Five Tips on How to Prevent a Heart Attack

Cardiology is renowned for its innovative procedures and cutting edge technology. However, one of my favorite scientific papers of 2014 did not address innovative techniques, DNA sequencing or new wonder drugs. It dealt with the fact that certain lifestyle habits and the absence of abdominal obesity may prevent most heart attacks.

Five Tips on How to Prevent Heart Attack

Toady, chronic noncommunicable diseases are one of the biggest challenges of medicine and healthcare in general. One hundred years ago doctors were busy dealing with infections; pneumonia, tuberculosis and gastroenteritis (1). Today it is heart disease, cancer, dementia, diabetes, and obesity.

The pandemic of chronic diseases seems to have started only a few decades ago. Although the underlying causes are multifactorial, modern western lifestyles are often blamed, implying that these diseases are potentially preventable.

However, the knowledge that lifestyle contributes to disease doesn’t necessarily provide an easy solution. Our lifestyle choices are easily manipulated by the external environment. We are constantly bombarded with advertisement, and the internet provides a steady flow of information that may be both overwhelming and confusing. What should we believe and who can we trust? 

Of course, every doctor should educate their patients about the relationship between lifestyle and disease. However, as Dr Bernard Lown, a great cardiologist and Nobel Peace Prize recipient once said: “Diligent prevention, unfortunately, plays second fiddle to heroic cures.”

It’s a fact that cardiologists are often more interested in the high-tech diagnostic and therapeutic aspects of their discipline than in preventive lifestyle measures. However, the 2014 paper I mentioned before certainly suggests that the latter may be much more effective when it comes to reducing the burden of heart disease in our society.

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Five Tips on How to Prevent Heart Attack

In September 2014, a paper by scientists lead by Agneta Åkesson PhD at Karolinska Institutet, Stockholm, Sweden, was published in the Journal of the American College of Cardiology (JACC), suggesting that five basic lifestyle factors may prevent approximately 80 percent of heart attacks in men (2).

But it’s not only about men because another study published 2007 by the same group of researchers observed that low-risk dietary and lifestyle behaviors may prevent 77% of heart attacks in women (3).

I’m not sure whether the medical community understands the potential impact of these findings. At least the 2014 paper didn’t to steal many news headlines.

About 600,000 people die of heart disease in the United States every year. This is approximately 25% of all deaths (3). Coronary heart disease, the most common cause of heart disease causes nearly 380,000 deaths annually.

Every year about 720,000 Americans have a heart attack (4). Of those, 515,000 are a first heart attack. Imagine if this number could be reduced by 80%, to 103.000 cases annually, with a therapy that is mostly without side effects and risks.

In 1997, the Swedish researchers sent a questionnaire that included approximately 350 items to men aged 45-79 years residing in two counties in central Sweden. A total of 48,850 men returned the questionnaire, but those with a history of cancer, coronary heart disease, self-reported hypertension and self-reported high cholesterol were excluded from this particular analysis, leaving 20,721 for the main analysis.

The men were followed for a mean of 11 years. During that period, there were 1,361 cases of a first myocardial infarction (heart attack).

The scientists studied the risk of heart attack in relation to the following five low-risk lifestyle behaviors: a healthy diet, moderate alcohol consumption, no smoking, being physically active, and having no abdominal obesity.

1. A Healthy Diet

Five Tips on How to Prevent Heart AttackAfter mutual adjustment for other elements of the low-risk profile, individuals with the highest score for a healthy diet had an 18% lower risk of heart attack than those with lower scores for the healthy diet.

A healthy diet was identified according to a Recommended Food Score developed by Kant and coworkers (5). This score emphasizes foods such as fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains, and fish.

A non-Recommended Food Score was defined based on 21 food items including red and processed meat, fried potatoes, solid fats, full-fat cheese, white bread and refined cereals and various sweet foods.

The men with the highest Recommended Food Score were more likely to have a higher level of education and were less likely to smoke or live alone, compared to men with lower scores of recommended foods.

Interestingly, men with the highest Recommended Food Score had a mean non-Recommended Food Score of 17 while those with lower scores of recommended foods had a mean non-Recommended Food Score of 15.

Although not mentioned in the paper, this suggests that those who ate the most “healthy” food didn’t eat less of the “unhealthy” food products.

Furthermore, mean daily energy intake was 2,900 kcal among that 20 % with the highest Recommended Food Score but 2,700 among the others.

A varied diet consisting of fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains and fish is associated with approximately 18% lower risk of having heart attack.

2. Moderate Alcohol Consumption

A low-risk alcohol group comprised men who consumed moderate amounts of alcohol (10-30 g/day). This is usually defined as no more than two drinks per day for men.

After adjustment for other low-risk profile elements, moderate alcohol consumption was associated with 11% lower risk of heart attack.

Previous studies have suggested that moderate alcohol consumption may provide cardiovascular benefits.

However, because heavy alcohol consumption is associated with a number of disease conditions and increased mortality, it is very difficult for the clinician to recommend moderate consumption of alcohol in order to reduce the risk of cardiovascular disease.

Recommending people who don’t drink to start drinking in order to achieve possible health benefits is also highly controversial.

For those who already drink, it is important to understand that the evidence suggesting that alcohol improves health only applies to light or moderate drinking and not to binge drinking or heavy drinking.

Moderate alcohol consumption is associated with 11% lower risk of heart attack

3. No Smoking

Never smokers and those who quit smoking > 20 years ago were classified as non-smokers.

