Ep. 363 Challenging the Diet-Heart Hypothesis: Reevaluating Nutrition and Health with Dr. David Diamond

I am honored to connect with Dr. Dave Diamond today.

Dr. Diamond is a professor at the University of South Florida in their Department of Psychology, Molecular Pharmacology, and Physiology. He has a Ph.D. in biology, specializing in behavioral neuroscience.

In our discussion today, Dr. Diamond talks about his journey as a neuroscientist and his interest in heart disease, and we discuss how Ancel Keys, the nutritional department at Harvard, and governmental dietary guidelines have significantly hindered our state of health. We explore the diet-heart hypothesis, the effects of seed oils and low-fat diets, the misconceptions surrounding cholesterol, metabolic errors, and the role of insulin resistance in coronary artery disease and metabolic health. We also scrutinize the implications of scientific misconduct, the effects of statins, and the role of nutrition in shaping lipid panels. 

Join us for today’s valuable, insightful, and informative conversation with Dr. Dave Diamond.

“This low-fat kind of dieting in which people feel it is okay to eat bread and avoid the butter has contributed to the obesity epidemic.”

– Dr. David Diamond

IN THIS EPISODE YOU WILL LEARN:

• How Dr. Diamond became a leading voice in heart disease research
• The negative impact of a low-fat, high-carb diet 
• How the American Heart Association ignored the effects of sugar on heart disease
• How seed oils have contributed to the obesity epidemic 
• Why a low-carb diet could increase the risk of heart disease
• How the demonization of cholesterol deflects from nutritional factors exacerbating poor metabolic health
• How the benefits of statins get overstated 
• How statins can lead to strokes and heart attacks and contribute to metabolic damage
• The perils of scientific misconduct and the profit-driven pharmaceutical industry
• The benefits of a low-carb diet

Connect with Cynthia Thurlow

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• Submit your questions to support@cynthiathurlow.com

Connect with Dr. David Diamond

• On X (Twitter)  
• Email Dr. Diamond: ddiamond@usf.edu 

Transcript

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:29] Today, I had the honor of connecting with Dr. Dave Diamond. He’s a professor in the Departments of Psychology, Molecular Pharmacology, and Physiology at the University of South Florida, and he has his PhD in Biology with a specialization in Behavioral Neuroscience. Today, we spoke at length about his background as a neuroscientist and his interest in heart disease, how Ancel Keys, the Harvard Nutritional Department and government dietary guidelines have derailed our health so significantly. The role of the diet heart hypothesis, the impact of seed oils in a low-fat diet, the demonization of cholesterol, the errors of metabolism, and how insulin resistance plays a role in coronary artery disease and poor metabolic health. The role of scientific misconduct, the impact of statins, as well as the role of nutrition on our lipid panels. This is an incredibly helpful, insightful and informative discussion. I will definitely be having Dr. Diamond back with good reason, as you will soon see. 

[00:01:37] Well, Dr. Diamond, such a pleasure to connect with you, bring you, and introduce you to my Everyday Wellness community. I would love to really start the conversation with your background, because you started as a neuroscientist and now you are what I believe to be a leading voice, speaking about some of the research that’s been done around not just the diet-heart hypothesis, but also cholesterol and driving mechanisms of coronary artery disease, as well as treatment. 

Dr. David Diamond: [00:02:06] Well, thank you for inviting me, Cynthia. I appreciate being able to share with you my history, my experience, and how I’m sharing that information with people at conferences and in my publications. I guess, I’ll just share with you a bit of my background. 

Cynthia Thurlow: [00:02:20] That would be great. I think listeners would really appreciate it because it really speaks to the fact that, we can start in one area of research or in the university level, and we can be inspired to pivot and focus in other areas. So, I always look at it as, there’s the first stage of our careers and sometimes the second stage, and they may be very different from one another. But obviously your research background allows you to look at the existing research from a very different level, as opposed to a clinical level like myself, where we’re looking sometimes at, and I know we’ll get to this talk looking at relative risk versus absolute risk and how that information gets extrapolated and shared with clinicians. 

Dr. David Diamond: [00:03:03] Okay. Well, first, I’ve been a neuroscientist now for 46 years. I started when I was an undergrad and became enamored with study of the brain and started doing brain surgeries on animals. And I’m still a neuroscientist, I still do neuroscience research, and that has always been my primary area of research and continues to do so. And I would say there’s a reason why I developed an interest in heart disease. And that was because about 25 years ago, I took a blood test. And the purpose of the blood test was just to get life insurance. And I was very surprised and disappointed to see that I was put in a high-risk group to be able to get my life insurance. And the high risk was because I had extremely high triglycerides and very low HDL. And because of that, I was considered to be very high risk. And I’ve learned this now, normally, you’d like to have your triglyceride value, preferably below 100, and your HDL would be a comparable number. So, the two of the ratios between the two would be about one to one, and you prefer it not to, for the triglycerides, more than twice the HDL value. 

[00:04:08] So my triglycerides 25 years ago were 1000, HDL was about 30. [Cynthia laughs] You, with your background in cardiology, would be quite alarmed, and my doctor was quite alarmed. That ratio I’m looking at was about 30, whereas the ratio really shouldn’t be more than 2:1. I knew a good bit about the brain, but very little about heart disease, and I did what any guy would do in that situation. I ignored it. [Cynthia laughs] Some years passed, five years passed or so, and things didn’t improve. Figured I could just exercise my way to better health and get aerobics, lots of tennis, cut back on the fat in my diet, which, again, showed my ignorance. And all that happened was my ratio just simply deteriorated. And I was gaining a good bit of weight at the time as well, which is really frustrating because I was exercising so much. What I’ve learned since then is that you don’t exercise your way to better health or to lower weight by itself. 

