Balanced Bites Podcast | Diane Sanfilippo & Liz Wolfe

Podcast Episode #286: Healthy Fats & Cholesterol with Dr. Cate Shanahan

Diane Sanfilippo Cholesterol, Fats and Oils, Featured, Podcast Episodes 3 Comments

Balanced Bites Podcast | Diane Sanfilippo & Liz WolfeTopics

  4. The saturated fat myth [9:58]
  5. Seed and vegetable oils [22:30]
  7. Ketogenic and high fat diets [43:13]


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You’re listening to the Balanced Bites podcast episode 286.

Diane Sanfilippo: Welcome to the Balanced Bites podcast. I’m Diane; a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and The 21-Day Sugar Detox. I live in San Francisco with my husband and fur kids; and I’m back from Hawaii and I’m not sure I’m thrilled about it.


So Liz is on a quick break again this week, as I interview an amazing leader in the health and real food community; Dr. Cate Shanahan. But before we get started, let’s hear from one of our sponsors.



Diane Sanfilippo: Alright everyone! It’s just me today; no cohost. But I have an amazing guest, and before we dive into this week’s interview, which I’m super excited about, I wanted to just remind everyone that I’ll be at Expo West when this episode is airing. So if you're there and you see me, or you think you see me; please say hi. I think it would be super fun to get to meet anyone who is there who happens to be milling around or maybe you’re helping out a brand at a booth; definitely let me know!

2. Introducing our guest, Dr. Cate and something she’s digging [2:38]

Dr. Cate Shanahan is a board certified Family Physician. She trained in biochemistry and genetics at Cornell University before attending Robert Wood Johnson Medical School. She practiced in Hawaii for ten years where she studied ethnobotany and her healthiest patients’ culinary habits. She consults for the LA Lakers. And in March 2017 will be relocating to Newtown, CT; New-town? Newton? New-town? {laughs}

Dr. Cate Shanahan: New-town.

Diane Sanfilippo: Newtown! To open a new office. How are you today?

Dr. Cate Shanahan: I’m doing great, thanks. Yes, I’m hoping that the Newtown is going to be better than the old town.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: That’s how I remember it.

Diane Sanfilippo: Well I’m glad to have you here. I’m excited to dive into today’s topic; but before I do that, I think it would be really fun to give our listeners a little bit of a more casual introduction to you with something you’re digging lately.

Dr. Cate Shanahan: Yeah, I’m really digging my neighborhood now that I have to say goodbye to it.

Diane Sanfilippo: {laughing}

Dr. Cate Shanahan: So I’m saying goodbye to all the sandstone formations, and all the little trails, and I’m being very sentimental about it. {laughs} But, onward and upward. And the other thing I’m really digging, is I got some samples of Ventresca tuna; it’s a canned tuna, from Vital Choice. They were nice enough to give me a shipment of them. They are so good. And what I love about it; I just opened up the can. One day I was like; well what can I do with this? So I threw in randomly a bunch of pumpkin seeds, the sprouted pumpkin seeds, and it was so good! It’s like my new favorite lunch.

Diane Sanfilippo: Well, I don’t know if you know this, but they’re one of our podcast sponsors. {laughs}

Dr. Cate Shanahan: Oh well that works out!

Diane Sanfilippo: Fortunate that that was something you're digging lately, that was not planned at all. But I have tried that tuna; and you’re right, it is amazing. And thank you for the reminder that when I place my next order I will include that, because it’s kind of buttery and; yeah it’s just really delicious.

Dr. Cate Shanahan: It was so good! With those; it took me 30 seconds to make this, and it was like something I would have paid for at a restaurant. It was a magical combination there; because they’re crunchy, the sprouted pumpkin seeds, and they’re a little salty, and they have olive oil too. So it was good.

Diane Sanfilippo: Love that; that’s a really good one. Thanks for sharing that.

Dr. Cate Shanahan: {laughs} Yeah cool.


Diane Sanfilippo: Alright, so today’s topic we’re going to talk about all things related to fats; healthy fats, cholesterol, all kinds of good stuff. But before we dive into listener questions, what I want to do is just have you talk about this topic from your perspective. If we look at, I guess kind of zeroing in on how what we eat in terms of fat and cholesterol affects our health in terms of any sort of cardiovascular disease risk, or cholesterol levels, and just the truth about that from your perspective, as well as where we’re kind of going astray. And knowing that our listeners are pretty keen on the whole; we’re not afraid of egg yolks, we’re not afraid of eating fat or that it’s going to directly cause heart disease or any of that.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: But at the same time, there still is confusion. And I would say; not just confusion but just that little bit of apprehension; like, are we really ok? Is this really {laughs}.

Dr. Cate Shanahan: Right!

Diane Sanfilippo: Like, are we sure?

Dr. Cate Shanahan: Is that glob of butter really not going to end up giving me a heart attack or a TIA.

Diane Sanfilippo: Totally.

Dr. Cate Shanahan: Yeah.

Diane Sanfilippo: Totally; and also, what are some truths that we know about, what can predict heart disease and what does all of this mean for just the average person? So that’s a lot. But feel free to just kind of talk about your perspective on all of this.

Dr. Cate Shanahan: Well, you know I’m really glad that you’re wanting to talk about this. Because this is really the meat of the matter for me, as a doctor. Because when I; of course when I went through medical school, I learned the typical soundbite nutrition; I call it soundbite science. Where you have all these complicated diseases, but you have one cause. So cholesterol causes heart attacks, salt causes hypertension; fat makes you fat. And really it didn’t go any deeper than that.

Actually the reason I decided to call the book my husband and I wrote together Deep Nutrition was because we went deeper than that. And really, that’s what’s inspired me to look in this whole new direction anyway. Because when I got sick at one point in time, I had to change my diet in order to get better. Because nothing else was working. And I came across the idea that there was such a thing as essential fatty acids; these fish oils. And that completely blew my mind; because I just had this idea that all fat was the same, it was all bad, end of story. So that little glimmer of a light suggesting there was a whole other bucket of information out there that I could look into about fats; it was just the perfect thing for me. Because as a biochemist; I went to Cornell for biochemistry before I attended medical school, after I graduated from college. Just the chemistry of the fatty acids was something that I really could drill down into. It was missing information that just helped me understand everything.

And of course, once you start understanding that this whole idea that saturated fat is bad for you “might” be a lie, then it really poses all these questions that I hope we’re going to maybe answer a little bit today. So, if it’s not true, then what does cause heart disease? And how do I know if I’m at risk? And this whole field of cardiology is about to undergo a major shift. And I think it might take 5 years, but I’ve been seeing amazing headlines in the medical journals. There was one where this cardiologist was talking about; the headline was, “Eat Some Cheese.” {laughs}

Diane Sanfilippo: That’s kind of hilarious that that’s an exciting headline; but hey, you know.

Dr. Cate Shanahan: {laughing} I like the “some.”

Diane Sanfilippo: Well they have to, you know, introduce moderation with everything, otherwise somebody might be in trouble.

Dr. Cate Shanahan: Exactly. But it reminds me of “the cheese stands alone.” In the song that you learn in elementary school. {laughs}

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: So the cheese is standing alone right now with a few cardiologists not afraid to gather around and say; “Hey, go ahead. We don’t think this is going to kill you anymore.” So I thought that was very earth shattering, and hopefully it will lead to the next big thing which is understanding that statins are not the cure-all, and they’re actually even dangerous. The cholesterol lowering drug; statins.

4. The saturated fat myth [9:58]

Diane Sanfilippo: Right. So what I’d love to ask you about, and before we get into our listener questions. I tend to be pretty self-indulgent with my questions on this show {laughs}. We just bring on guests that I want to talk to and ask questions of, so. You know; this is how we go.

Dr. Cate Shanahan: I’m here to serve.

Diane Sanfilippo: But I’m curious whatever sort of background or whatever sort of thoughts you have on vegetable oils, and what we need to know about why they’re unhealthy; what folks need to know about any of that. Because it seems like, if we use common sense, we would know that naturally occurring fats in foods like butter and cheese; it seems crazy, if you’re not thinking, “What does the research say?” if you’re just thinking as a person who has lived through time, just looking at what our grandparents and great grandparents ate. Once we started introducing the “science” to what we’re eating and what we’re producing, as what we call food. I’m air-quotes all over the place. You know; things we call “food” that are made by man versus very naturally occurring things. Once we introduce all of that, that’s when things start to get confusing. But, we can’t ignore that sometimes, something that’s “made” isn’t the worst. But sometimes it kind of is the worst. And from my estimation, vegetable oils are far more concerning than something like grains.

Dr. Cate Shanahan: Oh yes.