Not smoking was associated with 36% lower risk of heart attack after adjustment for other low-risk profile elements.

Of course, this doesn’t come as a surprise. The evidence linking smoking to increased risk of myocardial infarction and death is incontrovertible (7). However, the results highlight the huge health benefits of not smoking.

Not smoking is associated with 36%  lower risk of heart attack 

4. Being Physically Active

Five Tips on How to Prevent Heart Attack


Physical activity was assessed by the e
questionnaire. Participants reported their level of activity at work and home and during leisure time in the year before the study started.

A low-risk physical activity behavior included both daily non-exercise physical activity (walking/bicycling) and a more vigorous weekly exercise, pre-specified according to criteria from another study (3).

After statistical adjustment, men who were physically active had a 3% lower risk of heart attack compared to those who were not physically active.

The importance of exercise for cardiovascular health has been previously documented. Fifteen years ago the Honolulu Heart Program clearly illustrated the effect of regular walking, suggesting that the risk of coronary heart disease is reduced with increases in distance walked (8).

Physical activity is associated with a 3% lower risk off heart attack 

5. Having No Abdominal Obesity

Central or visceral obesity has been found to be a strong marker of cardiovascular risk in a number of studies.

The Swedish investigators defined abdominal obesity as a waist circumference > 95 cm (38 inches).

After adjustment for other low-risk profile elements, the absence of abdominal obesity was associated with a 12% lower risk of heart attack.

The absence of abdominal obesity is associated with a 12% lower risk of heart attack

The Take-Home Message

Although the study by Åkesson and coworkers defined five separate low-risk elements associated with lower risk of heart attack, it also underscores the importance of multiple combined lifestyle habits.

A total of 1,724 (8%) men had none of the five low-risk elements present, and 166 (10%) of that group suffered heart attacks.

In contrast, 212 (1%) men had all five low-risk elements. Of those only three (1.4%) had heart attacks.

Therefore, almost 4 of 5 heart attacks may be preventable with a combined low-risk behavior.

In an accompanying editorial to the paper in the JACC (9) Darius Mozaffarian MD wrote: “In light of the breadth of previous mechanistic, physiological, observational, and clinical trial evidence on the impact of lifestyle, it is time to prioritize these most basic and fundamental behaviors to reduce the health and economic burdens of cardiometabolic diseases.”

So my message is simple:

If you eat healthily, don’t smoke, consume alcohol in moderation, regularly exercise and avoid overweight you will greatly reduce your risk of having a heart attack. These measures are more effective than any known medical therapy. Most people don’t need complex technology or a magic pill to avoid heart disease.

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59 thoughts on “Five Tips on How to Prevent a Heart Attack”

  1. Doc,

    a great article. As for the lifestyle studies you recited, as important as they are, I don’t think there’s any real news to report. The first 10-year follow-up of the 7CS study was published already in the 1970s. As concluded by Daniel Steinberg, an interesting case were the Japanese. The Japanese males of the 1950s sustaining largely on carbohydrate (white-rice & soy beans) had the highest level of cigarette smoking and chronically elevated blood-pressure, yet atherosclerotic heart events accounted around 1/10 to what observed in working-age American males at the time.

    “One important line of evidence comes from a consideration of the Japanese experience. In 1952, mortality from CHD among Japanese men 55 to 64 years of age was <10% of what it was in the United States.15,16 Their total cholesterol levels at the time averaged ≈160 mg/dL (estimated LDL, ≈80 mg/dL). It is noteworthy that the Japanese enjoyed this relative immunity to CHD despite the fact that the prevalence of one of the major risk factors—cigarette smoking—was much higher in Japan than in Western countries,17 and another—-hypertension—was just as high.18 Even the diabetic population in Japan fares better than the diabetic population in Western countries. In 1985, almost 30% of British male diabetics but only ≈15% of the Japanese male diabetics had CHD.19 The implication is that if blood cholesterol levels are sufficiently low, the other dominant risk factors, including cigarette smoking, hypertension, and diabetes mellitus, constitute much less of a threat".

    “A crucially important point needs to be noted here: For whatever reasons, the Japanese have their lower cholesterol levels for their entire lifetimes.

    So, perhaps given the evidence from multiple directions, but importantly from genetic studies, maybe the best advice to lower the risk for CHD is to eat a simple plant-based diet and have very low LDL consistently throughout the life.

    • It’s interesting that on the island of Kitava, in 1989, 80 percent of the adults were daily smokers. Yet they had no heart disease. Must be something about the food. Excerpt: The elderly residents of Kitava generally remain quite active up until the very end, when they begin to suffer fatigue for a few days and then die from what appears to be an infection or some type of rapid degeneration. https://www.staffanlindeberg.com/TheKitavaStudy.html

    • Since the 1970s cholesterol levels have gone up among the Japanese while mortality from coronary heart disease has dropped (ref). Certainly smoking and high blood pressure have become less frequent. But anyway, it’s interesting to note that the rise in cholesterol among the Japanese has not stopped coronary heart disease mortality from declining.

      • Doc,

        primary prevention with top-snotch drugs skew pretty much all the data with cholesterol these days. The only reliable data we get with cholesterol and CHD is the kind of the data that track the cumulative burden of individual throughout the life-time (versus the snap-shot data).

        Do I need to even go the placebo controlled trials showing that lowering LDL even among old people reduces the odds for CHD (the oldest patients at Scandinavian simvastatin trial were in their 70s). Are you suggesting that the Japanese are fundamentally different and that giving some ezetemibe to Japanese does not translate to lower risk of CHD in direct relation to LDL being lowered?

