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Comment by EZ-E | Hacker News Reader

I fixed my high cholesterol problem with oats... Months ago I replaced my daily dinner with a mix of oats + banana + protein powder + 1 tbsp olive oil + peanut butter + flaxseeds + oat milk - all mixed in a blender. My bad cholesterol (LDL levels) tanked from 160 mg/dL to 91 mg/dL. My daily dinners before that were not even that unhealthy. Dropping sat fat intake had nowhere near that much effect for me. For me and I assume for many others, lack soluble fibers are the root cause of high LDL levels.

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So it appears oat fibers are just quite effective natural bile acid sequestrants[1]. That makes me wonder why don't we use this class of locally-acting compounds as first line cholesterol lowering treatment, instead going straight for the "bazooka" of systemic acting statins that have lots of side-effects, even affecting personality[2].

[1] https://en.wikipedia.org/wiki/Bile_acid_sequestrant

[2] https://www.bbc.com/future/article/20200108-the-medications-...

My guess is something like, because there aren't patents on food.

There's no financial incentive for the healthcare industry to promote a healthy lifestyle.

Doctors and public health organizations literally have dietary and physical activity guidelines.

True, it is more complicated.

For one, there could be some financial incentives mixed in in that health insurance companies would want their people to be healthier so they don't pay out as much, but it's not that simple for them either - the health industry as a whole profits more if there is more treatment ergo more health problems. If health care was cheap or less needed the insurers themselves would make less.

More importantly, there can be other than financial incentives mixed in for doctors and public health organizations to encourage health. Doctors for example take an oath and I think often genuinely want their people to be healthy. Public health organizations may be more murky but there's definitely a financial and otherwise incentive for the government itself minus those corrupted by the health industry, to want people to have less health problems.

The problem is entirely about patients refusing to do what they know is good for them if it takes any self-discipline, so doctors resort to medication.

You can't force them to have healthy lifestyles.

Patient compliance is notoriously fickle, especially when it comes to changing one's lifestyle (diet).

Synthetic, stronger versions are available, as cholestyramine, colestipol or colesevalam, that can be taken as medicines, instead of demanding large changes to diet.

Because medication is more effective. Side effects from statins are relatively uncommon and generally mild, so it wouldn’t be ethical to use lifestyle as a first-line treatment in place of, say, a combination of low dose statin and pcsk9 inhibitors.

However many clinicians do take a “let’s sort out the problem as quickly as possible with medication, and if you want to try lifestyle and back off (or even stop entirely) the meds and see how your cholesterol is afterwards, we can do that.”

This seems like a good balance to me.

Wait isn’t this the other way around?

In reality lifestyle modifications are more conservative than using a medication so lifestyle modification would be first line from an ethical perspective.

In reality though it does seem like statins are used first line by many clinicians. But ethically speaking conservative interventions like lifestyle modification in terms of changing diet and exercise should be used prior to medicating a young otherwise healthy person.

In other groups such as when someone has had a recent heart attack of course the thought process is different. Such people should be immediately placed on a statin.

No, because we have a huge body of evidence pointing to both the safety and efficacy of lipid lowering medications. We know that as far as LDL-c goes, the lower the better, so since we have safe drugs that lower more effectively than lifestyle interventions, these are the first line option in most cases.

This isn’t true in the slightest.

Lifestyle is more effective and has less side effects.

Lifestyle is the first line of treatment, with meds being a later line of action.

What’s the evidence that lifestyle intervention is more effective than combination medication therapy?

I've been doing something similar for breakfast, one cup of oatmeal + one cup of water and about two tablespoons of chia seeds, microwave for 2 minutes. Add a banana and some honey, top it with whole roasted almonds and some raspberries. It has been doing wonders for my digestion. I'll have to try to add olive oil as well. My LDL was 150 last time I checked. I wonder what it is now since I've been doing this meal several times a week.

One of my most used appliances is a Tiger rice cooker with Porridge and timer function.