[00:05:07] So finally, at some point, my doctor got very frustrated with me. He pretty much had been demanding I go on medication, such as statins and a variety of other medications. But I just remember the moment, about 5 to 10 years after I was first diagnosed, being at very high risk, which, by the way, I’ve been paying very high rates on my life insurance, which has just recently expired. I’d like to say that my life insurance, term insurance expired before I did. 

[laughter]

[00:05:35] So finally my doctor sat me down. He said, “It’s absolutely urgent. You must go on a statin. You’re on the verge of having a heart attack.” And I just figured, “Well, I have a bachelor’s degree and a PhD in biology. My specialization was neuroscience, but I’ve always enjoyed biology.” And I finally sat down and read the biochemistry of high triglycerides and realized that what’s happening is that my liver is converting all that excess sugar that I was consuming into triglyceride. It wasn’t the fat I was eating. I was patting myself on the back saying, “Isn’t that great? I’m eating bread without the butter; I’m coming back on the meat and I’m just eating rolls of bread.” And finally realize I actually have a genetic anomaly in which I’m extremely efficient at converting carbohydrates to triglycerides. It’s very rare for anybody to have their triglycerides over 300 or 400. And so, there’s a subset of people that have this extreme efficiency of converting carbs to triglycerides, and it’s called familial hypertriglyceridemia. And it does appear to be genetic. My brother has it as well. 

[00:06:38] Once I learned that and I looked in the literature and saw that it’s carbohydrates that are the demon on my plate, I cut back on carbs and saw that. I mean, I’m not as low as I would like, I’m low carb now, but I was able to get my triglycerides down to under 200, which is a relatively safe level. So, I’m between 150 to 200. And my HDL basically almost doubled into the 50s. So I’m healthier, I lost weight, I feel better. It may very well be that for someone with my genetic condition, that a ratio of 3:1, 4:1 may be as good as it’s going to get. So, this I learned. Now, what happens is when your triglycerides are so astronomically high, as mine were, they can’t even measure LDL because the high triglycerides distort the LDL level. So, I felt great about lowering my triglycerides and raising my HDL, put me into a better ratio. And then once my triglycerides got low enough, then I could have my LDL measure, LDL being the bad cholesterol. People say, “If you have a high LDL, then you’re at risk for having a heart disease.

[00:07:42]. So finally, my triglycerides go low enough and I measure my LDL, and once again, my doctor was alarmed because my LDL was super high. It’s like at 200, my total cholesterol was about 300. So once again, he wanted me to go on Lipitor, any other cholesterol lowering medication. But at this point, I had the ammunition. I had learned about cholesterol. And so, I finally learned that LDL is not the bad cholesterol it’s been made out to be, that in fact, if you’ve got really good health markers, such as blood pressure, so my blood pressure is good, my blood sugar is good, the other markers are all good. But in that metabolic context, that I feel I don’t need to worry about having high LDL. But I still, given that I have that genetic anomaly, that you have relatively high triglycerides, and I’d like my HDL be better, but those are the two primary markers that are really anomalous for me. Other than that, everything is very good.

[00:08:38] So therefore, I’m living in a somewhat cautious state, and I have cautiously declined taking any medication for my cholesterol. So that brings us to the current time in which I started giving talks and podcasts and sharing this information. And as a result of giving talks in the podcast, I’ve also connected with just some outstanding clinicians, and I’ve published papers. Now, past 10 years, I’ve published about a dozen papers about cholesterol, and challenging the conventional view that high cholesterol alone increases our risk of developing cardiovascular disease. And so, I’ve gone toe to toe with some of the people on the field who have disagreed with me. But basically, I really think it’s my background in biology that has given me that confidence to be able to read the medical literature and share that both with laypeople as well as cardiologists. I’ve spoken at cardiology meetings, at diabetes meetings, and low carb meetings, and sure, people have disagreed with me, but I don’t think they have stated that I’m misattributing the science itself. The science to me says it’s very clear, “In the absence of other risk factors, such as diabetes, smoking, hypertension, there’s no reason to fear high cholesterol.” 

Cynthia Thurlow: [00:09:59] No, it’s so interesting, and thank you for sharing a bit about your background and how with nutritional changes, you were able to drive down those markers. And yes, for listeners, triglycerides over 1000 would have made me very nervous many years ago about pancreatitis. That was usually the thing that we were most concerned about. And so, let’s really pivot the conversation and talk a little bit about a character named Ancel Keys that we have spoken a few times about on the podcast and the diet-heart hypothesis. Where did we come from in terms of the Eisenhower administration when he had a myocardial infarction, a heart attack, Ancel Keys kind of intervened, and we started to deflect attention from the primary drivers. The things that I think really do contribute to cardiovascular disease, poor metabolic health, looking at processed carbs and sugars, and start focusing in on fat and demonizing cholesterol. 

Dr. David Diamond: [00:10:56] Yeah. I’m really glad you raised the specter of Ancel Keys. 

Cynthia Thurlow: [00:11:59] That’s the character. 