      • Axel, the paper you cited clearly states that this is explained by “classic” population level risk factors. Nothing strange about this. No one’s claiming that higher LDL levels are the ONLY thing that matters.

      • Exactly Mie. “Nothing strange about that”. But highlights the fact that CHD mortality can be lowered without lowering cholesterol and as you said; LDL-C is not the only thing that matters – it sometimes tends to be forgotten – not by you though 🙂

  2. Thank you for this. Such common sense approaches. I don’t think physicians I know spend much time on showing patients the importance of these 5 risk potentials. Many just write for a statin and/or antihypertensive and routinely do stress testing or a cardiac cath. I worked in a hospital that specialized in cardiac care before I retired in 1996. High volumes of cardiac caths, stress testing and many coronary bypass grafts.

    Of the 5 risk factors there are 2 I didn’t quite understand in their ranking as lowering MI:
    Diet- the data is confusing to me. The lower risk diet subjects ate 200 more calories/day? And the food lists that are considered healthy are a little questionable to me.
    In all of my reading on diet and CHD, research on this subject is so difficult to define. Then, if we begin with a fallacy as to healthy food, the research is meaningless.
    Abdominal fat- 95cm just seems so high for a waist in determining abdominal fat. I think in inches that is around 37? Can’t there be abdominal fat with much smaller waists?

    In all, this is still a small group of empowering actions a person can take to decrease his chances of heart attack! Loved it!

    • Hi tannngl

      The definition of abdominal obesity was > 95 cm which is approx. 38 inches (I’ve added it now). Remember that these are male individuals, it would be lower for women.

      I agree that the dietary are not entirely clear. They don’t tell you what not to eat. However the message is obviously that eating fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains and fish is likely to be helpful when it comes to avoiding coronary heart disease. The data doesn’t tell you anything else about these dietary items or any other foods.

  3. Dave,

    it would be more informative if we had some studies in which the arteries of Kitavans themselves were subjected to scrutiny. These people die rather early so whether they have a cardiac event during their lifetime is less relevant, at least if we are trying to understand something about the causes of CHD.

    We do have artery data from high-smoker, pacific people, though. https://www.sciencedirect.com/science/article/pii/0021968173900313
    https://healthylongevity.blogspot.fi/2012/11/traditional-diets-in-asia-pacific-and.html

    • Richard,

      The healthylongevity website is fascinating. Thanks for the link.

      You commented, “These people die rather early so whether they have a cardiac event during their lifetime is less relevant, at least if we are trying to understand something about the causes of CHD.”

      Perhaps. But the article said, “…average lifespan was around 45 years. The remaining life expectancy at 45 years of age is more difficult to determine, but may be similar to Swedish figures.”

      As there was no cardiac disease in the 6% of the population aged 60-95 years, deaths from accidents and infectious diseases seem irrelevant.

      It’s interesting to note the similarities between the Kitavan and Okinawan diets; low in added sugars and polyunsaturated oils and high in root corps. Kitavans ate yams, sweet potatos, taro, and tapioca. The Okinawan dietary staple was sweet potatoes.

  4. Hi Doc,

    You confused me a bit by mentioning this as a healthy-diet-tip to prevent a heart-attack: “A varied diet consisting of fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains and fish is associated with approximately 18% lower risk of having heart attack.”

    From your previous oktober 2014 blogpost: “Today, blaming the rising incidence of coronary heart disease 40-50 years ago on the intake of red meat, whole-fat milk, cheese, cream, butter and eggs appears naive at best.”

    You changed your mind about the whole-fat dairy?

    (Btw I agree with you about the whole foods like fruits, vegetables, nuts, etc.)

    • Hi Janet

      Thanks for bringing up this issue because I really think it’s important and clearly something that can and should be debated. Do low fat dairy products belong in a healthy diet?

      Firstly. I haven’t changed my mind about whole fat dairy products. I still believe that natural fats should (in most cases) be part of a healthy diet. Furthermore, I think low-fat dairy products may often be problematic because of the amount of added sugar.

      In the case of the blog article above I was merely reporting the findings of this particular study which incidentally used a definition for healthy diet that included reduced-fat dairy products. And obviously, this dietary score was associated with reduced risk of coronary heart disease.

      However, I don’t think the findings of the study tell us anything about whole fat dairy products. In fact, if you look at table 1 in the paper (I mentioned the findings in may blog article), you can see that those with the highest Recommended Food Score also had higher non-Recommended Food Score (which by the way included solid fats and full-fat cheese). Interestingly the authors didn’t comment on this finding in their paper.

      But I definitively believe, as you do, that fruits, vegetables and nuts should be included in a diet that has its primary aim to reduce the risk of heart disease.

      • “Firstly. I haven’t changed my mind about whole fat dairy products. I still believe that natural fats should (in most cases) be part of a healthy diet. Furthermore, I think low-fat dairy products may often be problematic because of the amount of added sugar.

        In the case of the blog article above I was merely reporting the findings of this particular study which incidentally used a definition for healthy diet that included reduced-fat dairy products.

        Well why in god’s name would you “merely report” findings that go against what you believe? What’s worse, these recommendations are based upon an observational study, which by nature cannot prove causality. People reading this particular post might get the impression that the recommendations are iron clad, when instead they’re based upon the worst kind of science out there.

      • Hi Bob

        “Well why in god’s name would you “merely report” findings that go against what you believe?”