It's been used pretty much every day for 7+ years since I purchased it.

Every night I put 130g steel cut oats in, 400-420g of water, set it to cook for 45 mins and be ready for when I wake up in the morning. I'll then add 25g protein powder, sometimes a few berries or sprinkle with seeds/nuts. A nutritional power house.

I find steel cut oats more filling, a lot more substantial with ground oats more goopey. Steel cut oats are normally a hassle to cook but it's set and forget with the rice cooker. From what i've read I also believe the fact they sit soaking over night in water also is breaks down the starches which helps nutrient absorption.

Does wonders for digestion and satiety. Everything runs like clockwork with them. If I don't have them for a few days, things get irregular and a noticeable difference in satiety for the rest of the day where i end up snacking as feel hungry after meals.

I came up with a microwave steel cut oat method that worked well. Going from memory, I put the oats and hot water in a bowl in the microwave and set it for 45 seconds 100%, then 9 minutes at power level 2. One of those microwaves with "Cook 1" and "Cook 2" on it. The hot water I put in initially was basically boiling hot, you might need to do more time on cook 1 if you put in less hot water (at work we had one of those instant boiling water things).

Damn, I just blast my oats until they threaten to overflow the bowl and call it a day. Does this technique unlock some creaminess or something unique?

I found that steel cut oats needed more cooking than just blasting them for a couple minutes.

You can skip the whole cooking part if you leave your oats and water mixed overnight!

Put your oats, portion of milk, some berries, cinnamon and honey in a container and leave it in the fridge overnight.

Do it now.

Come thank me tomorrow morning once you've tried it.

I've been doing this for a very long time but I use rolled oats and plain water (I drain the water completely before eating). I eat soaked oats every day and always have a fresh bowl or two soaking in the fridge. They are still fine to eat even if they've been soaking for more than 24h.

I like the fact that they are more concentrated in terms of calories/nutrients per 100g than cooked oats and also provide steadier energy. I often pair them with a protein drink (pea protein + rice protein), a drizzle of avocado/olive oil, and berries. Takes just a few minutes to prepare.

This works well for rolled oats but not for steel cut. Both types are much nicer cooked in a pot with stirring to bring out the creaminess (like risotto).

Overnight oats made with milk and yoghurt in equal proportions has all the creaminess you could ever dream of.

Hell, go full insanity mode and make your overnight oats with cream!

It's possible to both soak and cook the oats.

The overnight oats (rolled or steel cut) will cook much faster after they've soaked up liquid. If you're adding ingredients such as egg (two per 1/3 cup s.c. oats) this takes care of the raw elements as well.

Is there an added health or digestive benefit of fully soaking the oats, overnight or microwaved? Or is it just a matter of taste? I just add some hot water and milk (indeed I'm not sure if what I have are plain or instant oats)

Plain oats is a pain in the ass to cook. It takes real long and requires constant vigilance. Instant oats just needs some boiling water and 30 seconds in the microwave.

I might be wrong, but I do think non-instant oats is more nutritious.

But to answer your question, it's a combo of laziness and taking care of future me. Nothing beats opening the fridge in the morning, groggy AF, and finding delish breakfast ready to go, and it's dirt easy to prepare with no pots to clean afterwards.

Regarding berries, those can be deep-frozen, and turn the oatmush into icy slush. Giving it an unexpected but nice texture. At the same time the aromas from the berries went into everything, but the milk didn't get thick like buttermilk. Like it can happen with too much citrus/orange/mandarine/clementine in milk. Of course one can vary and combine that with different yoghurts, kefir, kombucha, and so on.

Come thank me, once you've tried it. If cold stuff is your thing at all, which could be compensated with some nice green tea, or coffee, ofc.

Steel cut whole groats have really good nutrition. That tough brown skin is full of good stuff. I do mine in the pressure cooker for 20 mins with 1:1:3 oats:milk:water.