Dr. David Diamond: [00:11:01] It’s certainly a powerful character. And I think we can actually back up a bit into the 19th century, because then you actually had greater availability of sugar. And obesity became an issue both in the US and England, around the world, and you had people studying obesity at the time. And there’s a famous person named Banting, who was obese and lived in London, middle of the 19th century, and his doctor, actually, what really can be considered a scientist of a sort, and had learned about how the liver converts glucose into fat, and had recommended to Banting that he consumed less carbs. The word carbohydrate hadn’t even been invented yet, but part of his recommendation was basically to eat less potatoes and bread, among other things. It was a very primitive time nutritionally, but probably one of the critical things that Banting did was to cut back on potatoes and bread. Banting lost about 50 pounds. And he was an elderly gentleman in his 60s and really had very, rather poor health. He probably had type 2 diabetes, lost the weight. He wrote a book on Letter on Corpulence, and described exactly what he ate and how he lost the weight. He lived another 20 years into his 80s and became very healthy. 

[00:12:20] And others as well, in the 19th century in the US, were noticing people becoming obese and were commenting on how it was associated with sugar consumption. And this continued into the 20th century. One really important person was Alfred Pennington, who prescribed the low-carb, high-fat diet to obese people. This is in the 1950s, and so there was actually a meeting by the American Heart Association, and the president of the American Medical Association said, “The ideal diet for an obese person is a low-carb, high-fat diet, and this is in the 1950s.” So, I think people really need to understand that there was established science on the benefits of the low-carb diet prior to Ancel Keys, in a sense, coming to power in the 1950s, Ancel Keys had very different thoughts. Ancel Keys was a physiologist out of the University of Minnesota, I believe, and people like to say that he was a very important person because the government came to him and he came up with K rations, which actually are named after him. But he really was an obscurity despite what his supporters say. But Ancel Keys decided, based on his observations of people around the world, that consuming fat is what makes people fat and develop heart disease. And it started off it was just fat of any kind. 

[00:13:39] Later on, when it turns out there’s no association at all fat to heart disease and obesity, he modified it to become saturated fat. And there is an association of consuming saturated fat, which is the kind of fat you find in animal fat and tropical oils. There is an association of consuming saturated fat with obesity and heart disease. What Keys decided to ignore was the really strong association of consuming saturated fat with sugar. I mean, it’s remarkable how close the association is. So what that means is that typically you have the kind of the meal that leads to heart disease and obesity, which is have a cheeseburger, French fries, soda, and finish about some ice cream. Now, that is a meal that’s loaded with saturated fat. It’s also loaded with sugar, and it’s a meal that leads to poor health. Well, and that’s why you can have an association of saturated fat with heart disease. Ancel Keys decided to ignore the sugar component. He actively was against the idea that sugar influenced a person’s health and became a strong proponent to the idea that saturated fat would raise your cholesterol and therefore cause you to have heart disease. It was the diet-heart hypothesis, and he was very influential. Ancel Keys basically said the reason why Eisenhower had a heart attack, myocardial infarction in 1955 was because he ate sausage. It’s the sausage and bacon.

[00:15:01] And in fact, Eisenhower already had been diagnosed with heart disease before he was a president. And what people either chose to ignore or didn’t pay attention to is fact that Eisenhower was a chain smoker and he smoked before he was president. He smoked while he was president. And that without a doubt and all the stress of being president contributed to him developing heart disease. It wasn’t the sausage and bacon that he enjoyed so much, but at the time, it was Ancel Keys, who then went on national television along with Eisenhower’s physician, and basically proposed the idea that it’s saturated fat that causes heart disease. And there just weren’t enough people at the time that understood nutrition sufficiently to be able to oppose Keys’ view, which was opposing to the work that Pennington had done and others. And he was then supported, as well as the American Heart Association by Procter & Gamble, which had then developed margarine. And margarine was seen as superior to butter because it was a vegetable product. And that’s why you hear now vegetable oil. It sounds so great to have corn oil and soybean oil, which we can get to as well, which it’s nothing like– You don’t just squeeze an ear of corn and out comes oil. [Cynthia laughs] 

[00:16:10] We now know how incredibly unhealthy it was, especially to have the margarine of the first half of the 20th century, which is loaded with the trans fats. But there was widespread approval now of the use of margarine to replace butter and the use of soybean oil and corn oil, which no doubt we know interferes with good health. And so, Ancel Keys, is now a powerful person who was having major influence on people’s careers, he then developed epidemiological work looking at six countries, and clearly was designed, people have been apologetic for Keys, but this study was designed clearly to support his view that fat caused heart disease. And they say there was a reason to exclude countries such as France and Switzerland, where people consume a high percentage of their calories are from fats, especially animal fats, and they have a very low rate of heart disease. And Keys just chose to ignore France and Switzerland and other countries. And so he ignored sugar, he ignored the countries and ignored the people who consumed high fat, low carb. 

[00:17:15] And the American Heart Association, he was a part of the American Heart association still recommends margarine over butter and still recommends people have extremely low percentage of their diet as saturated fat. I would say and really, a person I admire so much, Dr. Nadir Ali, who is a cardiologist, he just said it. And it’s recorded that the “American Heart Association is one of the most corrupt organizations in the world.” Not my opinion. That’s his opinion. It was recorded at the Low Carb Denver meeting, and I completely agree with him. The American Heart Association became a powerhouse and is now supported by dozens of drugs and drug companies and food companies. So, we need to understand that when we see guidelines coming out of the American Heart Association, that they’re financially conflicted. This is an organization that’s very strongly supported by the food and drug companies, and so they know where their bread is buttered [Cynthia laughs] or margarine, as they would prefer. And so, beyond Ancel Keys, who I consider one of the worst scientists of all, because he was biased and because he chose to ignore all the work that had been done on sugar, the association of sugar with heart disease, and the combination of sugar and saturated fat with heart disease, that I think was a powerful trigger. 