        For me, science is not about choosing teams. I don’t have a monopoly on the truth. I’m not a preacher.
        I will continue to discuss and report results of interesting scientific studies. I will not only pick studies that support my own “beliefs”.

      • I can respect wanting to be fair and balanced but the fact remains that the data these recommendations are based upon are mere correlations and no conclusion can rightfully be drawn upon that.

        As an example it’s common sense that there exists a correlation between gray hair and all-cause mortality. Should people start dyeing their hair a different color in order to rid themselves of the “risky” gray hair? If you were to confuse correlation with cause and effect one would do this but obviously that wouldn’t be correct. Gray hair is an effect of age, not a cause of death.

        In this particular case these data from observational studies are riddled with confounders that make them nearly worthless. I wouldn’t care if I believed that all of the suggestions were harmless but including eating whole grains perpetuates the myth that these foods are healthy. Perhaps they’re a little less unhealthy than white flour but regardless, they don’t belong in a recommendation to improve your odds of not dying from heart disease.

      • “… but the fact remains that the data these recommendations are based upon are mere correlations and no conclusion can rightfully be drawn upon that.”

        E.g. Oslo Diet Heart Study, Lyon Diet Heart Study and PREDIMED have shown that similar guidelines do indeed work in reducing CVD risk/end points.

  5. The concept that modifying these five risks can cut heart attack risk by 80% is being widely spread in the US. I think we can all agree that our patients should exercise, not smoke, not be fat and eat a nutritious diet.
    Most of the debate centers on what constitutes a nutritious diet.
    The study which developed the Recommended Food Score (RFS) by Kant and coworkers includes these comments on the limitations of their data:

    “It would be premature to conclude that the observed inverse relationship between RFS and mortality is causal. Given the observational epidemiologic nature of our study, the possibility that RFS is a surrogate for some unknown, poorly measured, or inadequately controlled determinant of mortality cannot be ruled out. Smoking status, physical inactivity, alcohol use, vitamin supplement use, and education level (a potential proxy for certain environmental exposures or lifestyle characteristics) were all associated with RFS in this study. Although we controlled for these and other factors as best as we could, we cannot dismiss the possibility of residual confounding. Furthermore, given that our cohort consists of participants in a screening study, it is possible our results have limited generalizability. It would certainly be valuable to see whether the RFS-mortality association holds in other large cohorts of men and women.”

    In addition, the components of the RFS are somewhat arbitrarily bundled together. For example, I would agree that fruit, vegetables, fish, nuts and legumes are nutritious and heart healthy. I do not advocate low fat dairy but tell my patients there is no evidence that low fat dairy lowers their risk of heart attack over full fat dairy products and is less likely to contribute to obesity (https://wp.me/p30zF0-5) The better RFS are more likely a marker for less processed food with less added sugar rather than lower RFS.

  6. Axel!
    Thank you for the link to Bernard Lown….This gentleman extinguishes the ‘Spooky’ innuendo’s of CAD and takes on the reality and ugliness of money and motives of some/probably most Cardiologists and Thoracic Surgeons.

    “Good health is bad for business”

    I am in agreement with Dr Anthony P…regarding a basic outline on nutrition.

    The topic of this post is re-hashed blah blah blah! And unintersting…but! The comments compensate.

  7. I appreciate your reply. I’m a (Dutch) dietitian for many years now, but I have the feeling that the more I read about (blood)lipid´s etc. the less I know ;-). I learn a lot here on your blog. Thanks Axel!

    • Thanks Janet

      Appreciate your interest in my blog.

      In this and many other areas, the feeling of “knowing less” is usually a sign of good knowledge. Those who think they have all the answers often “know less” 🙂

  8. @ Bob Johnson,

    “…but including eating whole grains perpetuates the myth that these foods are healthy. Perhaps they’re a little less unhealthy than white flour but regardless, they don’t belong in a recommendation to improve your odds of not dying from heart disease.”

    For decades, fats were relentlessly demonized because it was thought that high fat intake was the underlying cause of obesity and heart disease. Now, carbohydrates are being demonized in the same way. Excerpt: “Glycation and its damage is ultimately a cumulative process, so every bit of sugar or starch we eat eventually counts. Every piece of candy, cookie, bread, or potato, every spoonful of honey, and every drop of soda effectively shortens your life—something to think about.”

    That’s the extreme view. Here’s a more measured assessment: https://freetheanimal.com/2015/01/hormesis-afraid-unrefined.html

    • Hi Dave,

      I agree, the evidence against saturated fat was terrible and this is the kind of evidence that nutritional science is rife with and we’ve suffered for a long time from this terrible advice. The recommendations this article was based upon is of the same sort of evidence.

      Now as to your quote on carbohydrates I’m not sure where you got that but it’s an extreme view and not one I personally hold. I think that any food that spikes your blood sugar is detrimental but any damage can be reversed entirely by ceasing to consume those types of food. It’s my personal belief (and one that I realize isn’t completely backed up by good data but seems reasonable) that nearly all chronic disease (CHD, cancer, dabetes, etc.) is caused by excessive blood sugar/insulin resistance caused by a continual consumption of carbohydrates. The cure for high blood sugar/insulin resistance is simply to stop eating them, no drugs necessary.

      This is why I get a bit perturbed when I know Doc Axel also believes this to some degree yet feels he needs to be fair and balanced in his own blog, where wouldn’t really need to feel that way. If I want an article about how healthy whole grains are because of some observational study results I’ll read something from Yahoo or Huffington Post, when I want a nuanced view from someone who deals with reality every day I turn to personal blogs.

