#525: Cholesterol-Lowering Medication – Dr. Paddy Barrett

Food science and behavior are intimately connected. One critical but often overlooked facet of this connection is food texture and its substantial impact on eating behavior and energy intake. Food texture encompasses characteristics such as hardness and structure. It categorizes food into liquids, semi-solids, and solids, each with a wide range of textures—from dry and crispy to elastic and more substantial. This classification deeply affects how we consume food. The time it takes to chew and swallow a food item can vary greatly based on its texture. Different textures can also influence the speed at which satiety signals are triggered. Eating rate is a highly individual trait, stable over time, and consistent across different contexts. Some people are naturally slower eaters, while others consume food quickly. This variance can have significant implications for energy intake and body weight. In this episode, Dr. Marlou Lasschuijt, an assistant professor in the Sensory Science and Eating Behaviour group at Wageningen University, discusses the above topics and their implications. Links: Subscribe to Sigma Nutrition Premium (for study notes and transcripts) Go to episode page The Restructure Project Receive our free weekly email: the Sigma Synopsis Timestamps: 00:14 Introduction 00:47 Dr. Lasschuijt’s Research Focus 04:23 Understanding Food Texture and Eating Behavior 06:37 Impact of Food Texture on Satiation and Eating Rate 16:55 Applications and Innovations in Food Science 18:31 Unanswered Questions 25:34 Practical Recommendations  27:00 Current and Upcoming Research Projects

Cholesterol-lowering medications, particularly statins, play a pivotal role in reducing low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) concentrations, which are causal markers in atherosclerosis development. The efficacy of these medications is well-documented, with numerous clinical trials demonstrating substantial benefits in reducing cardiovascular events and improving overall mortality rates. Despite the robust evidence supporting the benefits of cholesterol-lowering medications, there are various misconceptions and misunderstandings regarding their use. One common myth is that these drugs are unnecessary for those without overt cardiovascular symptoms, ignoring the preventative benefits for at-risk individuals. Concerns about side effects, such as muscle pain, liver damage, and cognitive impairment, are often exaggerated. While side effects are possible, they are typically mild and manageable. Regular monitoring and adjustments by healthcare providers can help mitigate any adverse effects, ensuring that the benefits of reducing LDL-C and apoB far outweigh the risks. In this episode, preventative cardiologist Dr. Paddy Barrett discusses the different types of lipid-lowering medications, their mechanisms of action, the side effects that may occur, and the misconceptions about the drugs that are unfortunately widespread. Timestamps: 00:14 Introduction 03:26 Dr. Barrett’s Background 04:50 What is “Lipid Lowering”? 05:30 Overview of Lipids and Atherosclerosis 09:58 Setting Targets for Lipid Levels 15:52 Medications for Lowering LDL and ApoB 20:12 Statins: Types, Effects, and Side Effects 35:38 Addressing Concerns and Misconceptions 42:47 Future of Lipid Lowering Therapies Links: Go to episode page Subscribe to Sigma Nutrition PREMIUM drpaddybarrett.com Dr. Barrett’s Substack Book: Heart. An Owner’s Guide Receive our free weekly email: the Sigma Synopsis

When aiming for healthy aging and reducing chronic disease risk over the lifecourse, exercise, specifically a combination of resistance training and cardiorespiratory fitness, has a fundamental role to play. In addition it can mitigate age-related declines and support independence in later years. A strong evidence base exists showing the benefits of increased strength and cardiorespiratory fitness on a range of important outcomes related to lifespan and healthspan. But some intriguing questions remain, such as: How strong is strong enough? At what point do we maximize the benefits of exercise? How “fit” do we need to be? Is simple participation enough or do we need a true training adaptation? How can this actually be implemented in practice so that it is doable? In this episode, Dr. Jordan Feigenbaum shares his insights on this topic and offers advice on how we can increase our probability of a long healthspan, through exercise interventions. Links: Subscribe to Sigma Nutrition Premium Go to episode page Join Sigma's email list Barbell Medicine Timestamps: 04:40 Dr. Feigenbaum’s Journey and Barbell Medicine’s Mission 05:57 Defining and Achieving Healthy Aging 10:37 The Impact of Exercise on Health and Longevity 28:52 Strength Training: How Much is Enough? 38:43 Muscle Mass vs. Strength: What Matters More for Health? 47:18 The Paradox of Muscle Mass vs. Strength 49:05 Designing an Effective Strength Training Program 01:01:27 Cardiorespiratory Fitness: Importance and Assessment 01:06:19 Optimizing Cardio Training: Intensity and Volume