Diane Sanfilippo: So, what is it that we need to know about what’s so bad about vegetable oils?

Dr. Cate Shanahan: Yeah, so vegetable oils were actually guilty of causing heart attacks and strokes all along; and in fact, Ancel Keys, the father of this idea, they call him the father of the diet heart hypothesis, and he’s the one that created this image of saturated fat clogging up in our arteries that continues to just be the rule of the day here in mainstream medicine, as of this moment. Hopefully that will change.

But he actually literally framed saturated fat for crimes committed by vegetable oil; and that’s one of the things that I’m always; I love this topic because I’m always hoping to get more people to see that no one really ever believed saturated fat; there was never any evidence that saturated fat was bad. The whole time, this Ancel Keys, and the people who have continued his research at Harvard, like Walter Willett, who is still at Harvard, the whole time that Keys was talking about saturated fat; he was referring to margarines that were made out of hydrogenated vegetable oil, because that’s what he studied. But the way he talked about it, he misled doctors and the public into thinking that he was actually studying butter and eggs. But he was studying hydrogenated vegetable oil, and it’s just really, it’s the crime of the century.

I think this guy, Ancel Keys, is like the worst criminal really. And he’s getting away with literally with murder. And they’re worshipping him at Harvard. And this is the crux of the problem with modern medicine. This is why half of the people that I speak to don’t want to go to regular doctors anymore, because we’re so mixed up about this issue, and everything falls out from here. Because it was this issue; the idea that saturated fat was bad for us; that destroyed our relationship with food.

Before Ancel Keys; before the 1950s, before World War II, there was no concern about it. It was just; don’t eat too much, obviously. But we had whole foods; we had farmers that we knew. People would buy food; they would buy chickens, they would buy whole chickens. They didn’t have to get the boneless skinless chicken breast to have every last shred of animal fat removed. And it was that one directive, the “avoid saturated fat” that obliterated our relationship with traditional cuisine, traditional cooking; even our respect for cooking. It was in the 50s that this phrase that I hate was invented, “Cooking and cleaning.” Have you ever heard that phrase? {laughs}

Diane Sanfilippo: Of course; totally.

Dr. Cate Shanahan: I mean, when did those two things get put together? It’s as if those are the menial tasks that are beneath the modern housewife. And so to have that kind of mentality, it was just all part of what was happening in the 50s. Doctors went right along with it. And in doing that, we discarded; we didn’t realize we were discarding the most valuable source of nutrition information, the biggest body of nutrition science available to us, which was traditional cuisine. Because it’s not random that all cultures did the same things; which we call the four pillars of cuisine. But it’s not random that you go anywhere on this planet and you see chickens, and pigs, and some kind of vegetable, some kind of root vegetable. You see the same kind of animals; very often you see dairy products. It’s not random; this is what we need.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: {laughs} And we just discarded all of that, because somebody told us that saturated fat was going to clog our arteries. And it was like; oh my gosh! How could we be so; that’s dangerous, to just be so laissez faire about everything people had done just because some guy in a white jacket says to.

Diane Sanfilippo: I like how worked up you get about it.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: I can picture you are extremely animated on the other end of this recording.

Dr. Cate Shanahan: Yeah, I’m like a Muppet over here.

Diane Sanfilippo: Because it is something. And we talk about this in detail at length in our Master Class; we’ve got a lot of students in our class right now who are podcast listeners; and they’re like, “Yes! We just learned about this!” Because our fat and cholesterol module is broken into three videos, because it’s so much information; whereas most of them are one video. We give them 2 weeks, and I still don’t think it’s enough time, because it’s just so much information.

But you know; I think it’s part of the modern headspace, which we’re getting away from a bit now. I would say my generation and those younger, who no longer just kind of bow down to the white coat. And I do think that there’s something about this notion; part of it could be that we have Dr. Google now, which is for better or for worse. But I do think that people need to realize that doctors are people too, and they’re not immune to group think, and they’re not immune to following something because it’s “always been that way” or following something because that’s what they’re taught. And I think when we look for doctors to help us, I think it’s just as important to find somebody that you respect as a thinking person, not just because they have this MD after their name. so I think that’s really a big challenging thought process to kind of put forward; but unfortunately, it’s one of the reasons why it is hard for a lot of folks who are struggling with their health to find somebody who is really going to work with them.

But again; they’re people too, and some of them, I would guess a lot of them don’t even realize that they’re perpetuating such unhealthy, I don’t know; zeitgeist about what to eat and; anyway. That’s a whole other topic. But you know, do you think a lot of folks bought into it because of the way that we named these things? Because we’re calling it fat versus lipids; or because of this idea of saturated or solid sounds like it’s going to harden our arteries? Do you think part of it is also the language that we’ve used?

Dr. Cate Shanahan: Totally. I think that’s a great point. Yeah, saturated. It sounds like it’s filling you, or you’re going to be full of it really quick.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: Suddenly you’re just going to turn into it. {laughs}

Diane Sanfilippo: Yeah.

Dr. Cate Shanahan: Absolutely, yes. And I think also that the visual image that Ancel Keys created was of an artery being clogged with grease, as if that’s exactly what happens.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: As if you ate butter, then it would just end up little bits of butter in your arteries. Which is as ridiculous as saying, “Well you better blend all your food. Because if you don’t, chunks of it are going to get stuck in your arteries.” {laughs} But because he used chemical words, like saturated and polyunsaturated and stuff like this; that gave him the aura of deeper knowledge. And doctors at that time didn’t have to learn organic chemistry, and not everyone today does, and most doctors actually frankly forget it, because it’s not made relevant.

So it was just like that, a little bit of knowledge kind of thing. It’s kind of like what Mark Twain said something really smart about that. It’s like, “I never let knowledge get in the way of;” no. “it’s not what you don’t know that gets you in trouble, it’s what you think you know that just ain’t so.”

Diane Sanfilippo: Yes!

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: That’s so true. The power of being an effective communicator, or strong orator, for example can really mislead a lot of people.

Dr. Cate Shanahan: Yes.

Diane Sanfilippo: But we don’t have to get into the details {laughs} of what else that can affect in our world. But yeah, I think that; I draw the analogy, which sounds crazy to people, but it’s just as crazy that for the same reason eating a piece of broccoli which is hard on your plate and solid; doesn’t then directly transfer to being a piece of broccoli clogging your artery. It’s just as absurd to think that eating saturated fat or something in the form of butter or lard will do the same thing. Because what we forget in that translation of food on the outside of our body to chewed, and then assimilated as nutrients in the body, we forget that there’s an entire digestive process by which our body is mechanically and chemically breaking down food into nutrients that then it will do something with. It doesn’t do anything with the whole food; and by that token, if it doesn’t digest the whole food and doesn’t fully break it down, it doesn’t then just get into your arteries. You will poop it out whole. {laughs}

Dr. Cate Shanahan: {laughs} Exactly.

Diane Sanfilippo: If you’re not digesting fats properly, they will be in the toilet. If you're not digesting kale or corn properly; they will be in the toilet, and you will see them. So it doesn’t just go from your plate to your artery. And I’m laughing because it is absurd that we would ever think that that could happen; but it’s not absurd that people have been misled to believe that that’s the way that it works in the body. You know; because somehow, it’s very easy to be afraid of that.

Dr. Cate Shanahan: Yes, exactly. Especially, like I say, when somebody’s got a white coat on and they’re using words that pertain to this whole other field of knowledge; chemistry, that not everyone is very well versed in. so it seems like; “well how am I ever going to learn all of chemistry.” That sounds like a chemistry word, so it must be true, right? It’s just, it’s still misleading us because we’re still seeing really bad science coming out every single day. And because there are half-truths in it; so the half-truth is what enables the people who are the editors to be fooled into thinking it’s actually useful progression of science, but it’s not. And as a scientist, it’s very frustrating. And I see; I feel like it’s the number one problem, is that people are misrepresenting a limited understanding of something as the whole story. Yeah. So. Nowhere is it more of an issue, though, than with cardiology and with heart health.

5. Seed and vegetable oils [22:30]

Diane Sanfilippo: Right. So, is there anything else that you want folks to know about seed oils, vegetable oils, etc. We know that trans fats; and when we talk about trans fats what we mean is fats that were, perhaps, liquid at room temperature, typically polyunsaturated fatty acids, that through a chemical process; perhaps pressure, heat, chemical application; have become solid. It’s a hydrogenation process; you can kind of Google for more on that. But we talk about that, of course, again in the Master Class; or we show what happens to the chemical structure of these fats. And folks can often think about it; hydrogenated oil would be something like canola oil that is liquid in its initial state, but then it’s turned into something like Crisco, which is solid at room temperature, and that is a hydrogenated oil, meaning we’ve actually added hydrogen to it and we’ve applied this process that makes it hard instead of soft; instead of liquid. And that has different applications in a culinary world. We understand that that does different things to your pie crust, or to your salad dressing, etc. but what happens in the body when we eat these different things; besides even the trans fats, which we know can be inflammatory. What about just vegetable oils in general, that I know we’re all avoiding. Things like canola, corn oil; soybean oil, etc.