[00:18:29] But if you’ll give me a moment to elaborate on this further, not only was it Ancel Keys, but if you look at the Harvard Nutrition Department, you have seen an area that appears to be so important. I mean, you mentioned Harvard, and they command respect, but Harvard has been supportive of low fat, vegetarian-type diet for decades. And Harvard authors had a major review in the 1960s out of the nutrition department and they emphasized how bad saturated fat was for you, and they even included data on how harmful high sugar is. But they chose to ignore it when they were making the recommendations, and they emphasized that people should consume low-fat food. And then I say that was, strike one was Ancel Key. Strike two was Harvard. Strike three was when the government came out with their dietary guideline and basically emphasized low-fat food was the way America should go. George McGovern, in the 1970s was on a very low-fat diet. He couldn’t handle it very well because it’s really not palatable, and it leaves you craving for food. And people on a low-fat diet are just unhappy because it’s so unsatisfying. 

[00:19:41] But he and his colleagues decided that America needs to go low fat. And the result, I think, has been tragic. And I remember, I have to tell you, in my ignorance, I grew up with the idea that consuming fat, especially saturated fat, is unhealthy. And I was not a vegetarian, but I certainly was concerned about eating meat. And I was eating veggie burgers, while I was in college and beyond, because I thought it was healthier than eating beef. So, I was very much influenced by sort of this triple whammy, Ancel Keys, Harvard coming out, and the government with their dietary guidelines. So, this had a major influence because you see the obesity epidemic, which really took off beginning on 1970s, as continuing. So, there are really two critical factors I think people should be aware of. The first is the seed oils. And, there are some really good people, Cate Shanahan and Chris Knobbe, who are getting that information out there that we need to understand that corn oil, soybean oil are so unhealthy and the other seed oils. You don’t just squeeze an ear of corn and out comes oil. You don’t squeeze soybeans and out comes oil. They have to be treated with organics such as hexane and others, which we know is so unhealthy. 

[00:20:56] And ultimately, you can get sugar out of corn, you get oil out of corn, but it’s just so incredibly unhealthy. That’s the first thing. And the second is this low-fat kind of dieting in which people feel like, “It’s okay to eat bread, you just have to avoid the butter.” And that has contributed to the obesity epidemic. So, it’s that combination that has been so harmful, and that is where we still are today. Now, it is widely recognized that the low-fat diet was a complete failure. You even see people at Harvard saying, “That the low-fat diet was a failure.” The low-fat diet fails in the clinical trials compared to other diets. So, it’s really not recommended anymore. The low-carb diet is now being promoted a little bit. The American Diabetes Association has actually recognized the value of low-carb diet. But you won’t see the American Heart Association recommending low carb. In fact, every year, when you look at the list of the best diets and even the worst diets, you see low carb, especially ketogenic diet, is at the bottom. It’s still not recommended in the dietary guidelines. 

[00:22:04] And what’s the big Bugaboo? What’s the real fear in the low-carb diet that leads us to cholesterol? Because in some people, when they go on a low-carb diet, their cholesterol rises. And you see this is pointed to by cardiologists, this is pointed to by American Heart Association as saying, “You take a chance and you’re going to lose weight, but you take a chance in increasing your risk of developing heart disease by going on a low-carb diet.” So that’s where the fear is with low-carb diet. And that’s why it’s considered a really unhealthy diet, because you can raise your so-called bad cholesterol, the LDL cholesterol. 

Cynthia Thurlow: [00:22:40] And yet, that’s such a beautiful and eloquent depiction of what has gone wrong over the past hundred plus years. And I think if more clinicians really understood, and I think that we get exposure during our, science classes and in graduate school, but I think we forget how critically important cholesterol is in so many biochemical processes in the body, and even to the point where as someone who prescribed statins for 16 plus years, and I would oftentimes reduce the dose when my patient’s total cholesterol fell below 150, and I would get admonished for that. And now the research is certainly showing that, is there any wonder that people are having net cognitive deficits related to chronic statin utilization? And be clear, we’re not telling anyone to stop anything. This is not medical advice. We’re just kind of speaking through this. 

[00:23:36] So cholesterol got demonized, and then the deflection of focusing in on total cholesterol and good versus bad cholesterol, and I’d make the argument that that’s really not the case. And yet, what’s really the primary driver of cardiovascular disease, peripheral vascular disease, etc., is really this rampant poor metabolic health, insulin resistance, inflammation, oxidative stress. And for so many individuals, even people who are probably listening to this podcast, I think it’s over a third of people don’t even realize they’re pre-diabetic or even diabetic. And so, we have deflected attention from the nutritional component that is exacerbating this poor metabolic health. And we’re choosing, and I say we as clinicians, in many instances, we’re choosing, to stay stuck in a paradigm that is no longer not only effective, but it’s not even factual. 

Dr. David Diamond: [00:24:28] That was beautifully stated. [Cynthia laughs] So, we’re enjoying, each of us I think sharing what I would like to say is less biased the good science. But things do get complicated, because there can be an association of cholesterol with heart disease, and lowering cholesterol can be shown to actually reduce the incidence of heart disease. This is where the confusion comes in, because we’ve probably all seen the ads, and I’m sure when you were prescribing statins and you would go to a medical conference, you would see that statins can reduce heart disease by 30%, 40%, 50%, and that’s really impressive. And this is what you’ll find in the medical journals. And this actually goes back decades to dramatically reduce mortality and heart attacks with the use of statins. And this is where I’ve learned about the manipulation of the data. When you hear numbers like that, 50% reduction in heart attacks, it sounds really impressive, but we really need to dig deep. And I had an epiphany when I started reading about, “Well, what is the actual raw data? How many heart attacks are actually reduced when you’re reducing it by 50%?” So, not making this up. So, let’s take, typically, some real data. One example could be, let’s say, Lipitor. And in a study, and I like to say, “Let me back up a bit.” Most of the time in these studies on heart disease, people are terribly uncooperative. They just don’t die. 

