First, do no harm” ??

    • Typical cholesterol levels have been studied. The way ‘normal’ lab values are determined is by taking thousands of samples from so-called ‘healthy’ people, finding the mean (average) and setting as the normal range two standard deviations from this mean. This was done years ago, which is why back in the day the upper limit of normal for total cholesterol was in the low to mid 300s (I can’t remember the exact number).

      Once cholesterol hysteria set in, the ‘authorities’ decided that normal wasn’t the same as healthy so they started reducing the higher number. First it dropped to 240 then to 220 and then to 200 where it is now.

  6. Surely you have seen the results of the HUNT 2 study in Norway? See here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

    A study of over 50,000 Norwegians over 10 years, men and women, ages 20-74? (that’s 500,000 patient-years). The higher the overall cholesterol level, the lower the mortality rate for women, all causes and cardiovascular alone. For men, the correlation was less impressive. As I understand it, chosterol level appeared to be “neutral” (ie not correlated to cholesterol levels). Very interesting and worth publicizing (very embarrassing for proponents of the cholesterol theory).

    • Yep, I’ve seen it. It is devastating to those who believe in the cholesterol hypothesis, but they try to pretend it doesn’t exist or is some kind of outlier.

  7. “this does appear somewhat unusual” you must admit they seem to have a sense of humor, however you forgot to highlight the next part
    “although again the series is small”….. meaning ..? …Right ! the whole exercise didn’t really amount to much

    • I contemplated mentioning it, but the post was going on too long as it was.

      You’ve got to understand, these guys spent 8 or 9 years of their careers working on this study. And they had a couple of New York Times articles out there discussing them and their work. They were true believers in the hypothesis. It must have been a bitter pill to swallow for them when they looked at the mortality statistics showing the very thing all the polyunsaturated fat was supposed to do – prevent people from dying from heart disease – was going in the opposite direction. So, instead of being up front about it, they papered it over with a happy abstract and used weasel words in the body of the paper while making it difficult for anyone trying to tease out the true results to do so. And then, for those who did, minimized the devastating (to their hypothesis) findings by using the language you quoted in your comment.

      Had these authors been true scientists instead of hypothesis defenders, they would have focused on the bad outcome and reported that their hypothesis was flawed. By doing so, they might have added some value to the body of scientific literature.

      • Spot on about “true scientists,” Dr. Eades!
        Why is it that so many researchers–who should know better–go into experiments intending to prove/support what they *already* believe, rather than starting with open minds and letting the data speak for themselves? This is why we end up with studies about low-fat and low cholesterol diets, aerobic exercise, and other standard interventions with conclusions along the lines of:

        Well, since we *know* low-fat diets are good for health/heart disease/diabetes/weight loss, since the subjects in our study did *not* improve in these areas, clearly the intervention diet wasn’t low ENOUGH in fat. Or the participants didn’t exercise *enough.* If they had cut fat down even *more,* or exercised even *more,* then we would have seen the results we wanted.

        That’s what we end up with, instead of: “Wow…looks like maybe our hypothesis is WRONG.”

        All I can say, is: if the low-cholesterol and low-fat “thing” has been proven beyond the shadow of a doubt–as many “experts” would claim–then we have to wonder why so many studies are still being done. If it was settled, we could have declared “case closed” in 1960. 😉

    • Thanks for the link. I hadn’t seen that paper. But it pretty much concurs with most of the other studies including the Anti-Coronary Club study. Replacing saturated fat with polyunsaturated fat reduces cholesterol but either doesn’t reduce deaths, or, as in the case of this study and the Anti-Coronary Club study, actually increases the death rate. The researchers always seem to focus on the risk factor reduction, which, in my view, is total idiocy.

      • The thing about this analysis is that it was cited in Science Daily, so it may get some general attention. Even though the findings in the Canadian analysis are not new, your average GP is not going to pay attention to a 1957 study.

  8. Another great post – so exciting to see your name in my email list so often these days. Keep it up!

    btw – there’s a small word displacement in the following:

    Here is some of that footage, specifically dealing with these cholesterol studies and their outcomes. And it in, me, doing my best to bite my tongue to keep it civil.

    I think you mean “And in it, me . . .” in that last sentence. You did, btw, do a fine tongue-biting job — appeared completely civil and the bloody tongue barely showed.

  9. good post. I always read your posts. It is very enlightening. My total cholesterol has been around 275 to 300 ever since 30 years ago, and am 60 now and still O.K and never take Lipitor or whatever statin, I simply ignore my my physician advise. I have no heart problem and still mountain bike about 3,000 km a year. So far so good.

    • Wow and my doctor wants me to lower my cholesterol which was 5.13mmol/L (tested August/2013). Mind you, there are other considerations such as high BP. He wants me on a statin plus a BP-lowering drug. I’m trying to avoid medications at all costs. Quite frankly, the side effects frighten me. Not to mention the possible interactions. My TC was as high as 6.12mmol/L several years ago when my BP was 120/70 so my doctor at the time wasn’t overly concerned with my cholesterol numbers. Apparently I had a very good TC/HDL ratio.