Dr. Cate Shanahan: Yes. We all should avoid them; however, they constitute about 30% of the daily caloric intake of the average American. Somewhere between 25 and 45% is the range. So it’s not insignificant, unless you are consciously going out of your way to look for them and take them out of your diet, you’re getting too many to be healthy. And they’re affecting your health in one way or the other. Because; and I’m glad you brought up the distinction between hydrogenating them and just having them, still in their liquid state. Because a lot of chefs and home cooks have their eye on that hydrogenation idea, and that’s what makes these oils bad. But if they’re not hydrogenated, then they’re fine; but that’s not the case.

And the reason has to do, of course, with the chemistry. Because to put it real simply; the fatty acids, the type of fats that are in these oils. So fats and oils are made out of fatty acids. And it doesn’t matter, but there are three of them that are bonded to glycerol; so that’s is considered a fat, whether it’s a liquid or a solid, it’s still called a fat, if there are three of them bonded to glycerol. But that doesn’t matter; that’s just a fun chemistry fact of the day I guess {laughs}.

The type of fatty acid that’s there; whether it’s saturated or monounsaturated or polyunsaturated is what makes all the difference to whether it’s able to handle being cooked with and heated and processed or not. So the seed oils, like soy, and palm, and canola; those are the three most common. Those are loaded with polyunsaturated fats that are too fragile to be extensively heated, or chemically treated. But they are, in order to extract them from the seed on a massive industrial scale that happens today, and 99.99% of the canola, soy, and palm oil is going to be extracted in a factory. You could, theoretically, do it on a very small scale, and basically make it yourself.

Actually, I just saw these; they’ve got these little machines now, that are like the size of a printer or a bread machine; and you can pour in any kind of seed; and chug, chug, chug, chug you’ll get a pretty great oil out of it. It’s not going to be refined in any way, and it’s barely going to be heated, so that’s some new toy I want to get {laughs} as soon as I relocate to Connecticut and try with peanuts and sesame just to see how it tastes. Because you can do it; you can make it yourself, and that’s going to be the optimal, freshest, healthiest.

But getting back to the industrial process, and what you buy when you’re buying it in a bottle in a grocery store, or what restaurant chefs are using, or what’s in most salad dressings; it’s this chemically treated, harshly processed stuff. And those fragile polyunsaturated fatty acids, which are why it’s liquid, they’re bendy. Right? That’s why it’s liquid. On a molecular scale, saturated fat is stiff, like a toothpick, and these things would be wiggly. So if you picked them up they’d go limp. And that bendiness and wiggliness is also what makes them fragile, so that they are broken down easily. They are broken into new molecules that don’t exist in nature. They degrade, and they degrade into toxins. So one category of toxins, we call trans fat. Because it’s just, any fatty acid with a certain type of angle to the bond; total chemistry trivia.

Other; there are many other different types of categories of bad fats that are present in these vegetable oils than just trans. So there’s aldehydes, there’s reactive carbonyls, there’s cyclic hydrocarbons. Every single one of those things is a different category of toxin, and there are multiple different examples of those in each bottle of canola oil, for example. Not very many, if you haven’t cooked with it. So probably somewhere on the order of 5 to 8% is going to be these nasty molecules. That’s still a lot, because we’re talking about gram amounts rather than nanogram, which is what we’re talking about when we’re talking about contamination with PCPs and the stuff in the drinking water and all that, that you get from the bottles. The BPA-free, or whatever the water bottles are supposed to be these days. That stuff is like one-millionth of concentration, and these are just as bad and a million times the concentration.

But then when you cook with them, or even worst; the worst of the worst, when restaurants use them in the deep fryer, they cook with them for as long as a week, they’re just completely degraded. They’re so toxic that the air; breathing that air has been associated with cancer.

Diane Sanfilippo: Wow.

Dr. Cate Shanahan: And the fats, the bits of fat that fly around over the fryer are so reactive that they bond to the wall and they bond to everything that they touch, and fuse with them on a molecular level, so that they had to invent a whole new kind of cleaner for kitchens, once they started.

Diane Sanfilippo: I believe that.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: That’s intense. So I think what’s important to call out from what you talked about here; because we get this question a lot. So two things; one, when these oils; so we’ll use canola as a good example. You guys can Google, Canola oil, how it’s made. There’s an amazing video. It’s very matter of fact; it’s not like if I were to be teaching about vegan ways of eating and showing you how animals are slaughtered; which, you know, killing something is never going to be beautiful to watch. Unless you find that beautiful, which you may. There is death in all that we eat, but I digress.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: But I’m saying it’s not like; “Watch this video; you’re never going to want to eat meat again.” It’s, watch this video, they’re just telling you how this oil is made, and they sound kind of proud of the process. But when you think about it from a critical perspective, you realize that none of that seems natural at all.

So the point that you made that we talk about BPA in plastic, and it’s like; microscopic levels; that can be harmful, but it’s microscopic levels. Whereas when we’re talking about something like canola oil; what’s perhaps already damaged in that bottle might be 5-8% of what’s in the bottle; not on this really tiny scale. It’s already gone through some damage, just to land in the bottle, because of the type of fatty acid profile making these oils up is so high in polyunsaturated fats; and maybe even monounsaturated. Very low in saturated fat; which is our most stable fat. And then also, you mentioned when we cook with it.


Diane Sanfilippo: So here’s a question. Because a lot of folks ask us about this; they say, “Well is it only unhealthy if we cook with it?” Because we look at something like a canola, or any of these other seed oils, and some of them have a really high “smoke point” right? Which is what we’ve been taught as where they start to degrade, is when they hit these smoke points. So if they have a high smoke point, what you’re saying is, and this is what Liz and I have kind of been teaching for a while is that they’re already damaged once they’re just in the bottle, so even if you don’t cook with it you’re already getting something that has some damage going on. But then when you cook with it, it just kind of becomes much worse. Is that?

Dr. Cate Shanahan: Yes.

Diane Sanfilippo: Yeah.

Dr. Cate Shanahan: Yes, exactly right. When you think about, “What is smoke?” {laughs} it’s like something that is a small gaseous, almost gaseous molecule. But it’s a very small molecule compared to the oil. So there’s a lot of degradation that has occurred; in other words, what I’m getting at is there is a lot of damage that has occurred to the molecule before it turns into smoke. And that’s the issue; it’s that damage that we can’t see. If it were smoking, well then we’re not eating it because it just vaporized.

The whole concept of smoke point, I think, was invented by people who wanted to sell this crap oil to chefs in a busy restaurant because it’s like; no good chef would sit there and watch the food just burn, right? They’re going to take action. And that action is simply stirring it. But it means if you’re trying to do 10 dishes at a time, now you’ve got to be watching 10 dishes that might need stirring and that’s harder to do. So if you just get this stuff that doesn’t smoke until a much higher temperature; then you're not going to have that blackened bit that is an alert to the customer that the chef wasn’t paying attention.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: {laughs} And I have a friend in LA who is a chef, and she explained to me that it is very difficult in a commercial kitchen to use olive oil because of the BTUs that come out of those stovetops.

Diane Sanfilippo: They get really hot.

Dr. Cate Shanahan: Yeah! And so commercial kitchens are now dependent on this high smoke point material, and you’d basically have to redesign your kitchen to be able to regularly use a better quality oil. And that’s the degree to which the infrastructure has been built around this, essentially, convenience oil. It’s dirt cheap; nobody is allergic to it; it has a neutral flavor. That’s what the chefs say, right? Because it doesn’t taste like peanuts; it doesn’t taste like coconut; it doesn’t taste like anything. Because it isn’t food. {laughs}

Diane Sanfilippo: Yeah. So I get this question a lot, too, because of the; you know we’ve got olive oil, and avocado oil, that folks are like, “Can I cook with them or not?” And I tend to; I have a whole guide to cooking fats where I rank fats, and not everyone has to agree with this and maybe one say something about it will change. But for the last 6 or more years I’ve stood by this way of ranking fats for cooking. And it doesn’t mean I never cook with olive oil; and I’ll throw this out there, I rank fats for cooking in terms of what’s most ideal by what has the highest percentage of saturated fatty acids. So by that token, coconut oil is at the top of the list, and then butter, cocoa butter, which not most of us really cook with, but it’s there if you wanted to. It does rank well in this breakdown. Tallow; I have palm oil, which you mentioned palm seed, and I’m wondering if that’s a different thing that you’re talking about?

