Thread by @DBelardoMD

Another day, another “biohacker” telling people to put butter in their coffee & call it healthy. I love when @bulletproofexec shows up in my comment section on IG. I don’t get $$ from pharma, Asprey. I don’t want patients to put butter in their coffee bc I don’t want them to die.

And we don’t tell patients to drink soda either. Please, share with #medtwitter the “thousands of years of medical learning” as you call it, that demonstrates drinking butter is healthy? You’ve only made millions promoting this idea and other pseudoscience. I’ll wait.

For anyone who needs context: Dave Asprey @bulletproofexec
“How the CEO of Bulletproof Coffee turned buttered coffee into a multimillion-dollar empire”

But yet, us doctors recommending guideline based medicine, we are the shills @DrJenGunter

businessinsider.com/bulletproof-co…

But what’s interesting @bulletproofexec - we DO have randomized controlled trials, that actually inform our recommendations for patients. Putting butter in coffee is NOT healthy. We should go through some of these trials maybe?

Saturated Fat
-meta-analysis of 395 published, metabolic ward experiments of the effects of various dietary lipids on blood cholesterol – which clearly demonstrates how saturated fat increases LDL-c
Isocaloric increases in SFA intake were assoc w/ ⬆️ in total and LDL-c

Ronald Mensink did a regression analysis. Purpose of this was to account for the differences in in the ward trials (previous tweet)– since the SFA is replacing other things, replacing SFA w/ mufa/pufa or CHO...

His regression analysis addressed the question—what is the effect of the SFA alone on ⬆️ LDL-C versus – how much is that because of what you’re replacing it with? So the purpose of the meta regression was to have equations to control out for those factors-

and give you the predicted and observed LDL-C based on SFA intake, taking account for all those things into the equation – known as the Mensink equations.

So if you look at these dots – each one represents a trial- these were low end trials –some of them are down to 10 individuals – that’s how much little variability there is here.

Wow, look at that! The more saturated fat you eat, the higher it will raise your LDL-c

I’m still going @bulletproofexec , you with me?

Why does it matter that you make millions telling people to drink butter as biohacking Dave Asprey? Look no further than the European Atherosclerosis Society Consensus Panel on LDL!

They went into this in great detail in this consensus statement and found that consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.

They assessed whether the association btwn LDL & ASCVD actually fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, & randomized trials of LDL-lowering therapies

Meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, & RCTs including more than 2 million participants w/ over 20 million person-years of follow-up & over 150000 cardiovascular events have demonstrated a remarkably consistent dose-dependent

log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C. Both the naturally randomized genetic studies & the

randomized intervention trials consistently demonstrate that any mechanism of lowering plasma LDL particle concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C

Well you might be wondering... what about secondary prevention of ASCVD? Don’t worry @bulletproofexec , we have an RCT for that too!

The Lyon Heart Study— an Interventional study that increased legume, bread, fruit and vegetable consumption

And guess what! They decreased meat, butter (your favorite @bulletproofexec ), cream

And they also increased margarine (vegetable based margarine rich in PUFA)

And guess what... IMPRESSIVE outcomes!
Subjects following the diet which decreased butter and red meat, and increased fruits, vegetables and legumes, had a 50% to 70% lower risk of recurrent heart disease, even THOUGH their arm of the study had more smokers! Wild isn’t it?

So, in short... that’s why we don’t recommend our patients drink butter @bulletproofexec . Not because of pharma. Because of science.