[laughter]

[00:26:04] -It’s very rare in which people die in these studies. It is actually relatively rare in which people have heart attacks. So, you can have 30,000 people enrolled in a study, and maybe 2% of the untreated people will have a heart attack. And so. 98% of the people are just, as I say, “Uncooperative. They’re not having a heart attack.” So, it is a problem. So, it is very rare in any of these studies to be able to find people who are basically having a heart attack at a very high rate. I can contrast that with cancer studies where you have a high mortality, and you can study people who have terminal cancer, and maybe most of them might die without treatment. So, getting back to the heart disease studies, it’s quite accurate to say 98% of the people who are not treated will not have a heart attack. Okay, so you’re left with 2% that actually have a heart attack. Now, you have a group of people that are given a treatment, such as Lipitor, and in that group of people, 99% of the people don’t have a heart attack. So, the actual difference is 2% of the people have a heart attack without any treatment. 1% have a heart attack with the treatment. The real difference is a reduction of 1%. So, you treat 100 people, 90% versus 98% of them will not have a heart attack without any treatment. You treat 100 people with a statin, one person will benefit. 99% do not have a benefit. 

[00:27:32] Well, the real difference is called absolute risk benefit. The real benefit is 1%. Can you imagine the advertiser saying, “Lipitor reduces heart attacks by 1%?” [Cynthia laughs] It’ll say, “Do you feel lucky? Are you the one out of 100 that’ll have one less heart attack?” But no, where does that 50% come from? Well, one is 50% of two, and that’s called the relative risk. And I’ve published papers showing that, in fact, laypeople and physicians don’t understand what that 50% means. They think half of all people take Lipitor, not going to have a heart attack, when in fact, it’s really about 1%. It’s actually even worse with Crestor. This study with Crestor from about 20 years ago had even fewer people had heart attacks. The Crestor study published in Lancet, I believe, was explicitly done in healthy people because they wanted to show that Crestor could benefit healthy people. And almost nobody, I mean, we’re talking, like, way less than 1% had either heart attack or die. And so, it actually turned out, I believe these numbers are really accurate. 0.7% of the people that were not treated had a heart attack, and 0.35% of the people treated with Crestor had a heart attack, way less than 1%. And what do they advertise? “Crestor reduced heart attacks by 50%.” And they don’t even mention, when they’re summarizing this or showing this at medical conferences, they don’t mention that the real difference is a fraction of 1% is 0.35%. And that I found to be so upsetting that I wrote a paper explicitly like this with a colleague of mine, Dr. Paul Everton, who actually had worked in his career with the CDC at NIH, was the founding chair of our Department of Epidemiology. 

[00:29:27] And there’s a sense of outrage. People need to understand the magnitude, which is minuscule, of these statin benefits. And once they see that, and I have to say, this is really quite satisfying, I’ve had people at my talks, including MDs, but when they see the real trivial benefit of statins, they just stop taking it. And again, I want to emphasize, we’re just talking science here. We’re not giving medical advice. People choose on their own to stop taking the statins. Now, why is it that statins actually do have this incredibly small benefit? Well, there are two reasons. First is, statins are kind of dirty drugs. They don’t just lower cholesterol, they do other things. Statins also block clotting. And part of poor health is having excess coagulation, or clotting. It leads to strokes; it leads to blockage of the coronary arteries. It leads to heart attacks. And one thing statins do is that they lower, they reduce clotting. The other thing is there is sort of the bad cholesterol. There is a foreign cholesterol that can be considered bad. There are a lot of proteins in the body that are damaged by oxidation, by high blood sugar. And in fact, when you measure your A1c, what you’re really measuring is damaged hemoglobin. Hemoglobin carries the oxygen. And so, that A1c measure, in a sense, is telling you how much of that A1c has been damaged by glucose. 

[00:30:48] Because glucose has a capacity that is extremely rare in the body, most activity, most reactions in the body require an enzyme to be able to combine molecules. Glucose has this capacity to glom onto a molecule. Glucose can bind to a molecule without any need for enzymes called glycation. So, when we have high blood sugar, that glucose molecule attaches to proteins, which then interferes with their functioning. So, the glucose binds to hemoglobin, which interferes with the ability to process oxygen. It binds with so many proteins, which is why with type 2 diabetes, people have so many diseases, because the proteins aren’t functioning properly. So, getting back to cholesterol, LDL cholesterol, as well as hemoglobin, is damaged by sugar. And so that’s called, a subset of it is called small, dense LDL and this is clearly a result of damaged metabolism. So not only do you have damaged hemoglobin, you have damaged LDL. Well, when you have high LDL, and part of it is damaged, the small dense LDL, therefore it contributes to what I call the maelstrom of metabolic harm.