      • It’s indeed your personal belief and nothing more. There’s no evidence that complex carbs (you know, the ones that are recommended) cause any of the chronic diseases you mention.

      • So are you saying whole grains don’t spike blood sugar levels for hours? And that if you eat whole grains at every meal and snack (6 meals per day according to the “experts”) you aren’t elevating your blood sugar for all your waking hours? Are you saying that bathing your cells and organs in sugar water continuously won’t have any detrimental effects?

        You live in a fantasy world of denial.

      • I’m saying this (and I quote):

        There’s no evidence that complex carbs (you know, the ones that are recommended) cause any of the chronic diseases you mention.

        Of course eating carbs causes blood sugar levels to rise. So does eating protein. There’s a PHYSIOLOGICAL reason for this, you know.

        And where did I recommend eating X meals a day? There’s no HARD evidence (end point data) of a particular meal frequency being superior/inferior to another.

        Don’t know about denialism, but if you want hysteria take a look in the mirror.

      • Mie – this is the problem, you don’t read what other people write before you start responding. If you had bothered to read what I wrote you’d have understood that I didn’t attribute the 6 small meals a day to you but to the nutritional “experts” who do a great job of parroting the conventional wisdom and a lousy job of using their brains.

        And of course I understand that protein can lead to gluconeogenesis but the thing is that protein won’t spike your blood sugar to nosebleed levels, that is strictly the domain of carbs and in particular wheat, which has a higher glycemic index than even regular sugar. (I can’t stress this enough – that “healthy, whole wheat” pushes your blood sugar higher and for a longer duration than even pure sugar).

        I’ve caught your act before on other threads and it was always a waste of time. Like all great trolls you’re really good at shifting the narrative a tiny bit, enough to make people think you actually know what you’re talking about. But you do people here a huge disservice with your subtle shifting of the goalposts, strawman arguments and loaded questions – there are people here who have tried following the advice of the “experts” with no or negative success and are looking for alternatives. You attack people with different ideas as if it’s a personal affront that someone thinks differently than you. Here’s an idea – stop it. Having a thread devolve like they do when you get involved makes them almost unreadable – which may be your goal, I don’t know.

        This is the last time I will respond to you- unless you wish to have an actual discussion that furthers a conversation and isn’t just your typical internet bash session.

      • Bob, I read what you wrote – and kinda thought it would be obvious to … well, anyone, that as you reply to a person’s comments, you should deal with what the person actually SAID. You know, instead of babbling about anonymous “experts” (whoever that may be).

        In addition, GI in itself is a poor measure of what’s healthy for any given person and what isn’t. E.g. whole grain products, which CONSISTENTLY excel in population level studies and as part of healthy diet in intervention studies, too. What matters is the fact that NO quality randomized controlled trials – or meta-analyses conducted of them – show that that carbs (those recommended, I’m not talking about sugar) per se are to blame for … Well, anything.

        And about the pity act at the end of your message: please. If you talk nonsense, expect to get comments. Carbophobia makes no sense and there’s no reason NOT to call it what it is. I’ve made no strawman arguments either nor moved any goalposts – and you know it as you “conveniently” chose to back off before my reply.

        Troll along.

      • “The cure for high blood sugar/insulin resistance is simply to stop eating them, no drugs necessary.”
        No, Bob. That’s not the cure for Insulin Resistance. See *link redacted, as it makes the comment gets flagged as SPAM*

        If a food spikes your blood glucose excessively, then you are the problem, not the food.

      • “While everyone is entitled to their beliefs”

        Gee, thanks for allowing me that.

        It’s not carbohydrates that’s the problem. It’s over-refining

        And yet, study after study after study show that people lose more body fat and their health markers improve more on a low carb diet than something like the DASH diet. That would make me think that whole grains aren’t all that great either.

        A high-carb, low-fat diet based on whole, minimally-refined animal &
        vegetable produce doesn’t cause the above diseases, because it’s
        nutrient-dense, energy-poor. Check out my blog (link in profile).

        Please forgive me for not searching your blog to find where you prove beyond a shadow of a doubt that a high carb diet doesn’t cause chronic disease. It’s a beautiful day here in California and I’ve got things to do.

        No, Bob. That’s not the cure for Insulin Resistance. See *link redacted, as it makes the comment gets flagged as SPAM*. If a whole, minimally-refined food spikes your blood glucose excessively, then you are the problem, not the food.

        I have no idea what that means. Are you seriously blaming the person who has insulin resistance for having insulin resistance? Are you saying a person with insulin resistance needs to put down the fork and go exercise more? I’m not really impressed by that argument and I’m quite sure hundreds of millions of people who have tried hard to follow that advice and didn’t have success aren’t impressed by it either.

        How tough a concept is it? If excess blood sugar leads to insulin resistance over time, why is not eating foods that raise blood sugar to alleviate insulin resistance such a tough concept to consider?

      • Hi Bob!

        “Gee, thanks for allowing me that.”
        You’re welcome! 😀

        “And yet, study after study after study show that people lose more body fat and their health markers improve more on a low carb diet than something like the DASH diet. That would make me think that whole grains aren’t all that great either.”
        Links, please. Oh, wait. You can’t post links here. Your comment ends up in a SPAM bin. I don’t believe you. The A to Z study shows that insulin sensitive (i.e. healthy) fat people get better results on a HCLF diet. Insulin resistant (i.e. sick) fat people get better results on a LCHF diet.