  10. Another issue I wish you’d address sometime. There is at least one study showing that when people have been on a statin and then stop taking it, the mortality increases. Bernstein said that for that reason, although he won’t prescribe statins, when a patient comes to him on a statin, he’s loathe to recommend that they stop taking it.

    “I don’t like suddenly stopping a statin, because the incidence of sudden heart attack is tripled in people who suddenly stopped taking a statin. Even though I don’t like to prescribe it, I don’t like to stop it.”

    Richard K. Bernstein MD Beating Diabetes Type 2 (Kindle Location 3864).

    A couple of links:

    http://www.medpagetoday.com/Rheumatology/Arthritis/31916
    http://abcnews.go.com/Health/Healthday/story?id=4508482

    I don’t know how good the evidence is, but if Bernstein believes it, there must be something to it.

    My mother was put on a statin after she had a heart attack, even though her cholesterol levels were normal. I asked why, and they said because it reduces inflammation. She did develop dementia, but she was in her mid-90s, so that wasn’t surprising. I wanted to try stopping the statin, but although I’m willing to risk my own health in an experiment, I didn’t want to risk hers, so I didn’t. She lived to be 98.

    I think one solution to this dilemma might be to slowly reduce the statin dose to zero instead of stopping it suddenly.

    • I have taken many patients off statins without a problem, but that is anecdotal evidence. I’m not familiar with the research showing a rebound effect in those patients who do discontinue statin therapy. If they discontinue it on their own, they may be falling victim to the adherer effect, which is very strong.

      Here is a post I wrote about the adherer effect, an effect often forgotten in the analysis of many studies. The ones you link to in your comment could well be showing this effect in play. Be sure to read the long piece by Taubes in the NY Times that I linked to in this post.

      • Thanks for links. I think I read the Taubes story some time ago but didn’t remember much of it.

        I agree that if patients discontinue on their own, the adherer effect might explain the results. Here’s an article in which the decision seems to have been made by the physicians. But these were sick people hospitalized after an AMI, and they note that perhaps the physicians saw no need to continue statins on those with a poor prognosis, which would bias results.

        http://tinyurl.com/k6q7dsw

        In this study they also looked for mortality differences in patients who discontinued other drugs and found none.

        My personal bias is that the body doesn’t like abrupt changes, so you’re better off changing things gradually. But who knows. I stopped Lipitor suddenly after that Joslin lipid study was concluded, and I think I’m still alive, although some days I’m not sure.

  11. Although I do not have an extensive, formal education, I did study introductory statistics in college; and I still joke to this day that statistics is mathematical lying. I frequent your blog to learn as much as I can, and it seems to me from many of your posts that it’s often too easy for researchers to manipulate data in their favor. As a result, I have a hard time trusting “studies”.

    I’m beginning to think that sometimes heart attacks, and/or heart disease, exist because they’re supposed to. Sure, we can strive for healthy lifestyles, but that, in and of itself, is no guarantee.

    • Yes, this is a real double-edged sword. On the one hand, the focus is finally moving away from driving cholesterol levels as low as possible while on the other hand, more people will now be bullied into going on statins.

  12. Lest anyone think the lipid hypothesis is in any danger of falling and impoverishing statin pushers, take a look at this.

    Shift In Cholesterol Advice Could Double Statin Use
    by Richard Knox

    NPR – November 12, 2013

    After decades of cajoling Americans to know their cholesterol level and get it down as low as possible, the nation’s leading heart specialists are changing course….

    http://www.npr.org/blogs/health/2013/11/12/244815077/a-shift-in-cholesterol-advice-could-double-statin-use?sc=17&f=1001

  13. Many, if not most, comments on the article in Washington Post I manager to read in 15 minutes were negative – people complained on muscle pain, fatigue, depression, irregular heart rate.
    I noticed a new advertisement on TV of law companies fishing for the people eager to file a lawsuit – they encouraged diabetics who were on statines to contact their lawyers.
    It looks like the negative perception of statines is on the rise.

  14. I am in the UK and we have Dr Malcolm Kendrick (The Great cholesterol Con) fighting in our corner. He put the two ‘Heart of the Matter’ programmes on his blog, but I have only just watched them on this blog, I’m sorry to say. What brilliant programmes, and the extra footage from Dr Eades was as interesting if not more so, as the programmes themselves. I ask the question: what is WRONG with the scientists? The drug companies are transparently after money, but I thought the essence of science was a search for knowledge, progress and enlightenment? Are there no real scientists anymore? Can anyone give an answer to this? It’s all very disheartening for the lay person.