[00:31:56] You got high blood sugar, high blood pressure, damaged hemoglobin, damaged cholesterol, all of which converge on a damaged artery and damaged brains. And so that small dense LDL contributes to the overall damage. And one thing the statins are doing is it’s reducing all cholesterol, including the small dense LDL. So, it’s almost as a side effect the statins are having this benefit. So, then the next question is, “Well, then why not just take a statin anyway, at least it’s got some benefits.” And I would agree if statins didn’t cause any harm, and this is where you will get sort of this notion that, “Oh, well, it’s okay, it doesn’t really cause too much harm.” American Heart Association says, “Statins don’t really cause much harm. It’s very rare.” Well, it’s not so rare. And we reviewed the literature, and in my papers, we reviewed dozens of papers showing all the different forms of harm that statin can cause. Statin can actually interfere with the functioning of the pancreas, which is why you see increased blood sugar. You see significantly increased new-onset diabetes, which has been trivialized by American Heart Association and cardiologists think it’s extremely rare, but it’s not.

[00:33:04] In general, you’re probably looking at another 5% to 6% of people over the course of five years that are going to have diabetes as a result of taking statin. Another one, which we published a paper on, is that statins can get into the brain, some set of statins can get into the brain. It really depends on the molecular structure. The brain has a protected status called the blood-brain barrier, and many of the drugs cannot get into the brain. Some statins can’t get in the brain. The statins that can get into the brain actually interfere with the brain’s own machinery to make cholesterol. And understand, you had said, “How important cholesterol is?” Cholesterol is so important to the brain that it controls its own cholesterol. It makes its own cholesterol, and it uses cholesterol to make new connections, new synapses to generate new cells, neurogenesis. And so, the statins that can get into the brain, for example, Lipitor, one of the best getting into the brain. When you look at cognitive problems, Lipitor has one of the highest rates of reporting to the FDA of cognitive deficits. 

[00:34:08] There was an incredibly important paper published a bit over a decade ago, and it’s been completely ignored by mainstream cardiology, by the American Heart Association, published in a medical journal. But you had were 75-year-old people, men and women, all on statins, in which a majority that happened to be on Lipitor and other kinds of statins that can get into the brain. They all had gone to their doctors reporting memory problems, and they were diagnosed as officially having dementia. Well, as an experiment, they took all these people off of their statins, and you can actually see their cholesterol rose. So, you know that they were off of their statins, and they’re now tested a month later, as a group, their dementia disappeared. They’re no longer diagnosed with dementia. This has to be frightening to me to realize that when we’ve got this epidemic of Alzheimer’s disease now, and we’re approaching almost half of older people are taking statins. We don’t know what percentage of these people actually have a normal functioning brain, which has been impaired as a result of taking the statins. No one has followed up on that study. It’s not the kind of study the American Heart Association wants to fund. It’s not going to a study that makes people’s careers.

[00:35:25] In fact, they could potentially break someone’s career to come out with a finding like that. But that’s a study, I think it’s incredibly important. And cardiologists and you prescribing statins, no doubt you had patients coming to you, telling you they had what’s called brain fog, impaired cognition. And then the idea is, well, then you find a lower dose, you find an alternative statin, and then often people go from Lipitor to Crestor because there are fewer side effects. And as the cardiologist, you feel good about that, “Oh, that’s great. I found a statin that doesn’t have the brain fog.” Well, the Crestor is now associated with increased diabetes as well as there are so many other side effects and of course, muscle damage. And so, what the statins are doing is interfering with muscle function, interfering with mitochondrial function. Now, I tell you something else that has been an epidemic, is heart failure. And I’m saying the heart is just a muscle. We know that statins interfere with muscle functioning, that they cause deterioration. Well, the heart being a muscle and the heart now potentially adversely being affected by statins. No one is looking into the epidemic of heart failure over the last few decades in relation to statins. 

[00:36:38] Now, there is one magnificent paper that comes to mind in which people all diagnosed with heart failure. Now, the real downside of heart failure is that it does have a high rate of mortality. As many as half of people diagnosed with heart failure will die within five years. Well, this study was extraordinary because these people are all diagnosed with heart failure. They’re all on statins. They were all taken off of the statin now, followed for the next couple years, and there’s almost nobody died of heart failure, which is completely contrary to conventional medicine. So, there’s so much going on in conventional medicine promoting the idea that cholesterol is harmful. Cholesterol itself causes heart disease, and you need to take medication to lower your cholesterol. And there are new drugs coming out all the time that can target LDL. And on that topic, and I’m kind of rambling and rambling, but I was shifting a little bit, that topic, LDL has been just a great source for industry to target. I mean, think about it, “Have you seen the ads for Cheerios?” You got a food that basically tastes like cardboard,-

[laughter]

[00:37:43] -and they don’t truly, they don’t come out Cheerios, but it tastes good. The focus of the ads for Cheerios is its heart healthy. And you’ve got an elderly person with his grandchild, and she says, “Grandpa, why are you eating Cheerios?” “Well, because it’s good for my heart.” You can’t say it tastes good. You have to say it’s good for my heart. It’s like, just like having medicine for breakfast. And garlic, you name it, and nuts, and food and drugs. LDL is basically the cash cow because everybody wants to lower their LDL. They’ll take a supplement, they’ll eat something, but they may not even want to eat to be able to lower their LDL. And this is the world we live in now in which LDL has been demonized, and it promotes industry, that food and the drug and supplement industry. And so, that’s quite a story we’ve just uncovered. [chuckles] 

Cynthia Thurlow: [00:38:33] No, absolutely. You did such a beautiful job, and I think, starting with the role of scientific misconduct, I think for many individuals, I’m certainly not perfect, but we lean into the advisory committees, we attend medical conferences, and we assume that, people are supposed to disclose relationships that they have with either private or public industry. And understanding that, in many ways, we have gotten so far away from reading research that we’re not even realizing we’re being stooped over. Looking at this absolute relative risk, I want to just point out, and I found this statistic amount amazing. In 2023, there were 90 million prescriptions for statins. That’s number one. And the most prescribed medication in 2023 was Lipitor. What we’ve been talking about, it’s a $30 million year industry, so you can understand intellectually why there is a disincentive to disrupt this very profitable industry. But yet what we’re really speaking to is helping people understand, like having that honest conversation with your clinician to say, “Is this really justified? Do I really need to be on a statin therapy or on a lipid lowering agent? Is there something else I can do?”