I also use a pressure cooker (instant pot) but it doesn't take nearly that long. 3 minutes on high, rest for 10 minutes, vent. I also use 1:3 oats:water and add a splash of half and half when I serve it. I'll usually do a batch of 1 cup oats, 3 cups water, two cut up apples, and a lot of cinnamon. That's four servings and I reheat the leftovers in a microwave with some additional water. I also like to add walnuts when I serve.

For steel-cut whole groats, the tough whole seeds cut in half width-ways? Mine would be crunchy and whole after just 3 mins. Even after 15 mins pressure they were a bit firm. Rolled I cook in 5 mins.

I only know one kind of steel cut whole oat:

https://mccanns.com/product/mccanns-traditional-steel-cut-ir...

I'm using an instant pot. Maybe it develops more pressure? But 3 minutes high, rest for 10 minutes, vent, is just a bit on the al dente side. Cooked through, but slightly chewy.

Sometimes I sauté the dry oats in a pat of butter for a few minutes before adding the water and cooking. It gives them a nice nutty flavor.

We're definitely talking about the same. Very interesting.

> Sometimes I sauté the dry oats in a pat of butter for a few minutes before adding the water and cooking. It gives them a nice nutty flavor.

Sounds great. It's the nuttiness from the skins I like about them compared to rolled.

1:3 oats to water ratio in weight or volume? Since you mentioned instant pot I am assuming volume (cups)?

> one cup of oatmeal + one cup of water

Do you need a knife and fork?

I don't like when my food is too mushy. This is a perfect ratio for me

Not the poster, but I grew up eating oatmeal that you would slice. Toss a pot on the wood stove, done when you remembered to grab it. Milk and honey on soft slices of oatmeal. Honestly don’t eat oatmeal much today, but was confused the first time I had oatmeal away from him and it wasn’t at least like lumpy. I’m sure that pot had to be soaked for a half an hour every morning.

Add some walnuts. See my other comment for reasoning.

Oat fiber. I've been taking 30g of oat fiber everyday for the past 3 years. Slugging it down in 8oz of warm water and 10g of nooch. Not only are my cholesterol levels fantastic after starting that regime, but very regular as well.

fiber is important but the unique cholesterol benefits from oats is around glucans esp. β-glucan

also found in mushrooms, rye, some fruits, pectin, etc.

oat fiber is fine but you'd probably see similar benefits from psyllium husks or other fiber sources.

> I'll have to try to add olive oil as well

You've got almonds and chia, so your fats should already be covered.

> peanut butter

While peanut butter does contain some useful nutrients, there are much better choices out there in case someone would like to further improve/optimize their nutrition. Many topics in nutrition can be quite debatable but IMHO most other nuts outperform peanuts (which aren't even nuts) in many ways. Furthermore I'd say peanuts aren't that useful as a protein source in this situation given that protein powder is already being added.

I recently discovered the world of nut butters, and usually choose them over whole nuts due to easier digestibility and nutrient availability. Unless I'm eating macadamia nuts which already feel quite easy on the gut.

Peanut butter is much cheaper as nut butters are usually very expensive (at least here), but I agree, substituting peanut butter with tahini drastically improved my stomach/digestive issues.

I added it for weight maintenance/gain (I'm close to underweight)

Peanut butter is cheap and delicious. A lot of people hyper-optimising nutrition (I was one of them) tend to forget much more obvious stuff like fiber, amino-acid profiles, absorption of specific vitamins like D, etc.

But also high in fat and thus calories. Lower-grade brands also add in garbage like palm fat or sugar. But like with all things, it depends a lot on the quantities you consume and also what else you eat and drink.

Of course, but personally I find it hard to eat too much of a ‘nut’ butter. I did keto for some months and was, in fact, almost always nauseatingly full from all the fat.

Interesting. I could eat PBJs all day long, if someone let me (and thank you to all the loving people who don't!)