Dr. Cate Shanahan: Palm kernel. Yeah, palm kernel oil is different than palm oil, and palm kernel oil is much more saturated.

Diane Sanfilippo: Ok. Well, so maybe I should have listed it as palm kernel oil, because that is 54% saturated. Then lard, then duck fat. And then we go to the fats that are much more unsaturated, which actually duck fat kind of falls almost to that place. But it does have a lot more saturated fat than something like avocado oil or olive oil; which are very similar in their profiles, about 70% monounsaturated, 20% or so saturated, and then about 10% polyunsaturated. So where do you stand on the idea of cooking with some of these sort of middle ground oils?

Dr. Cate Shanahan: Yeah, I think all else being equal; your rule of the more saturated is a good one. But all else isn’t always equal in cooking, right? So with olive oil a lot of times you’re going to be cooking vegetables, which have, themselves, a lot of antioxidants. Or garlic.

Diane Sanfilippo: Or water that releases.

Dr. Cate Shanahan: Yes!

Diane Sanfilippo: Maybe lowers the temperature.

Dr. Cate Shanahan: Exactly. So yeah, totally; all else being equal, that’s a good rule. And some interesting little tidbits on that; the chefs, I love this chef Ripert; do you know who he is? He’s a French chef.

Diane Sanfilippo: Yes. Eric?

Dr. Cate Shanahan: Eric Ripert.

Diane Sanfilippo: Yeah.

Dr. Cate Shanahan: Yeah. I think probably every woman who has ever watched Anthony Bourdain remembers chef Eric Ripert. {laughs}

Diane Sanfilippo: {laughs} I’ve watched everything on the Food Network and beyond. So PBS to all of Anthony Bourdain’s type shows. I’m a major food television consumer.

Dr. Cate Shanahan: So he was on there like twice; but I remember every minute, probably. And what he said, though, that was really amazing to me was that they add butter to olive oil.

Diane Sanfilippo: Yeah.

Dr. Cate Shanahan: Because it protects the olive oil. And they, somehow, not knowing any chemistry. They must have observed through flavor or something; but that’s very literally true because; not just because the butter is saturated but because it has different kinds of antioxidants in there, particularly in Europe when it comes from grass-fed cows. So yeah; good chefs, this is why I usually point to traditional recipes. Because there is this curation of observation that has gone on that is secretly behind the writing of what appears to be a very simple list. {laughs}

Diane Sanfilippo: Mm-hmm.

Dr. Cate Shanahan: But very often, there’s just so much intelligence behind it. So people have asked me; “Should I not cook with olive oil?” And I would say; don’t literally let it catch on fire, like don’t use it for flambee; but on the other hand, you don’t want to flambee really much of anything.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: {laughs} You know, except something that’s really going to burn off well, like pure alcohol. But, the other point in there that when you’re talking about the saturated fatty acid profile, it’s really going to vary more than I think a lot of folks; more than even I realize because I was just speaking to a lipid researcher in UC Riverside says that she has analyzed the fatty acid profile of lard from, you know, pigs that are commercially fed soy; pretty much nothing but soy and corn. And their fat; even though lard, even though we think of it as a saturated, solid fat; their fatty acid profile is so similar; I mean it’s very low in saturated fat. She didn’t give me the breakdown, but she said it was very similar to corn oil.

Diane Sanfilippo: Right.

Dr. Cate Shanahan: And the fact that it is solid, is because it’s held in a matrix of connective tissue. So just because it looks solid, doesn’t mean it really is a lot of saturated fat. So this just points to the whole idea of properly sourcing. I’m pretty sure there are a few companies, that I’m sure you’ve mentioned, that do properly source and get the grass-fed, pasture raised tallow and lard and all that stuff.

Diane Sanfilippo: Yeah, and that’s something too for folks who are like; well how do I know? That’s where we talk about the guide to food quality as well, and I have this broken down also in Practical Paleo. Basically anything we ever talk about, there’s probably a guide for this in the book. But there’s an entire guide to food quality, talking about meats, eggs, and dairy as one category, but also fats and oils are in their own category, where I do note the best will be things like organic cold pressed and from well-raised animals. So that’s kind of to that point. When I say well raised, it’s their environment and also obviously their diet. So that is the case for when we are getting fats, specifically if you want to buy something like lard, I think Epic and FatWorks tends to be two brands that are kind of out there.

And you know; we don’t need to go buy those fats on their own. You could have your pastured pig that you buy, and you could ask your farmer for some extra leaf lard, or extra; actually just the fat and you can render it yourself. There are lots of how-to’s on the internet, you know, of how to do that. So as long as you're getting them from animals that were fed more of a natural diet, or given something that’s not so focused on grains and soy and all of that, you should be fine. We’ve definitely had this question about grass-fed beef, and the same kind of thing applies there. When they’re eating grass 100% of the time, the fat that we get on the meat is a much better profile than when they’re not fed grass 100% of the time. So it all goes hand in hand. I think that’s a good point, when we talk about animal fats and what we’re getting from them.

Dr. Cate Shanahan: Absolutely. Yeah, you know, we had a chicken the other day that was pasture raised, and my husband tried to cook it just by deep frying it; we use peanut oil. But what I’m getting at was the skin was so tough.

Diane Sanfilippo: {laughs}

Dr. Cate Shanahan: It was; the way that we cook our meat has changed.

Diane Sanfilippo: Yeah.

Dr. Cate Shanahan: Because I don’t know how you’re supposed to cook that except to slow cook it maybe. I don’t; it just made me wonder, what on earth did the pilgrims do when they had these turkeys {laughs} that were all wild.

Diane Sanfilippo: They were running around, and I bet we need to dig up some old cookbooks. There’s a used book store over here that has a lot of these relic amazing looking, old, dusty, dingy cookbooks; those would probably tell you how to cook that chicken that really walked, you know.

Dr. Cate Shanahan: {laughs} Right.

Liz Wolfe: Today’s podcast is sponsored by Vital Choice seafood and organics; purveyor of premium sustainably sourced seafood and a certified B corporation. Vital choice offers a wide range of fish, shellfish, humanely raised meat, protein rich bone broths, and paleo friendly snacks like organic dark chocolate, super antioxidant trail mix, and bison jerky. From week night dinners to weekend brunches, is your source for real food.

7. Ketogenic and high fat diets [43:13]

Diane Sanfilippo: So we have some questions here from our listeners that I would love to get to some of these. Before we get into the ones about cholesterol specifically we have one; actually we have quite a few folks. We had three different people asking your take on a ketogenic or a higher fat diet. And is there a way to identify or define how much fat is too much?

Dr. Cate Shanahan: Oh right, great question. So the goal; what I look for is the goal of your body being able to burn body fat between meals. And that will prevent you from being hungry, it will prevent you from being driven to snack by brain fatigue or blood sugar dropping; because it won’t drop; because you’ll be burning fat, and your liver converts fat to ketones. So you can be on a very high carb diet, and still be burning fat, ok? So it’s not all about the diet. It’s about other elements of your lifestyle that might force you to burn fat. For example; maybe you go 12 hours between meals and in between you’re running for 2 hours. You’re definitely going to be burning fat if you do that. So the goal is to burn fat.

So I don’t feel like we need to be worried particularly about you absolutely must have this macronutrient ratio. Your goal is to burn fat. You can skip meals, and if you feel bad while you're skipping meals, that’s a test that tells you you are not burning fat, and it doesn’t matter what your macronutrient ratios are in your diet. You could be eating 80-90% fat, and if you're hungry between meals, then you’re not accessing your body fat. So there’s something else that you need to do. And generally that something else that you need to is just don’t eat so often. {laughs}

So that’s a very important; we should consider almost the time span between meals as a macronutrient. Right? I don’t think we talk about that enough.

Diane Sanfilippo: That’s really interesting, because that’s one of the ways I try and tell people how to decide if that meal that you ate was sufficient for you; because people ask about snacking all the time. I’m like; well, what if you ate a little bit more in that meal, then you could go a little longer until your next meal, but a lot of folks are like; well I just can’t eat that much at once. {laughs} And I’m like; well I don’t know really know; I’m not sure about that problem, because {laughs} given a large plate of food I will pretty much eat all of it.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: I’m like, I don’t understand this limited appetite that you speak of. But, I do know what you’re talking about. That moment where an hour ago I was a bit hungry, and now it’s an hour later and we’re talking, and I haven’t eaten yet since my breakfast, and I was hungry and then I was doing something else, and I’m really not that hungry and my blood sugar is not dropping, and I’m kind of fine right now, and hopefully I am burning some body fat because I’ve got enough stored. Nobody needs to worry about that.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: But, yeah, I think there is a lot of confusion about that. Because folks are, first of all, always told by personal trainers; not all of them or “nutrition gurus” to eat 5 small meals a day, or to eat every 3 hours, or whatever it is. And you know, there is a lot of misconception about how that works. So, yeah I don’t know what else to highlight there.