[00:39:48] And I would advocate that nutrition can be very, very powerful. And I know for yourself, you speak quite a bit about the value of a low-carbohydrate diet being very efficacious for utilization in improving lipid profiles. And I do want to touch one thing is, when we’re looking at the side effects from statins, they are pervasive. I mean, they impact every cell in the body. They can impact cognition, they can reduce CoQ10, which is a vitamin that’s found in virtually all cells. I had so many patients that had myalgias or muscle aches that were a direct reflection of this precipitous drop. It impacts our ability to compose and properly set up bile salts. So, breaking down and emulsifying fats impacts, erectile dysfunction. It’s interesting, the statistic I looked at said Crestor increased the risk of erectile dysfunction by 2% to 7%. I’m sure when patients are started on some of these agents, these types of side effects are not fully disclosed. I think in a lot of different circumstances and especially for a male, I had many male patients that would talk about these things. It was incredibly problematic.

[00:41:01] Reduction in oxytocin, which is this key hormone in bonding, that is not just relative to bonding with an infant, its ability to connect with others, also lowers cortisol and then thinking about impact on immune function and higher risk of cancer. I mean, unless someone is sitting down and having this conversation and providing fully informed consent, I think a lot of people are on medications that in and of itself are not without side effects. I just wanted to make sure I kind of dovetailed that in there. But let’s pivot a little bit and talk about the role of low-carbohydrate diet and the impact on lipid lowering, because this is a really powerful association. And again, it goes back to this lack of desire to really focus in on nutrition when nutrition should be driving a lot of these principles and conversations with patients. 

Dr. David Diamond: [00:41:51] Nutrition is so complicated [Cynthia laughs] and that it’s so simple to say nutrition is complicated. I like to compare. Humans are like combination of cockroaches and rats. 

[laughter]

[00:42:05] People can survive on a very broad range. It’s hard to kill a either rat or cockroach, and they can live on almost anything. And people can actually live on almost any kind of diet. When you look at humans, prior to development of agriculture, just wandering the world, I mean, think about how amazing it is that people could survive in Africa and then wander the world and survive in the Arctic, and then just wander the world and eat whatever would happen to be available. And this is part of the beauty of being human, that we are capable of being healthy on such a broad range of diets that really complicates science. You have in particular the vegetarian science, which is not, basically, they’re not advocates for low carb, and they’re strong opponents for this view that LDL is not harmful. You will typically find, and there are many vegetarian cardiologists who I’ve gone to battle with, and this is the problem. When people become vegetarians, they appear to become healthier. And being a vegetarian can be relatively high-carb diet. I had a friend become a vegetarian not too long ago, and I said, “Oh, did you start smoking at the same time?” [Cynthia laughs] And of course, it’s a silly question. 

[00:43:15] And this is the problem with human behavior and human nutrition, is that if you look, for example, at vegetarian, that’s not a low-carb diet. It can be, but it’s not typically a low-carb diet. People who are vegetarians typically are college educated. They exercise, they don’t smoke, and they have a healthy lifestyle. They do all kinds of things like yoga and stress reduction. They do all these things that are right. And the healthy vegetarians also limit their sugar consumption. And these are the people who are so well educated but they’ll say, “I feel so good now that I’m not eating meat.” It’s the foolishness that really should be the title of the book, “The Foolish Vegetarian.” And there are really influential people who write books about how healthy it is to be a vegetarian, and they completely disregard the sugar component. And so, this is the problem. The evidence is so strong that really the two demons that I mentioned were the seed oils and the sugar. And we’re really talking about any food that will raise blood sugar. I don’t just say it’s sugar in your mouth. 

[00:44:19] People need to understand. People with diabetes should not be eating potatoes. Bread, potato really is like candy wrapped into a fiber and so it’ll cause your blood sugar to skyrocket. Eating bread will cause your blood sugar to go up. So, when I talk about low carb and really ketogenic diet is an extreme form of low carb, in which you’re having almost no carbohydrates, which I think is a great medical diet. And it really takes a lot of motivation for someone to be in ketosis. It really means a very limited amount of carbohydrates. And I do think it’s ideal for brain functioning. I think it should be included as a part of treatment for cancer. There’s a really great book out by Georgia Ede, on Change Your Diet, Change Your Mind. I absolutely adore the woman, and there are just so many, there are other doctors coming to realize that our brain really functions ideally when it’s got that combination of ketones and glucose. So, I’m an advocate for low-carb diet simply because I do think that’s the diet humans evolved to consume. When you look at the real world, before humans changed everything. In the real world, you don’t find the bananas and the fruit that we have in our supermarkets. The natural fruit has almost no sugar. Natural bananas in the wild are nothing like you find in the supermarket and the natural potatoes. 

