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Comment by mmagin | Hacker News Reader

So, I guess the American Heart Association is still committed to the LDL cholesterol causes cardiovascular disease idea.

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I'm not sure that I follow. Does high LDL cholesterol not increase your risk of cardiovascular disease?

There's been increasing evidence that high cholesterol is a symptom of cardiovascular disease, not the cause.

Editing because lots of people want sources.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/

http://www.health.harvard.edu/blog/panel-suggests-stop-warni...

http://bmjopen.bmj.com/content/6/6/e010401

https://en.wikipedia.org/wiki/Atherosclerosis#Accelerated_gr...

This is a group I was unaware of until providing you links: http://www.thincs.org/index.php

Can you source that? I'm having trouble finding much in the way of that claim.

There's not much of a correlation. I think only half of the cases of cardiovascular disease have elevated LDL cholesterol. It's always more complicated than simply having elevated cholesterol; it's overall diet, exercise, and plain old genetics that have the largest effect.

Agreed. Cardiovascular disease is definitely multifactorial, as are most diseases without a known genetic cause. Even those diseases with a clear genetic abnormality, the other factors contribute to the development of said disease.

Yes, and I'm not advocating that you should inject LDL Cholesterol everyday, just saying the science may have unfairly focused on one variable.

Can you link of that evidence? In form of scientific studies (quality ones)? This is not a general "you can't prove your point, you don't have science". I'm actually interested. I have been looking for hard science in this area and have seen none that would back up your claims.

I'm interested in this as well.

So far, all I've found is some research that artificially lowering LDL or raising HDL may not show clear correlation to lower heart disease risk- not quite the same thing as saying LDL isn't generally correlated to heart disease risk:

Broad overview:

  https://www.scientificamerican.com/article/cholesterol-conundrum/

Studies references (but not cited) in the article above:

  http://www.nejm.org/doi/full/10.1056/NEJMe0801608

  http://www.nejm.org/doi/full/10.1056/NEJMoa1107579

http://blogs.sciencemag.org/pipeline/archives/2017/05/18/now...

The linked paper goes into more detail, of course. And this is only one drug, but there are quite a few other failures of similar type, though less dramatic, discussed in the "Cardiovascular Disease" section of his blog. He always links the original papers, but they're often paywalled or highly technical.

It might be an indicator of other problems, but it's not clear that it's causative. Start reading _Good Calories, Bad Calories_ and go from there.

It's been a while since I've read that book, but I seem to remember Taubes argued that LDL cholesterol could plausibly have a negative effect on cardiovascular health and that VLDL cholesterol had a extremely negative effect on cardiovascular health. Am I misremembering?

Those are scientifically accepted ideas, but I haven't read Taubes' book. If he didn't say it, maybe you heard it elsewhere.

Yes, apparently the AHA is still committed to science.

Science or as N.N.Taleb says Scientism? There is an entire state in India where Coconut Oil is a main ingredient (Kerala) for centuries.

Indians also have surprisingly high rates of cardiovascular disease for a people with such low levels of obesity.

Kerala is sub-set of India and they have one the better socio-economic indices in India, from that my guess is better Health indices relatively speaking. The biggest problem in the state for Health is alcoholism (to my knowledge).

When it comes to food, I follow Micheal Pollen's rule, food that your grandma recognize a.k.a traditional food. Coconut Oil has been used in traditional foods in many parts of the world that is sufficient evidence for me.

People in India have eaten Betel nuts/leaves for generations, yet that causes oral cancer. Doesn't seem like sufficient enough evidence to me that traditional foods = healthy.

With all do respect for your personal health choices, that's not science nor "evidence". Just because some culture does something, doesn't mean it's the optimal way of things, especially nutrition. It's just something you have chosen to base your life on.

That is actually not very surprising. If you consider all the people in India, poverty and malnoursihment is still incredibly high. But there is much prosperity in the cities ... but healthy habits (like exercises, gym) have only recently started taking root. So obesity is more common amongst well to do Indians which in turn leads to cardiovascular diseases.

There are also tribes that actively drink alcohol or even consume natural opiates all the time. What's your point?

Population of Kerala : 34.8 million and many more live in Persian Gulf and other parts of India. This is a huge population, about size of Venezuela. When you talk about a State in India it pretty much is a large sample size.

When you're talking about India, 34 million people is a rounding error.

It's also a country with unusually high population diversity which means that genetically speaking you could be talking about a group of people that are naturally immune to the effects of whatever they're consuming. You'd have to take a broader sample to find out.

> When you're talking about India, 34 million people is a rounding error.

I don't understand your point. Sure its a rounding error when compared to the rest of India. But for the purposes of observing the effects of a certain foodstuff, that is certainly a large enough sample size of humans.

> It's also a country with unusually high population diversity which means that genetically speaking you could be talking about a group of people that are naturally immune to the effects of whatever they're consuming. You'd have to take a broader sample to find out.

This is highly unlikely. If there was such a genetic trait, I think it would be very apparent (e.g. we know certain populations in Africa are prone to sickle cell disease). Besides, its not just Kerala: most coastal regions in India have many many (delicious) coconut based cuisine which have been regularly consumed for generations.

What I mean is you may need to have a broader group in order to draw actual conclusions.

Medical research has been heavily damaged by not including enough diversity in the sample groups. One region of India is not necessarily proof of anything other than that particular group of people does not suffer any ill-effects.

For example, millions of Europeans have been consuming dairy products for generations and suffer no ill-effects but this is only because they have a mutation that allows them to process lactose in adulthood.

Yup. I wonder which one gives a better result: AHA taking a 10 person sample or millions of people over generations?

Sedentary life style has more to contribute than oils I think. Our lifestyle has changed dramatically over 50 years.

About 30 years ago people of Kerala almost exclusively used coconut oil. Then came advertisements and "studies" claiming coconut oil is bad and promoted other oils like sunflower etc. Since then heart disease has increased. This is general observation.

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