Dr. Cate Shanahan: Yeah, so sports nutrition is the worst; the most backwards of all the fields of nutrition. I just gave a webinar for an exercise physiology association that’s part of the American College of Sports Medicine; and I just love driving; it’s important to drive that point home because as well-meaning as everybody’s personal trainers may be, they’re hearing pretty much straight; they’re like mainlining advice from Coke, you know, on how important sugar is and how important it is to eat all the time, because they are also getting advice, their education, from companies that sell supplements. Muscle building supplements and stuff like this. So, that is a completely messed up field of science.

The reality is, a healthy metabolism at rest needs no sugar. A healthy metabolism at rest is not doing anything; has pretty much no business having issues with hypoglycemia or low blood sugar symptoms. Because at rest our muscles are not doing much of anything; but they’re certainly not burning sugar. We only burn sugar to significant degrees when our muscles are exercising at very high intensities. The name for this high intensity exercise is anaerobic exercise. So whether it’s sprinting; it could be a form of cardio that’s high intensity or a form of lifting that’s high intensity; lifting really heavy weights for a long time.

So that’s when people actually truly do need to consider how many carbs they need to refuel with. And that’s when people might actually get hungry. But if you’re not doing that, and you have any body fat, you have very little business being hungry in the course of a regular day, unless you're deficient in something else; like salts, or water, or protein. But very few people are deficient in protein. I have seen where people don’t get enough salt, because they drink so much caffeine they pee a lot of it out. But yeah. So, our hunger, we are over-sensitive to hungry, and we are partially made over-sensitive to hunger because of these vegetable oils in our diet which disrupt the hunger regulatory systems in our bodies.

So I realized that when the first thing I did when I changed my diet from a regular Standard American Diet; I thought, for years and years, that it was cutting out sugar. But the reality I realized was that I cut out vegetable oils first, and that is how I could cut out sugar with really very little effort. Because the vegetable oils, they disrupt the appetite, and they disrupt energy in the brain. And when your brain can’t get energy, it thinks you’re hungry. So no matter what the cause of the brain’s inability to get energy, you’re very likely to be told by your brain that now you’re hungry, you’ve got to eat. And particularly sugar, because it has, for a long time; if you’re on a Standard American Diet, equated sugar with energy.

And there are all these sugar detox programs out there; which are great, but I find that even easier {laughs} is detoxing your fat. Getting; because all you do is you swap it out for better tasting fats. So there’s no sacrifice.

Diane Sanfilippo: That’s so funny. And actually; I do have a sugar detox program, but that’s kind of exactly what we do.

Dr. Cate Shanahan: Awesome.

Diane Sanfilippo: It’s not exactly a bait and switch, but I call it a sugar detox but actually what we do is get you eating lots of healthy fats and avoiding vegetable oils, and refined foods, and get that stuff out. It is actually so much easier for people to avoid sugar, like you said, when we’re eating nourishing foods and nourishing fats and getting rid of the stuff that doesn’t do us any good.


Diane Sanfilippo: So when you were saying our appetites are kind of; they’re out of whack and we think we’re hungry more than we really are, or maybe our body wants something that wouldn’t be everything that we then eat but because we want, like you said, perhaps sodium or whatnot, we feel like we need to eat again. Do you mean between meals, or do you mean in general, like the amount that we’re eating all the time is probably more than we really all need to?

Dr. Cate Shanahan: Yeah. Right, both. So there’s no reason, unless, putting aside the idea of a mega exerciser; even if you work out for an hour, your body can easily make the amount of sugar that you likely burned. Maybe there’s like 100 or 200 calories; your body is always making sugar. Always. It’s always converting protein into sugar, because your red blood cells, and your brain, and your kidney have this baseline need for a little bit of sugar. And your body can easily ramp that up to create just a little bit more between meals if necessary.

But it shouldn’t be necessary, unless you’re really a mega exerciser. Again, because we just don’t do intense workout. We should be able to just burn our body fat. And the main challenge that I find people have when they have difficulty with weight, or hunger, or energy, or brain fog, is that there is something blocking their body’s access to the lipid that’s all stored under their skin. It could be; a lot of different types of deficiencies do it. But the number one thing is just the idea that if you’re hungry, you have to eat. Because our brain is easily tricked by time, right? So we look at the clock and we’re suddenly tired.

Diane Sanfilippo: I’m nodding my head. {laughs}

Dr. Cate Shanahan: {laughing} Yeah. So it’s just the idea that it’s mealtime, sometimes that makes us hungry. We’re completely Pavlovian that way, you know those dog experiments? They hear the bell ring; you look at the clock, you see 11:30, you feel hungry. But if you feel like you’re eating well, and you can concentrate and sometimes when you’re distracted and you don’t notice the clock, you just simply aren’t hungry; you can probably just ignore that. And that is the most important thing that you can do. Because we eat too much; we eat too often. It’s not just that we eat too much. We also eat too many times. And that has consequences on our ability to burn fat, and on our gut health. Because our guts need a break once in a while. And if we’re eating constantly, you know every 3 hours or whatever, if we’re having snacks between meals, even if they’re healthy snacks, it’s still…

I realized the other day that I had been wanting to get more protein, so I was forcing myself to eat lunch because I normally don’t eat lunch. And then I noticed in the afternoon my stomach was hurting; and I was like, you know what, my stomach is just not used to having to do anything in the afternoon, so now it’s complaining about that. {laughs} But there’s very little that we know about the effects of the necessity of fasting between meals in order for your microbiome to be normal.

Diane Sanfilippo: This is such a fascinating topic; I feel like we could do a whole other episode on this as well, because I know there are a lot of questions people have. They didn’t have them specifically for you, but if I asked for them, we would have 40 questions I’m sure come in, about intermittent fasting. There’s a lot on both sides about it, because we also get a lot of questions from, primarily female listeners, and a lot of them are dealing with some hormonal imbalances, and we also; Liz and I have seen this in practice a lot, as well as at seminars when we used to teach them. We had a lot of women who were undereating. So it’s tough to strike the balance between talking about somebody who perhaps is in fairly good health and has a couple of things that are kind of nagging; maybe the inability burn extra body fat. Maybe some digestive issues, like as you were talking about; for whom fasting may be just not eating that middle meal, but having a larger breakfast and a larger dinner; or whatever it’s going to be. Not underfeeding yourself overall, but giving your body that break in between meals, that may be pretty evolutionary in our nature. I mean, we wouldn’t have had an abundance of food all day every day right in the fridge.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: I mean, that’s not really normal. And I think what you are kind of hinting at is that there are a lot of biological, physiological systems that do benefit from that break between eating.

Dr. Cate Shanahan: Exactly.

Diane Sanfilippo: And it’s not about not eating enough, because we do; honestly, we have a good number of women who write in, and I’m like; I don’t know that you’re eating enough. So I hesitate to encourage people to fast who I think are already not eating enough. But, to your point; and this is something, it’s like lightbulbs for me, too. It’s like, you know what? I need to pay attention to this more because I’m home all day. And I don’t have to eat; but because I’m here, it’s easy enough to have lunch and maybe I didn’t need it. When I’m traveling, there are a lot of times when I basically just skip lunch and have a much bigger dinner, for me, because I’m pretty hungry {laughs} by the time I get there. I would say I have a pretty healthy appetite.

And, you know, again to the point about not needing a lot of carbs; our athletes, our listeners who do CrossFit, for example, even in a CrossFit workout, you have a few minutes in there where you are really kind of hard charging, and you’re doing what Dr. Cate referred to as anaerobic activity. Sometimes we call it glycogen dependent activity versus fat dependent. It’s that point when you are at the top of your heart rate limit. It’s that top range. And nobody really stays there for too long, and I think that’s the point that people need to know. Is that even if you are having some carbs after exercise, it’s not something that you need lots of all the time to replenish because you really didn’t use that much, and also your body is capable of making that stuff.

So it is a delicate balance; we don’t want people to take one conversation and pull it out of context and say; well, nobody needs any carbs ever, because that’s not what we’re saying. But it is a matter of what’s going on really in the body; what do you really need. Because like you said, Dr. Cate; do you mind that I keep calling you Dr. Cate? I just feel like.