[00:45:40] So humans, before the development of agriculture 5000 to 10,000 years ago, were not consuming lots of sugar and food that contain sugar. It’s almost as if you take our primitive physiology, which is really designed to have primarily animal source protein, and it’s like it goes into shock where we have these huge increases in blood sugar, and therefore the pancreas starts to say, “This is not right, we got to pump out some insulin.” But 10,000 years ago, and 100,000 years ago and beyond, that just didn’t happen. So just for advocate for low carb almost sounds like, “Well, you like that diet, but there are other diets that work better.” It’s not a diet. It’s simply mimicking the humans evolve to consume. And the real problem is that sugar tastes so good, [Cynthia chuckles] and Prada and food that raises our blood sugar tastes good. It is really like a drug. And when you advocate for low carb, you’re saying, “You need to stop taking your drugs. Your drugs being your addiction to sugar.” And that is a problem because people can be healthy. Again, being a vegetarian is not inherently unhealthy. 

[00:46:44] Now and again, I raise this issue of vegetarian, because the vegetarian, there has never been as far as we know, and currently, there is no culture that is vegan that can survive without supplements. And I think it’s a very important part of understanding nutrition. There are so many nutrients that are found in oil-based products. And I call the carnivore MDs, and I learned from them, and I see how basically they’re kind of sticking it to the vegetarian MDs. And the vegetarian MDs are almost, despite the Hippocratic Oath, I’ve got to believe the vegetarian MDs are just waiting for them and hoping that they would all have heart attacks. [Cynthia laughs] And it’s a great disappointment, I think, to them, but they won’t admit to it that these people who are carnivores are thriving as far as on their health. And you’ve got nutrients in animal-based products that are really either not found in fruits and vegetables or they’re not really bioavailable. And those obvious one is vitamin B12, which is only found in animal-based products and not in any fruit or vegetables. 

[00:47:47] And also there’s a really important vitamin K2, which you’re probably familiar with. K2 is also only found in animal-based products. And it’s very animal -based foods, very important for getting calcium to be deposited in the bones. And when you have insufficient K2, the calcium gets deposited just passively in soft tissue including our arteries. That combination, insufficient K2, high blood sugar, results in calcium deposited arteries and contributes to heart disease, but also osteoporosis. And you find that people who are vegans tend to have far more brittle bones, more osteoporosis, more broken bones as they age. So, it’s a real compromise. First of all, for people who are vegetarians or vegans only because of concern for animals, they’re really sacrificing their own health because of what they consider optimizing the health of animals, and I think we need to take that into consideration. Now, it doesn’t mean you’re automatically unhealthy if you’re vegetarian. There are supplements that I think can maintain good health for people who are vegetarian. It is more difficult to be a vegan and be healthy, but taking the proper supplements can certainly help. 

[00:48:53] And if animal welfare is a great concern for someone, then I understand why they would want to be vegetarian. I do emphasize to people, “Well, then have eggs and cheese.” You don’t have to kill animal to be able to get eggs and cheese from them. And it’s a compromise that people should be able to make because you’re just getting so many nutrients from eggs and cheese. And as long as you’re not sensitive, allergic to dairy, then it is a really great source of food. So, there’s my view on low carb, in which you can call it sort of modern paleo, in which the paleo diet is a bit of a variant on low carb because it says you shouldn’t even have food from any animals that were domesticated in the past 10,000 years, which means you’re not even having dairy, which I think is a bit extreme. 

Cynthia Thurlow: [00:49:40] Yeah. I think that you bring up so many good points and, ultimately, we want to select a nutritional paradigm or a nutritional philosophy that resonates, allows us to have the ability to sleep well, have plenty of energy, exercise and be sustainable. And what I’ve come to find is that sometimes these nutritional paradigms can be rigidly dogmatic. And I think it’s important to be curious and open that as an example, you know, some of the people that are doing carnivore, they may benefit from– These are people that have spoken to me about this. They may need to add some fruit, they may need some honey, they may need to broaden their horizons, just like the vegetarians. And I love that you brought up the eggs and the dairy because that’s generally how I’m able to help patients and clients get to their protein needs. Well, I’ve so enjoyed this conversation. I hope that I’ll be able to entice you to come back. Please let listeners know how to connect with you on social media, how to learn more about your work. 

Dr. David Diamond: [00:50:35] I’m on Twitter almost every day, which now we call it X.

[laughter]

[00:50:40] -And sometimes I battle with people who differ in my opinions. My username is @LDLSkeptic. I prefer that people not contact me for medical advice. I do get emails almost every day with someone saying, “I have high cholesterol. My doctor wants me to take a statin. What should I do?” And I always first, it’s just so many emails that I get that I prefer not to respond to people who ask those kind of questions. And of course, I’m not a physician, and even a physician wouldn’t really want to give people advice. So, I do share my talks with people, and I give people information. So, if someone would like information, they’re certainly welcome to send me an email at ddiamond@usf.edu. I’ve got a lot of papers published, so if someone wants to google my name, they can see my talks and see my publications. And I would say print them and bring them to your doctor. When your doctor’s insisting that you need to go on a statin, don’t say, “I told you so. Just show them.” Cynthia laughs] Show them my paper and see if your doctor is actually amenable to reading about my interpretation of the science.

Cynthia Thurlow: [00:51:42] So, well thank you.

Dr. David Diamond: [00:51:42] I really want to thank you, Cynthia, for inviting me to be on your show today.

Cynthia Thurlow: [00:51:47] Yeah, absolutely. I’ve been really looking forward to this conversation. Thank you for the work that you do and your advocacy, because for many individuals, it opens up their mind, and not just clinicians, but also patients, to the opportunities that there might be more to their life circumstances than they realize. 

Dr. David Diamond: [00:52:04] Oh, great. Great. Well, good that we’re working together on this. 

Cynthia Thurlow: [00:52:07] Yes. 

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