        “Please forgive me for not searching your blog to find where you prove beyond a shadow of a doubt that a high carb diet doesn’t cause chronic disease. It’s a beautiful day here in California and I’ve got things to do.”
        No. I won’t forgive you for choosing ignorance over knowledge. If you’re that lazy about educating yourself, why should I bother discussing anything with you, you ignoramus?

        “I have no idea what that means. Are you seriously blaming the person who has insulin resistance for having insulin resistance? Are you saying a person with insulin resistance needs to put down the fork and go exercise more? I’m not really impressed by that argument and I’m quite sure hundreds of millions of people who have tried hard to follow that advice and didn’t have success aren’t impressed by it either.”
        Hire a translator, then. If someone has IR and does nothing to fix it (I fixed mine, if you can be bothered to look at my blog and click on the label down the right hand side called “Insulin Resistance”, to find out how) then yes, I’m blaming them. IR is fixable (unless it’s caused by MODY).

        Don’t go putting words in my mouth, sunshine. I don’t appreciate the use of strawman arguments. Find what I wrote about IR (there’s a lot to read) and criticise that.

        “How tough a concept is it? If excess blood sugar leads to insulin
        resistance over time, why is not eating foods that raise blood sugar to alleviate insulin resistance such a tough concept to consider?”
        What concept? IR isn’t caused by high blood glucose. IR is caused by….just read my damned blog already! IR leads to hyperinsulinaemia and high blood glucose. You’ve got causation the wrong way around!

      • Nigel wrote – The A to Z study shows that insulin sensitive (i.e. healthy) fat people get better results on a HCLF diet. Insulin resistant (i.e. sick) fat people get better results on a LCHF diet.

        That’s great as long as you’re insulin sensitive. The problem is a lot of people (most?) aren’t and those are the people who can really benefit from ditching carbs. There are a couple of ways to see if you’re insulin resistant – the first is to see if you have metabolic syndrome, that’s a dead giveaway that you’re really in a bad way and that is easily reversed by a LCHF diet. The second is to test your fasting insulin (an insulin assay like those done by Dr. Joseph Kraft would be better still) but for just a ferw bucks you can actually test to see how your response to insulin is.

        Here’s the latest study I ran across showing people lose more weight and improve their health markers best on a low carb diet. I’d post more but I often get the impression that most links go unread. One of my favorite Churchill quotes is “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.” I have no doubt this is a basic truth.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428290/

        Don’t go putting words in my mouth, sunshine. I don’t appreciate the use of strawman arguments. Find what I wrote about IR (there’s a lot to read) and criticise that.

        Sigh…

        First off, why the sarcasm? Second, Why are you saying I presented a strawman argument when I started off by saying “I don’t have any idea what you’re talking about”? Telling someone to “go check out my blog” isn’t a great way to get them to understand what you’re saying. If you have a theory about insulin resistance then say what it is, the expectation that I’m going to search through your blog is ridiculous. It’s like when I ask global warming proponents what their proof is that man is heating up the planet and they say “There’s this thing called the internet, go have yourself a look”.

      • I’ve already told you that the vast majority of people with IR/IGT/Met Syn can fix it (except for those with MODY). Even early-stage T2DM can be fixed. You appear to be severely IR (idea resistant). Sadly, I can’t fix that.

        Do you seriously not know what a strawman argument is? Let me remind you. You wrote
        “Are you saying a person with insulin resistance needs to put down the fork and go exercise more? Diatribe against incorrect supposition follows”
        Do you get it, now?

        Everything that I know about diet & nutrition is in my blog, backed-up with high-quality evidence and fully indexed & labelled. If you can’t be arsed to look in my blog, I can’t be arsed to talk to you.
        Do you get it, now?

      • I’m getting the impression you don’t understand what the term “trolling” means.

        You respond to something I wrote over a year ago, I reply to
        your comment and now I’m the troll because I don’t want to go read
        through your blog which Disqus says is spam and won’t post the link to?

        BTW – did you notice I supplied a link to a study you asked for earlier or did you simply ignore it as I presumed you would?

        And seriously, I have no idea why you would expect any enthusiasm on my part when your attitude stinks to high heaven. I was serious about the wheat, I think you might be surprised how much ditching it from your diet mellows you out.

      • “I’m getting the impression you don’t understand what the term “trolling” means.”
        I’m getting the impression you’re an eejit.

        “You respond to something I wrote over a year ago, I reply to your comment and now I’m the troll because I don’t want to go read
        through your blog which Disqus says is spam and won’t post the link to?”
        You’re a (rubbish) troll, because you use obvious troll gambits e.g. pseudoscientific denialism, logical fallacies & gas-lighting.

        “BTW – did you notice I supplied a link to a study you asked for earlier or did you simply ignore it as I presumed you would?”
        Of course I noticed it. I read it. It’s one study. The subjects were almost certainly IR. As I said, IR (i.e. sick) fat people do better on LCHF diets than on HCLF diets. IR is reversible. Presume ≡ Assume. ∴ You’re an Ass.

        “And seriously, I have no idea why you would expect any enthusiasm on my part when your attitude stinks to high heaven. I was serious about the wheat, I think you might be surprised how much ditching it from your diet mellows you out.”
        I don’t eat wheat. What was I saying about you being an Ass?

        Now read the evidence in my blog or GTFO.

      • So you not eating wheat means I’m an ass? Interesting logic. And unfortunately it means your bad manners are simply because you’re a bit of a jerk.