Dr. Cate Shanahan: Oh yeah, that’s my brand. {laughs}

Diane Sanfilippo: {laughs} Ok. I was like; um should I be saying your last name? But we have been programmed by a lot of trainers and exercise people to think that there’s this other way to do it, but you’re speaking from a physiological point of view, and biochemistry, and what actually is happening in the body on a regular basis with all these types of exercise. And you do consult with athletes all the time.

Dr. Cate Shanahan: And actually tested fat burn. So for a couple of years, I was running my own office, called the Fat Burn Factory, and I tested to see how much fat people were burning. You can do this test; it’s called a metabolic cart test, and you wear a mask and you can do it resting or you can do it with exercise, and you can see on a breath by breath basis how much sugar versus fat you are burning as you ramp up your exercise. One of the things that people who; not just me, lots of people do this. We’ve all found is that the worst thing you can do for your fat burn is have carbs just before a workout. So even if you are a pretty good fat burner, if you bump up your insulin level with a bunch of carb, insulin physically obstructs your body’s ability to burn fat.

Diane Sanfilippo: I’m nodding along; I’m like yes! But we definitely; but then after exercise, and you can confirm this for me, if this is what I’ve been promoting is true. After exercise, we get this little bonus where we can pull sugar from the blood stream without too much insulin because we have this period of time when our body is sort of hypersensitized to it. I don’t know the biochemical reactions, I just know what I’ve learned from other folks about non-insulin mediated glucose transport; that being an actual thing where post workout, even with diabetics, for example, that’s one of the big benefits of exercise, is that they can get some of this into their cells without the need for more insulin. Yes, no?

Dr. Cate Shanahan: Yes, absolutely.

Diane Sanfilippo: OK. {laughs} I’m like; hopefully. I’m crossing my fingers. This is true, correct? But I think that’s really fascinating. And a lot of folks do struggle with that transition, when they are moving away from a very high carb diet, because they’ve just always felt like; well right before my workout I need to do half a banana, or something because they feel like they’re not going to make it through the workout. When I like to encourage people to do after that first week or two where you’re transitioning your diet; because I don’t want to send somebody into the gym who is going to pass out in the middle of class. But I do encourage people to allow that feeling to hit.

I go to the gym hungry every morning, and I’m kind of angry about it {laughs}. I’m like; I don’t want to do this, I just want a big breakfast. I don’t even want to go workout. But as soon as I start exercising, and I’m not in rest and digest mode anymore; I’m a little bit more in fight or flight, my energy is up, my heart rate is up, cortisol is kind of pumping a bit; I’m not hungry while I’m training. And then when I’m done, I can come home and eat. And I think a lot of people don’t trust their body enough. People think they’re going to be hypoglycemic; they think they’re going to pass out in the workout, and that’s the only time I’ve ever had a really bad experience was when I was eating very low carb, and I did a CrossFit workout, and I was working pretty hard because I was in an away gym, so you’ve got to do everything to the nth degree when you’re not in your own gym; you have to really represent {laughs}.

So I was eating low carb, trying to do a pretty intense CrossFit workout that probably lasted around 8 to 11 minutes, so it’s not very long, but folks who do CrossFit know those are pretty much max effort the whole time. I felt nauseous and had a headache for several hours after that workout. But I didn’t pass out, I just felt really ill after it. And I think that was a result of trying to do that type of work without having much glycogen store in the body from not eating carbs.

Dr. Cate Shanahan: It very well could be, but it also could be so many other things.

Diane Sanfilippo: Dehydrated; or who knows what.

Dr. Cate Shanahan: Yeah. Because if you don’t have sugar, often it could be that the early warning signs for you are headache; but typically we think of it as that bonking experience where your brain is just; you’re basically drunk or nonfunctional.

Diane Sanfilippo: Yeah, I was not really speaking for a while. {laughs}

Dr. Cate Shanahan: OK. Yeah, so that is more sugar related. Yeah, in Deep Nutrition we have a plan chapter, and we talk about, if you’re going to ease into this, the best way to do this is you have your breakfast be; concentrate on breakfast and getting your carbs out of breakfast completely if possible. And then later in the day, you can get carbs, after you’ve been up and walking around, and maybe you’ve used a little glycogen. Because if you’re not a good fat burner, and people who don’t follow a good diet generally are not. The best fat burners are still going to be burning a little bit of sugar just sitting around and walking around. So then you kind of emptied out those little suitcases in your muscles that store glycogen, and so now you could just refill those suitcases, and it doesn’t take insulin to do that, either; sort of what you were alluding to is there are methods by which your body; there are many cells in your body that don’t even require insulin in order to absorb glucose. It’s really the muscle and the adipose that really often require it.


Diane Sanfilippo: That’s really interesting. Seriously, I’m like 10 lines of notes here about other episodes I would like to just suck up all of your time. We have gone down a pretty intense rabbit hole, but before; I mean, we have taken up a lot of your time. But I do want to ask you about some questions and confusion folks have around statins, because I know it’s an area that you are deeply entwined in and understand about and can really help folks with. Do we have a few minutes to kind of talk about that?

Dr. Cate Shanahan: Oh yeah.

Diane Sanfilippo: Ok.

Dr. Cate Shanahan: Absolutely. Yeah, so;

Diane Sanfilippo: Yeah, so the questions that we have are things like; people are scared that if they don’t take it they’re going to have a heart attack. They’re afraid to transition off; they’re unsure. There’s just a lot of questions about that. So yeah. Go ahead and dive in {laughs}.

Dr. Cate Shanahan: yeah, so probably your listeners know a little bit about them, but statin drugs block your body’s ability to manufacture cholesterol, and they can do this in any tissue, and everybody is different. I mean, you don’t know what tissues in your body are going to be blocked. It could be your skin and you have skin issues; it could be your brain and you have slow deterioration of mental function. It could be your muscle. And it’s not just cholesterol that’s blocked; it’s the manufacture of some very basic building blocks called isoprenoids that hold your cells together, and that help your cells identify themselves. So it affects your tissue strength, and it affects; this is why statins cause muscle problems, because they can cause the muscle cells just to not be able to hold together any more, and they can cause immune system problems and there was just an article out about how it’s more likely to get; you’re more likely to suffer from shingles if you are on a statin because it affects your immune system. And I’ve seen more people die from infections, tragically, when on statins than I’d ever like to, and I believe it’s because of this connection.

So, statins have major risks, and they are plain and simple not something you would put in the water supply, like a lot of unfortunately mainstream doctors believe. Because we’ve sort of been brain washed. So what do you do? Well the fact is they do help some people who have rare genetic problems, at least I would be very; I would want to carefully monitor somebody with one of these genetic problems with their cholesterol, if they were not taking a statin. And because what they do is they help your blood, the particles that carry cholesterol in your blood are called lipoproteins, and they help; statins help your body get those lipoproteins out of your blood stream more rapidly. And these genetic disorders that people have, they have difficulty extracting the lipoproteins from the circulation fast enough, and the longer they stay in circulation the more they get oxidized. It’s sort of like, if you don’t clean your oven often enough, you’re going to get gunk in it. So statins are almost; you could think of them as oven cleaner. And they’re probably about as healthy.

But some people do benefit from them, and the biggest category of people who benefit from them are the willfully unhealthy, unfortunately. Like the people who smoke, who have already had heart attacks, who just don’t pay attention to their diet. Those people, I would not take them off a statin. You can’t move a mountain sometimes.

But then, there are people with these genetic disorders that we don’t even really have a clear understanding of, because there are so many different kinds of them. There are so many different things that can go wrong in the absorption of lipoproteins out of the blood stream and into the tissue. And every step along the way, there is a genetic disorder associated with it. And depending on exactly what you have, statins are going to be either very essential or maybe not even necessary. But at this point in time, we don’t have a way of distinguishing very well, other than trying to run the experiment, which is potentially dangerous, and if you’re not monitoring carefully you can get into trouble.

And the way I would monitor is not just with blood cholesterol tests, those are also important, but also with carotid artery ultrasound, very high sensitivity resolution form of ultrasound where they can see exactly how thick is the lining. So not just looking for plaque in that carotid artery, but looking for; its’ called an intima media ratio. So you look to see if there is thickening in that media, which is the layer there. That is representative of one of the earliest stages of plaque buildup called the fatty streak. So if you get that done by an ultrasound tech, because there are people who are not techs are not going to doing it very well. You could get it done poorly, you could get it done well. And you want to get it done by an ultrasound tech because it’s hard to reproduce, you have to put the probe in exactly the same place, to make sure you’re measuring the same thing. And you would measure it maybe every 6 months to see if being off the statins, you’re getting that build up. If that’s happening then you should possibly go back on the statin. Just because if you happen to have one of these genetic things, then you’re sort of out of luck there, and you might actually benefit from a statin.