Well, that J over there might be the trick. In keto I wouldn’t use jelly. I ate whatever fats and bits of protein I wanted, but it turns out that you’re full all the time and end up eating less (~2.2k calories vs my median of 2.6k).

The high fat is a benefit not a detriment.

Depends on the function you're trying to optimize.

Depends on your views of the lymphatic system and the role of fiber and protein. My fiber intake during keto was <15g, and I think my colon wasn’t happy.

It's definitely cheap and delicious, but I found that it actually started giving me breakouts on my forehead, especially around my brow line, when I started putting it in smoothies after training 4-5x per week. Switching over to using almond butter (or really just cheaper raw almonds since I'm blending anyways) made it go away.

Being pedantic the only nuts we generally eat that are actually nuts are hazelnuts. The rest are seeds, drupes, or as in the case of peanuts legumes.

Chestnuts?

Peanuts are an order of magnitude cheaper. Sometimes, if you buy a packet of "mixed nuts", you find the first three ingredients are three different types of peanut.

Soluble fiber in general helps lower LDL, beans and lentils work well too. One caution for diabetics, this meal could be pretty high in carbs for a single sitting depending on portions.

Interesting. I have almost the same smoothie every morning minus the banana and oats. Instead I use psyllium husks for fibre.

My cholesterol has been in range for years despite eating almost exclusively saturated fat since I'm in the keto camp. Just watched an interesting episode by Peter Attia and Layne Norton on seed oils which might shift my view on PUFAs a bit.

Thoughts?

Not related to your question, but the lead levels in psyllium husks are too high for me to consume them daily.

People are just different. I always wonder how we should think about eating and health on a personal level.

I can eat McDonalds and still get perfect blood results. (I dont do that anymore). I have a friend who does not like any vegetables and fruits, he is fine. But also friends who just look at a bag of sweets and grow fat. Allergies and stomach health can be very specific.

Of course you do control a lot. But at the same time, it seems very individual. Maybe a chance for personal AI nutrition practice?

30 % of the population have genetic makeup such that they can smoke all their life and not increase their risk of lung cancer by much, yet it's deadly for the other 70% of the population.

Many many studies over many decades, reviewed and controlled for other factors have showed that consumption of saturated fat increases heart health issues leading to death in the majority of the population. Finland and Norway have reduced the number of CVD at the population level by educating and pushing for a reduction in sat fat. You are probably one of the few exception.

This, and the infamous seed oils are subject on which Attia has controversial opinions - he is not an expert on nutrition, nor an epidemiologist, but neither am I, so my advice would be to broaden your sources of information.

Having said this, is the thing about PUFA the results of the studies from Walter Willet? I've just watch Chris MacAskill (Viva Longevity on YouTube) talking about it, it seems that PUFA (fatty fish, walnuts, sunflower seed oil) has the most positive effect on triglycerides across the whole population, and beyond reducing saturated fat and increasing fiber intake.

Likewise i switched my breakfast to oats around 3 years ago when my cholesterol was above the recommended high threshold and its been constantly in the higher end of the accetable range ever since. I would like it to be lower, but its much better than it used to be.

Blending reduces some of the effects of including soluble fibres - your stomach empties faster, blood sugar can spike more quickly (especially with fruit smoothies), and you lose some of the "scrubbing" action in the intestines.

I did the same, my cholesterol was lower than ever. What I think it happens was that I increase my proteins intake as well as the muscle.

> Months ago I replaced my daily dinner with a mix

Any particular reason for changing your dinner and not BF or lunch?

Breakfast I don’t eat. Lunch I typically eat outside, dinner after work I’m lazy to cook so replacing by a shake was perfect! 15 min all in for preparation, consumption, cleaning.

Soybeans have more fiber than oats. More soluble fiber too.

They’re also somewhat less flexible in terms of a yummy breakfast, more likely to be GMOs, and a heavily sprayed crop.

China would like to have a word with you. Soy milk in particular is hugely popular for breakfast, and there's about a zillion other ways to eat it too.