        I haven’t got a clue why you’ve awoken from your slumber to go after me. You’ve got a blog, so what? You’ve got some theory that you won’t share here and expect me to go run it down in a blog that Disqus says is spam. Who’s being unreasonable here? Let me give you some advice – calling me names is not going to motivate me or anyone to check out your ideas. I’m not sure why you didn’t know this already but it’s probably time you learned it.

      • Good morning, Bob.

        I read through a lot of your posts from your profile last night. You really shouldn’t get biochemistry information from journalists (I’m guessing Gary Taubes?) and/or self-appointed “experts” like Andreas Eenfeldt.

        See https://bit.ly/1ZbGUES for a list of educational resources. See. I can be nice!

        Your level of knowledge in 2015 is my level of knowledge in 2002. Unfortunately, the Dunning-Kruger effect makes you believe that you know much more than you actually do.

        Ciao for now!

  9. Despite trying to be a bit more physically active I have been struggling with my abdominal fat for some time now. I currently have a waist measurement of 92cm. Ive gained half a cm in the last 6 months… Ive recently been reading up on just how bad my excess fat is.. And Im wondering if professional help should be my next step? Its hard to know what opinions like a dietitian, nutritionist or a weightloss company. I need something cost effective also.

  10. @ Bob Johnson, The quote you wondered about was included in the FreetheAnimal hormesis article I linked to. The point I was trying to make is that recommendations to restrict either fat or carbohydrate intake need to be targeted to the appropriate audience. An example from Peter Kuo’s research: “It was necessary to raise the daily carbohydrate intake to 85-90% of the total daily caloric intake in order to induce hyperglyceridemia in normolipemic subjects.” https://ajcn.nutrition.org/content/20/2/116.abstract

    If you read the hormesis article, which is rather long, you’ll find that the author emphasizes the importance of adequate mineral intake. Added sugars and separated fats of any sort become problematic because they are generally devoid, dilute or imbalanced in terms of micronutrient content in general and mineral content in particular.

    • Well that’s good to know Dave but I’m not sure why you’re telling me this. I never said everyone should be eating a high fat, low carb diet. Everybody is different and some can do well on a diet loaded with “healthy whole grains”.

      But here’s the thing – the reaction to elevated blood sugar doesn’t remain static throughout a person’s life. The level of carbs a person can tolerate in their youth may not be the same as they get older. That’s why I usually tell people who ask that the only way they can tell is to actually measure their blood sugar throughout the day – I’m sure a lot of people with a “normal” fasting blood sugar would be surprised to see their BAC elevated over 140 for several hours after eating a supposedly healthy food. This is where the damage comes from – a chronic bathing of organs and tissue in sugar through out day, 24/7/365. Or a general rule of thumb is that if you’re overweight (particularly with abdominal fat), you’re most likely insulin resistant and the cure for this is to stop eating carbs, particularly wheat.

      You make it sound as if being low carb means you aren’t getting all the nutrition a body requires – quite the opposite in fact. You can pretty much eat all the vegetables you want and meat is loaded with nutrients, particulalrly grass fed animals. And I should point out that wheat is loaded with a compound called phytic acid, which binds with minerals like iron, zinc, magnesium, calcium, chromium, etc. and make any of these nutrients found in wheat unavailable for for your body to use. What’s worse is that phytic acid will also bind with these minerals from other foods you’ve eaten, reducing the available nutrition of all the foods people eat. Also wheat is full of lectins, which bind to the lining of the intestines and prevent nutrients from passing through the intestinal wall and into the bloodstream. This also causes inflammation as the body is continuously attempting to heal the gut lining. And don’t get me started on the proteins found in wheat that we aren’t adapted to properly metabolize.

      So don’t tell me that eating wheat is necesary due to some vague idea that people need to eat a “balanced” diet and that “everything in moderation” is the right way to go. I hate that sort of advice because you can’t tell me that anyone knows what a “moderate” amount of a toxin like wheat we can eat and be okay. I know that I thrive with zero wheat in my diet with my only carbohydrates coming from vegetables. I lost weight, my asthma disappeared, my eyesight got better and I no longer suffer from afternoon drowsiness after a carb-laden lunch. For a long time I would check my blood sugar and when eating low carb it never got over 90, and I think that’s how it should be. It’s worked for me and it’s worked for a lot of other people. And that’s why I think people should give it a try, they can always go back to their old way of eating.

      • “You make it sound as if being low carb means you aren’t getting all the nutrition a body requires…”

        Didn’t mean to make it sound one way or another. I suggest you read the freetheanimal article. I furnished the link because I thought you might find the information interesting and helpful.

        The point I was trying to make is that a healthy diet is one that is adequate in nutrients and appropriate for the individual. In addition, consumption of potentially toxic food components should be minimized.

        Regarding toxins, if you are familiar with my comments on other threads, you know that I am deeply concerned about advice to replace saturated fats with polyunsaturates. Excerpts from the Center for Science in the Public Interest article Richard urged us all to read:

        Q: Is it harmful to eat more omega-6 fats—which are found in some oils and nuts—than omega-3 fats?
        A: No. There have been heated discussions about how bad a high omega 6 to omega 3 ratio could be. Most of the evidence is from test tube and rat experiments. There is little evidence that this ratio affects human health.
        Q: So omega-6s may protect the heart as much as omega-3s?
        A: Yes. They may even be better. The bottom line is to replace saturated fats with polyunsaturated fats. https://www.cspinet.org/nah/pdfs/covermay2014.pdf

        The scientist being interviewed is Martijn Katan, member of the Royal Netherlands Academy of Arts and Sciences. The 2010 International Society for the Study of Fatty Acids and Lipids Dinner Debate contains some interesting discussion regarding Professor Katan’s assertion, that omega-6s protect the heart. https://theiem.org/library/IEM2010_ISSFAL_DinnerDeba-OUFR.pdf

      • Dave – I’m totally confused. The information you post makes it seem as if I’m taking the opposite side of the argument. In this case you make it seem as if I’m pro-polyunsaturated fats. Quite the contrary, I think they’re the devil’s spawn and should be avoided as much as possible.