But again, it does depend, right. So some people with the same; we call it familial hypercholesterolemia, as if it were one disease. But it’s many, many, many diseases. There are many different genetic abnormalities that lead to that. The only thing they have in common is that, in the family, there’s a lot of high cholesterol, and very often a lot of heart attacks and strokes prematurely because of it. And some of those folks really do need statins, I believe, and some of them probably could do better without them. And unfortunately the only way to distinguish is to; like I say, run this experiment. And you have to do it very carefully.

Diane Sanfilippo: Right. I think we did have one question from someone who said they have FH, and were on statins from age 18; now they’re 32 and they decided to stop taking them. But I think it’s important to know that this is the case where the evidence that’s out there debunking myths about high cholesterol, etc. They don’t apply to these genetic disorders. We’re talking about in someone who’s metabolism works properly.

Now, I will say this; I'm curious, at age 18 knowing that that was so many years ago, if that person was actually diagnosed with familial hypercholesterolemia, or if the doctor said, you know, this is genetic it runs in your family, and then that person translated it to that’s what that meant, versus at the time that person could have had a cholesterol of, let’s say, 250 or something, and what are we now, 15 years later or say saying; well maybe 15 years ago what you thought you heard wasn’t what you really heard, and you’ve been taking it for this long. So I’m just kind of throwing this out there, that it’s possible that this person does have the genetic disorder; and as you said, may not want to come off of those, or may come of them but need to have pretty rigorous follow-ups to make sure that’s an ok move; or I might argue that it’s possible that this person thought they had the genetic defect, but it was so long ago that it could have just been that that really wasn’t the case. Do you know what I’m saying?

Dr. Cate Shanahan: Yes, and it is true that because we use the terms a little bit loosely; like family history of hypercholesterolemia; does that equate to familial hyperlipidemia? It doesn’t, of course. But usually the diagnosis of familial hyperlipidemia is going to be made by someone who specializes in that; usually they’re called lipidologists, and there are certain criteria that they go through to get that. So it’s usually done by; I wouldn’t be comfortable as a family practice primary care doctor, I wouldn’t be comfortable just assigning that diagnosis to somebody because it has genetic implications for your children, and all this.

Diane Sanfilippo: I’m just curious if that many years ago, how accurately was this diagnosed? Because I feel like that was the time period when it was red flags all over the place about cholesterol levels over, even at that time, 180. You know?

Dr. Cate Shanahan: Right, exactly.

Diane Sanfilippo: So that’s just my; I don’t know, red flag, judging by the time period. You know what I mean?

Dr. Cate Shanahan: Yeah, good point. Absolutely.

Diane Sanfilippo: I don’t know, I just remember what it was like when I was a kid and somehow my cholesterol was tested when I was probably 10 years old. Like, why were we doing that anyway?

Dr. Cate Shanahan: Yeah. If that person with the question was on air, I would just say, “Did you go to a specialist?”

Diane Sanfilippo: Exactly {laughs}. We’ll find out.

Dr. Cate Shanahan: But these disorders are not that uncommon. Certain populations have as many as one in 200 people have a genetic disorder; so if you look at the whole country, that’s a massive number and a lot of them go undiagnosed their whole lives. So it is something to, if you do have high cholesterol and your LDL in particular is over 190, more than at least once, and not due to thyroid disease or something else, then you should be considered. You should ask to be referred to a specialist to get evaluated for that, particularly if you have a family history of people dying young of heart attacks; or having, not necessarily dying, but having a heart attack in their 40s, or 50s, or 60s for women. Absolutely, it’s an under diagnosed illness that’s out there.

The funny thing is; if this cholesterol thing were such a problem, and it is so relatively common, you would think that there would have been a lot more heart attacks before the modern diet. That there would have been a lot more people dying from heart attacks. So I really think the modern diet does play into it in a big way, into even these familial hyperlipidemia folks. And I think for those people, it is particularly important to get off the vegetable oils and not have too much sugar.

Now, whether or not you want to go on a high fat or ketogenic diet, that’s up to you. But very important; I think everyone, even in medicine, would agree that getting off the vegetables oils; the polyunsaturated pro-oxidative vegetable oils, which more and more doctors are starting to at least wake up to the idea that they might be bad for you. And the high amounts of sugar, particularly refined carbs, is especially important.

Diane Sanfilippo: Awesome. We definitely had a question come in about advice on statins, and this is somebody saying that their mom has had a heart attack, and is on statins since then; which from my education and from what you’re saying, seems to be a time when perhaps it’s not as curious that they would be taking them; it may actually be ok or beneficial, although you can let me know what the take is on that with women, because I’ve definitely heard both ways with women; and also they’re having a hard time saying anything. I mean, look telling your parents anything is pretty much impossible about this stuff. But “Convincing them that paleo would still work.” And you know, I want to hear your take on it, because my argument for that is just, eating healthier is better for everyone always. It doesn’t have anything to do with any of that.

Dr. Cate Shanahan: Yes. {laughs}

Diane Sanfilippo: Whether or not you need to lose weight; it doesn’t matter, your whole organ system will be functioning more optimally when you don’t put junk into it.

Dr. Cate Shanahan: Absolutely one would ever benefit from having a lot of sugar, and vegetable oils. I just know. So yeah; whether you want to follow a paleo diet to get off of those things; or just cut out those things {laughs} I think would be beneficial. But you know, to kind of go into a little bit of what happens in the medical system here with the idea of heart attacks; whether it’s a man or a woman. If it’s in a non-smoker, I’d say 95% of the folks who do not smoke who get diagnosed as having had a heart attack, usually it’s a small heart attack. If they’re in their 50s or 60s or 70s, it’s 95% of the time because of their diet. And if they would change their diet, their arteries would stop getting dirty, they would stop building plaque; and theoretically I believe that you really can reverse this stuff, because everything else in the body heals, why would the arteries be any different. And we ‘ve seen that in the few studies on this. Topic have been done; they’ve been done when the intervention wasn’t diet, it was statins. But there was some reversal, so I think dietary intervention would be more powerful by far.

And the majority of cases where people have these scares; they go into the hospital, they get admitted, it was a small heart attack, usually; usually that’s the case. They get some kind of a stent; very rarely now do they get a bypass. Always they come out of the hospital with a statin, and now they’re in the system, right? They have a stent in their heart, they’ve got these statins; they usually have 3 or 4 other drugs. And their life is taken over by this episode. And the way I see it is; first of all, 95% of the time I totally believe it was preventable if they just didn’t have so much dietary carbohydrate and vegetable oil; but they never hear that that was the cause, and they never hear that that is the most important thing they could do. Even if they were smoking, I would say that more important than quitting smoking, is cutting these vegetable oils and carbohydrates from your diet. Because we all know smokers to live to be 100, but I don’t know very many people at all who have eaten vegetable oils and sugars their whole lives and have made it that far. Because vegetable oils and sugars really weren’t around that long.

Diane Sanfilippo: {laughs} Yeah I was just going to say the exact same thing.

Dr. Cate Shanahan: We haven’t run the experiment {laughs}.

Diane Sanfilippo: Everyone on, what’s his name; Smucker’s 100-year-old birthday celebration, the first 50 years of their lives, this stuff didn’t even exist, so.

Dr. Cate Shanahan: Right.


Diane Sanfilippo: Really interesting. So, I’m going to wrap it up with one more question here because we have a lot more but, I don’t know; I just don’t want to take up too much more of your time. We have some folks who are asking about how to sort of navigate a doctor’s recommendations that they have when their cholesterol comes back, and it’s somewhere over 200, and it doesn’t look like their LDL is out of control here. Like you were saying over 190, and that’s definitely something that I’ve talked and taught about before. If your LDL is high, it’s definitely something to look into more. Basically, it looks like these folks are pretty much eating a healthy paleo type diet, their cholesterol number has come back; maybe it’s 220 for one, 270, so maybe that one could be something to ask about. But how do folks deal with doctors who are trying to put them on statin drugs; but by all other accounts, they’re healthy people. This is just where their cholesterol happens to be?

Dr. Cate Shanahan: Yeah, so I have a hard time dealing with doctors who {laughs} who don’t fully understand either, which is the majority of them on this topic. So you know; as a colleague, I just try to say; the worst are the cardiologists, because they’re the authority, they believe that they know better than me. And I just have to quietly kind of say; here’s what I think; you be the judge, patient. And I hate putting patients in the middle like that; and I don’t do it when I don’t think they can handle the mental stress.