    • It’s disheartening to the non-lay person as well. Science, as practiced by many people who should know better, is much like politics. People come down on one side or the other of the political spectrum then defend their candidate to the death irrespective of whether he/she totally screws up or not. It’s always been amazing for me to watch this in action because it shows just how irrational people really are. Instead of saying, okay, here are my political values, let me see how this candidate fits with them, or is this elected candidate of my own party living up to his/her election promises that were in accordance with my views. In the vast majority of cases, the candidate/elected official fails to perform, yet continues to have the support of the true blue members of his/her own party. Surprisingly, the people who are able to see through the charade are those who aren’t particularly politically involved, i.e., the independents. For the party stalwarts, it takes an enormous, public screwup of their candidate before they will abandon him/her, and even then you’ll find that at least 30-40% will hang in there as supporters.

      It’s that kind of irrationality at work in this kind of science. People come down on one side or the other of the debate, then search for every possible reason that in some way confirms their bias and ignore or explain away every finding – even huge ones – that doesn’t. It should be just the opposite. In real science, investigators look for ways to attack and disprove their own hypotheses, but, other than in physics and other hard sciences, this is almost never done.

      • I see that point. It sounds as though there is a sad shortage of honest scientists. I can see the dilemma they face in risking their funding if their findings don’t please those who give them grants. Difficult to know what to do there, unless the scientist is a millionaire and can afford his own research. As one interviewee said, perhaps we will have to wait for this generation to die out! That’s why is is so vital to keep on with your valuable work – you can reach the future scientists, even if this generation are a lost cause. Don’t give up whatever you do, and thank you from one member of the public who really appreciates what you are doing.

    • I may write on it. There’s not much to write, though. It’s the same old, same old.

      A group of people with a ton of conflicts of interest argue over what are going to be the new rules.

      It’s nice to see the finally admit that focusing on getting cholesterol levels lower and lower is a fool’s game. But it’s disheartening to see them continuing to push statins, probably even more vigorously now, to groups of people for whom no study has ever shown them to be of benefit in terms of lengthening their lives. To paraphrase Samuel Johnson, it’s kind of a triumph of hope over reality.

  15. Dr. Mike:

    I don’t have a Twitter account and am not ready to figure out how to get started with Twitter, so I’m off-subject here and posting about your tweets.

    Regarding the recent chef video showing the use of Sous Vide equipment to cook turkey: they have the meat sitting vertically in the metal rack, with the consequence that some of the meat, although sealed in a plastic bag, is not immersed in water.

    I’ve had one of your SVS’s for a couple of years, use it almost every day, and yet it frankly never occurred to me that food would cook just as well/predictably, unless it was fully immersed. I certainly don’t remember _ever_ seeing anything in your literature to the contrary.

    Would you settle this controversy once and for all: to immerse or not to immerse?

    • I don’t know what chef video you’re talking about, but I hope it isn’t one we produced.

      The food absolutely has to be totally immersed in the water to cook properly. Water is a vastly better conductor of heat than is air. The whole concept of sous vide cooking revolves around the rapid and efficient transfer of heat from the water to the food, which is about water density. If part of the food sticks out into the air, it won’t cook the same.

      I hope I’ve settled the controversy.

    • I’m going to study on the new cholesterol guidelines before making a knee-jerk reaction. The knee-jerk reaction is that they’re as bad as the previous ones and maybe even worse. They encourage even more people to be put on statins. I just want to read through the citations to see if there is anything new I haven’t already read before officially commenting.

      The SousVide Supreme is made for meat. In fact, we considered calling it the Meat Master until we figured out it cooks everything under the sun. What kinds of meat are you having trouble with? What temps are you using? How long are you leaving it in?

  16. How long are you leaving it in?
    Not as long when I was younger….Shees, the things I say to amuse myself.

    Lamb and steak …..56.5C for approx. 4 hrs
    Then brown in a frypan.

    I did not like the taste of salmon until having sous vide it.
    Sensational with whole baby beets, potatash and sour cream.

    BTW: You have been the catalyst and major stepping stone with your books and blog in improving my markers and health. It’s scary living with secondary prevention CHD.

    • 56.6C is about right. You don’t really need to leave it in that long unless you just want to. Temperature cooks and time tenderizes. Sometimes with good steaks and lamb, you can over tenderize, and they become a little mushy. Try leaving them in for a little over an hour or so, and give it a try. Sear them is a skillet as hot as you can get it just briefly. Just long enough to put color on the edge, but not enough to cook them. Maybe 30 secs to a min per side. Let me know how it works.

  17. Hi Mike – Great post!

    Check Table 2 of the Nov 66 paper as well. In the experimental group, overweight subjects were put on a 1,600 cal a day diet (poor dudes) until they lost weight. Table 2 confirms that the obesity risk on entry for the exp. group was 56.3% and this dropped to 15.7% at 2 years and 17.8% at 4 years (regain inevitable with low cal). The control group obesity factor risk stayed steady around 45%. Control & experiment were not kept similar therefore. Am I surprised that there were fewer coronary incidents in the group NOT eating all the pies?!

    Maybe the extra deaths were due to the overall risks of a low-fat diet, which a low-cal diet would have been (the paper notes that the overweight subjects were only allowed 19% of total cals as fat – a little over half what the other experiment subjects were getting.)

    Bye for now – Zoe