Does soy milk still have the fiber or is it like drinking fruit juice?

Oats are a heavily sprayed crop as well (at least in the US). Glyphosate is also further sprayed on oats as a drying agent. Fortunately Costco sells a brand of glyphosate free oats in bulk.

Can you be more specific with how you make it. Thanks!

Not op but for breakfast I do 1/4 cup steel cut oats, 1 cup water, 1 tbsp olive oil, 1 tbsp maple syrup, 1/4 tsp cinnamon, pinch of salt. Add a spoon of flax meal at the end. I sometimes add walnuts.

I wish I didn't need the maple syrup. Adjust to taste I guess. Doc says my cholesterol levels are immaculate.

• half of 1 cup rolled oats • 1 banana • 1 scoop soy or pea protein powder • 2 tablespoon flax seeds (make sure to buy whole and grind them, in my case I don't need to grind them separately the blender chops them while doing the shake) • 2 tablespoon peanut butter (100% peanut no added oil) • 1 tablespoon extra virgin olive oil • unsweetened oat or soy milk • I add some water if it's too thick

I blend the oats and the flax seeds first, then add the rest, blend again for 10 secs, boom - easy. You may want to adjust peanut butter quantity depending on whether you’re trying to lose, maintain or gain weight. 2 tbsp is me trying to maintain weight as I easily lose weight.

Do you cook the oats beforehand?

I don’t, they’re rolled oats and blended they are easy to drink as long as there is enough liquid

There's literally nothing wrong with saturated fat. Most polyunsaturated fats arelre problematic

The science around what fats are good or bad is so confusing I don't think we can say much about them with certainly, except that trans fats are probably bad. I lean towards "eat whole foods", but those can include anything from beef and coconut which are full of saturated fats, to fish and nuts which are full of polyunsaturated fats.

Limiting animal fats (which are mostly saturated fats) has a very noticeable and measurable effect on how I'm feeling and doing overall. Primarily using olive/avocado oil and nuts/seeds as my fat sources significantly improved my energy levels, mental clarity, sleep, and stress/HRV (as measured by my Garmin watch). I've noticed this so many times that I don't think this is a placebo. I haven't checked any specific blood markers that might be affected by dietary fats though.

Saturated fats _are_ essential for humans but you should be getting enough of them from non-animal sources.

YMMV

Akshually... Both chicken and pork, and even beef, have more mono- and poly-unsaturated fats combined than saturated fat.

I think that depends on the individual, or maybe on the dose. Years ago I read a bunch of books arguing for saturated fat, started eating a lot of it, and my cholesterol and triglycerides got horrifically bad. Even those books, which claimed high cholesterol is no big deal, were like "but if it goes over X then you need to fix that," and I was over X. I had high particle numbers too, which the books agreed was pretty bad. I went back to my normal diet and that took me back to my normal bloodwork.

Citation Needed.

My understanding is that the very few studies that showed positive impact of "adding" saturated fat turned out to be a replacement issue. They replaced junk (candy, refined carbs) with sat fat. Replacing with MUFA and PUFA showed a much greater effect.

you say "fixed" but have you asked "why" you think your cholesterol is broken and needs "fixed"?? why is your cholesterol broken? why is higher cholesterol numbers strictly associated with longer life? why is lower cholesterol numbers strictly associated with premature death? why do we think higher cholesterol numbers are bad when the worldwide data clearly shows higher numbers are healthier?

there are always layfolks who think they're smarter than the medical professionals

https://www.ahajournals.org/doi/pdf/10.1161/CIR.000000000000...

the medical professions you cite are the very people that are profiting off the propaganda you are spoon feeding yourself. and your very link does precisely zero to address the question being asked, why is high cholesterol bad? maybe journey away from the profit center and widen your view to answer the question instead of parroting propaganda from bigpharma...

https://pubmed.ncbi.nlm.nih.gov/21160131/

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