But it’s a big issue. One thing; the concrete piece of advice that I think might be useful; the most useful, is the fact is, no doctor in their right mind should tell you anything about your total cholesterol number. If your doctor is speaking to your total cholesterol number; meaning, not talking about your LDL, not talking about your triglycerides or your HDL, but he’s saying, “Your total cholesterol is over 200 and that’s a problem,” that doctor has no business prescribing you a medicine for statins. Because total cholesterol number is absolutely meaningless. And unfortunately, I would say half of the patients who have come to me on statins were put on statins because their total number was high; even though their HDL was very high, their triglycerides were beautiful, you know, and their LDL was like, meh. You, that could, may be a little high but whatever. But really the reason they were put on it was because their doctor said their total was too high.

Any doctor who is talking about the total number; I really feel strongly, this is an extreme statement I’m about to make; but that doctor has no business talking to you about your cholesterol numbers, because the total number is, there is so much evidence now that anybody who has been keeping up with the literature at all for the past 10 years they know that small dense particles are bad, they know that high HDL is good; they know that large fluffy HDL is good. All of that points to an increase of total cholesterol in your blood stream. So to still, in the face of all that evidence, to be talking about total cholesterol means you just have not kept up on anything about this topic in 10 years. And you're not qualified anymore; I’m sorry! They should be kicked out! {laughs} you have to go to another doctor about that. Find somebody who at least understands that HDL is more important than LDL, and small dense particles are bad, and triglycerides are an important marker. At least talk about that. And pretty much every town now is going to have a lipidologist who will understand these things. So you can always ask to be referred.

Diane Sanfilippo: That’s awesome. Yeah, I almost wish that the total number; I wish they didn’t do the math and show you the total number. Because that total number is not important. We do know more and more often now that there are; I think more often now we’re seeing doctors who realize that the triglyceride/HDL ratio; so dividing your triglycerides by your HDL, we’re seeing that that number is something that I’ve at least seen some people saying; ok, my doctor is noticing that this ratio is good. I’ve seen it on some blood panels lately, so that’s a good thing, because that does tell us a little bit more. Because it’s telling us how much of the good stuff we have with the HDL, and watching our triglycerides hopefully come down, as well.

I mean, my mom was a perfect example of just how much our diet affects all of this stuff. Because recently, she finally was like, telling me what was in her blood work. {laughs} You know, it’s like parents; you guys, my parents definitely don’t, they’re not interested in having my help, that’s for sure. But my mom’s triglycerides were probably; sorry to out you, mom. I want to say they were like 250; I was trying to pull up the email really quickly, but probably about 250. Her HDL was 64, and do I have her LDL here? I don’t think I put it in this recent email I wrote to her, because I think we had gotten some improvement. But her triglycerides dropped about 100 points just by changing the way she looks at carbohydrates to be eating on a regular basis.

Dr. Cate Shanahan: Awesome!

Diane Sanfilippo: And HDL was up to 72. Again, this is a one-time snap shot of that blood work, but watching her triglycerides drop; I mean, she is someone who that has been historically an issue. And I have to reminder her; your body is not doing well with this amount of carb intake. Which she doesn’t really need as much as she was probably eating.

Dr. Cate Shanahan: {laughs}

Diane Sanfilippo: But it is really interesting, and it can be affected in a pretty short amount of time. The body is pretty resilient, and we can make these changes. Anyway, I think that’s really helpful for our listeners. Gosh, we have a lot more we could talk about, but I think we’re going to wrap it up there, because we’ve got so much that folks can learn from this episode, and it was a big one. It was a doozy.

Dr. Cate Shanahan: {laughs}

11. Dr. Cate’s book; Deep Nutrition [1:26:29]

Diane Sanfilippo: So your book, Deep Nutrition, has recently re-released.

Dr. Cate Shanahan: Yes.

Diane Sanfilippo: Do you want to share a little bit about the book; what can folks get from it, what can they know about what’s happening with the re-release?

Dr. Cate Shanahan: Oh, yeah. So we wrote it originally it was released in 2009, and there has been so much new science since then that supports and advances some of the arguments that we were making. And I wanted to build that new evidence in and expand. So actually the new book is about twice as big, and has three times the references of the original. So there is ton of information. It’s almost; people have called it the bible, because it’s just so big and you kind of have to keep referring to it to really understand it.

But what we did; what it does, that I think is unique. We look at what it is about the modern diet that makes it so unhealthy. And we out that; those two components, which we’ve talked about, vegetable oil and sugar. We talk about exactly how they damage in all different ways; to our immune system, our nervous system, how they can lead to autoimmune disorders and cancers so that you can understand that these things just don’t make you overweight. {laughs} And they don’t just cause diabetes; they cause a lot of other things. And they even affect our genetics. So we talk about that.

And the other side of it is; well if you’re not going to have these worst components of the modern diet, what do you have? Or what did people used to do before the processed food era? And what we did was we systematically analyzed what all the traditional diets have in common, and we call those the four pillars of the human diet. And it’s fresh food; fermented and sprouted food; meat on the bone; and organ meat.

So when we were talking earlier in the show, we were like; it’s no accident that everywhere you go around the world, you see the same kind of animals, you see people making bone stock, soup. You would see, if you knew where to look {laughs} the fermenting; because fermentation takes place in dark chambers, {laughs} so you don’t really see that so easily. But everywhere around the world, people fermented whatever it was that they had extra of, and they would always eat all of the animal. They wouldn’t just throw away the organ meats. They would always boil the bones to make soup stocks. They would very often sprout grains, or sprout nuts and seeds to increase their digestibility. So all of these things were a part of the traditional diet.

And in this country, most people who aren’t consciously going out of their way to get fermented food, or bone broth, or organ meats, are really only getting the one of the four pillars, which is fresh food.

Diane Sanfilippo: Awesome. Luckily our listeners; we have encouraged them to be doing all of the above, but I’m sure it will solidify more of that for them, and probably a really excellent complement, I know. Of course a lot of our listeners probably have a copy of Practical Paleo, which is the same idea where it is this broad view; but I don’t get into all of the details as much on the science; I really talk about the basics of how the body should work and what you should eat. But if you want to go deeper on the nutrition, then this is a really great way to do that, to get a little bit more of that background information on exactly as the subtitle says; why your genes need traditional food. I think that’s really important. So I think that would be great. And we’ll put a link in the show notes, but you guys can get it anywhere books are sold; of course, on Amazon. Just look up Deep Nutrition, you’ll find it. It’s got a dark blue cover on it; that’s the new edition. So really cool. Very excited about that. I had first learned about the first edition back when I was in nutrition school, so I’m really excited about this new update.

So where can people connect with you and learn more and get more information from you?

Dr. Cate Shanahan: Yeah, come to my website. And I have some information there about how to communicate with your doctor about these issues. Just what is it that every doctor doesn’t know that they should know that if you really love your doctor and you feel like they might be open, I have some posts that you really could just print out so that doctors can understand how they kind of got bamboozled. And I also have a whole section on arterial health, and what you should do, and what about statins, and how do they affect you, and how to get off of them, and that kind of stuff.

Diane Sanfilippo: Awesome, we will definitely link to that but you guys can check it out. Dr. Cate. Thank you so much for spending so much time with me today! I’m sure our listeners are going to absolutely love this episode. It’s going to be instant classic, as my friend Sean Croxton would say. Really amazing; thank you so much.

Dr. Cate Shanahan: Thanks Diane; it was a lot of fun.


Diane Sanfilippo: Alright, that’s it for this week you guys. You can find me, Diane, at And of course you can find my Balanced Bites podcast cohost Liz Wolfe at Don’t forget to join our email lists for free goodies and updates you don’t find anywhere else on our websites or even on the podcast. And hey; I’m going to throw out a new recommendation. If you’ve got a friend who you think would enjoy listening to this show, let her know, or let him know. This is why Liz does the close out on all of these. I am stumbling over words! But let your friend know about the show, because I think lots of folks would love podcasts, but don’t know how to listen. So show her how to do it; just tap on her phone and subscribe for her, and let her know that you’ll be listening too, and you guys can talk about the show. Thanks so much; well catch you next week.

Comments 3

  1. Pingback: Healthy Fats & Cholesterol | What's Up Weekly with Diane | March 15th, 2017

  2. This was such a great podcast episode! So many light bulb moments. Thank you for continuing to bring amazing guests onto your show! This podcast episode is a great complement to the Master Class module about healthy fats and cholesterol. It’d be awesome have Dr. Cate on the show again–I’m sure she has so much more she could teach us! Thanks Diane and Liz 🙂

  3. Great episode … already emailed it to my parents 🙂

    Any tips for oils and eating out? I’m currently doing a SIBO diet so eating out way less often, but for when I’m done with that, how do you get around those bad oils out? Just wondering what you look for and ask for when at a restaurant. Thanks

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