        It’s almost as if you’re saying to yourself “Well this guy is talking about diet” so I’m just going to include a bunch of stuff that he didn’t talk about but because his main topic is diet I’ll include it here. If I’m confused I can’t imagine what other people are thinking.

        As for Richard Nikoley, I’m not a fan. He may have good ideas but he’s so abrasive I really want no part of him. Presenting ideas about diet that are contrary to popular opinion is difficult enough without having someone like Richard curse at you when you have a different opinion.

      • “Quite the contrary, I think they’re the devil’s spawn and should be avoided as much as possible.”

        And yet you call other people “trolls”.

        Dunning-Kruger, indeed.

  11. @ Bob Johnston,

    “As for Richard Nikoley, I’m not a fan. He may have good ideas but he’s so abrasive I really want no part of him. Presenting ideas about diet that are contrary to popular opinion is difficult enough without having someone like Richard curse at you when you have a different opinion.”

    The post I linked to contains no offensive language. It is a guest post.

    I’m glad we’re on the same page as far as omega-6s are concerned. Had I written the post we’re commenting on it would have contained six tips on how to prevent heart attack. I’m wondering. Do you agree that omega-6 intake exceeding 2% of caloric intake increases risk for heart attack?

  12. Dave – I really don’t have goal on the consumption of polyunsaturated oils other than to avoid completely vegetable and seed oils. You’re nearly always going to get some PUFA in any fatty food you eat so I simply try not to add to the total.

    • Bob, Twenty years ago I learned, the hard way that the seed oils are problematic and eliminated them from my diet. Or so I thought. Mayonnaise was the biggest problem. https://www.news.ucsb.edu/2014/014386/hold-mayo What I failed to realize back then was that my peanut butter intake was way too high and I was still getting too much omega-6. Fortunately, in late 2009 I heard NIH scientist Bill Lands say that there are 4,000 milligrams of omega-6 in each 28 gram, one ounce serving of peanuts. Cutting out peanut butter made a big difference in my health – leg pain subsided, gingivitis cleared up, blood pressure went back to normal, LDL cholesterol dropped 30 mg/dL, and I regained much of the strength and stamina I had lost as I approached retirement age. Since then I’ve been collecting omega-6 research. I’m looking at various lines of research including livestock feed experiments. https://www.bmj.com/content/349/bmj.g7654/rr-7

      Most likely your approach keeps your omega-6 intake low enough to protect you.

  13. “A varied diet consisting of fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains and fish is associated with approximately 18% lower risk of having Heart Attack.”

    Doesn’t sound like low carb to me.

    • And because I’m sure the 18% reduction was the relative risk and not the absolute risk I’m pretty sure the reduction is vanishingly small. I wonder what the stats would look like compared to an actual low carb diet.

  14. This phrase confused me a bit: “Furthermore, mean daily energy intake was 2,900 kcal among those 20% with the highest Recommended Food Score but 2,700 among the others.” — surely you have to be a competitive athlete to eat that much and not gain weight. I probably consume half of this amount of calories.

  15. the one thing about your recommended diet, including grains, is wheat and barley, especially wheat. Just finished reading “Wheat Belly” by Dr. William Davis. He proves conclusively that wheat is deadly especially by increasing visceral fat. He says it’s the gluten, which is also in barley, is the poison. There are about a dozen different other diseases caused by wheat. Millet to is a good substitute. God bless you. Check it out.

  16. Nigel wrote – The A to Z study shows that insulin sensitive (i.e. healthy) fat people get better results on a HCLF diet. Insulin resistant (i.e. sick) fat people get better results on a LCHF diet.

    That’s great as long as you’re insulin sensitive. The problem is a lot of people (most?) aren’t and those are the people who can really benefit from ditching carbs. There are a couple of ways to see if you’re insulin resistant – the first is to see if you have metabolic syndrome, that’s a dead giveaway that you’re really in a bad way and that is easily reversed by a LCHF diet. The second is to test your fasting insulin (an insulin assay like those done by Dr. Joseph Kraft would be better still) but for just a ferw bucks you can actually test to see how your response to insulin is.

    Here’s the latest study I ran across showing people lose more weight and improve their health markers best on a low carb diet. I’d post more but I don’t think for a second that any amount of data will have an impact on you. One of my favorite Churchill quotes is “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.” I have no doubt this is a basic truth.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428290/

    Don’t go putting words in my mouth, sunshine. I don’t appreciate the use of strawman arguments. Find what I wrote about IR (there’s a lot to read) and criticise that.

    Sigh…

    Why are you saying I presented a strawman argument when I started off by saying “I don’t have any idea what you’re talking about”? Telling someone to “go check out my blog” isn’t a great way to get them to understand what you’re saying. If you have a theory about insulin resistance then say what it is, the expectation that I’m going to search through your blog is ridiculous. It’s like when I ask global warming proponents what their proof is that man is heating up the planet and they say “There’s this thing called the internet, go have yourself a look”.

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