Contemporary society is witnessing a growing interest in, and embracing of, plant-based diets. Numerous athletes are now gravitating towards such dietary choices, motivated by concerns for health, performance or ethics. Consequently, coaches, nutritionists, and other fitness experts find themselves increasingly tasked with guiding athletes who adhere to plant-based diets. For coaches and trainers, understanding the possible impacts of these dietary preferences on athletes’ objectives is paramount, as is devising dietary plans that optimize their performance. This episode discusses the scientific and practical aspects of supporting athletes who have adopted a vegetarian lifestyle and diet. Links: Subscribe to Sigma Nutrition Premium Go to episode page - See related episodes Subscribe to Sigma's email newsletter

The Food Frequency Questionnaire (FFQ) stands as a cornerstone in nutritional research, offering valuable insights into dietary patterns and habits over a specified period. Despite its widespread use and established utility, the FFQ has not been immune to criticism, much of which arises from a misunderstanding of its purpose and inherent limitations. At its core, the FFQ is designed to assess the frequency and quantity of food consumption, aiming to capture long-term dietary behaviors rather than precise intake levels. Researchers employ it to investigate relationships between diet and various health outcomes, such as chronic diseases or nutritional deficiencies. However, critics argue that its reliance on self-reported data introduces biases and inaccuracies, leading to potential misestimation of nutrient intake. Additionally, some detractors question the FFQ’s ability to capture sporadic or infrequent dietary choices accurately. Yet, it’s crucial to recognize that the FFQ serves a specific purpose within the realm of nutrition research. While there are no doubt limitations, its strength lies in its ability to capture habitual dietary behaviors over an extended period. Moreover, researchers employ various strategies, such as validation studies and data adjustment techniques, to enhance the FFQ’s reliability and validity. In this episode, world-leading nutrition epidemiologist Dr. Deirdre Tobias discusses the development of the FFQ, the key concepts that are crucial to understand, common criticisms of the FFQ, and how we should evaluate the utility of this tool. Links: Go to episode page (guest biography, links, etc.) Subscribe to Sigma Nutrition Premium Interested in improving your ability to read nutrition research? Take a look at our course Applied Nutrition Literacy Join the Sigma Nutrition newsletter

Links: Subscribe to Premium (15% off this week!) Download detailed study notes and episode transcript Go to episode page About This Episode: “Personalized nutrition” has been promoted as an approach that will improve people’s health by prescribing them specific dietary recommendations based on their own genetic and phenotypic data. The premise is that given we each respond differently to foods, having general dietary recommendations may be doing many people a disservice. And by using an array of personal data, it is now possible to give unique diets that improve health. The early and interesting findings of research in this area was met with much fanfare, and indeed, many companies are now offering commercial direct-to-consumer services based on genetic and physiological testing, followed by “personalized” dietary prescription. Such testing may include genetic tests, microbiome testing, glucose monitoring data, and more. This data is then fed into machine learning algorithms to prescribe dietary recommendations. However, do the marketing claims match the current evidence? Does the “proof” it works that is often cited, actually back up the claims? Do personalized nutrition diets actually lead to improved health outcomes over generic, conventional dietary recommendations? Do personalized nutrition diets lead to better outcomes than standard dietetic/nutrition practice? To answer these questions, we go through the main studies cited in favor of personalized nutrition being superior to typical dietary advice, and see if they indeed support the claims. So is personalized nutrition superior to standard dietary advice? Let’s find out… Note: This was originally a Premium-exclusive episode. If you’d like to get more episodes like this, subscribe to Sigma Nutrition Premium.

The relationship between coffee and health is complex, encompassing areas like blood lipids, cardiovascular disease, neurodegenerative diseases, anxiety, and depression. Coffee has an interesting nutrient profile and contains diverse bioactive compounds that influence metabolism. Coffee has a potential impact on cardiovascular disease risk, with mechanisms that highlight potential benefits and some concerns. There may be an impact on blood pressure and blood lipid, but there are important nuances to this. Some research suggests that moderate intake may protect against neurodegenerative diseases like Alzheimer’s and Parkinson’s, with some mechanisms proposed for the observation.  Coffee’s effects on anxiety, depression, and sleep are common talking points and worthy of addressing. The context of the consumption and the individual in question will dictate the likely effects. Ultimately, coffee’s effects on health are influenced by various factors, warranting personalized approaches to consumption. In this episode, Simon Hill puts some questions to Danny Lennon about the impact of coffee on our health. Links: Go to episode page Subscribe to Sigma Nutrition Premium See Sigma's recommended resources Join the Sigma email list Simon's website: The Proof  

Links: Go to episode page Subscribe to Premium Join the Sigma email list Go to our recommended resources About This Episode: Have you ever wondered how exercise affects our appetite and energy intake? While we know that single bouts of exercise can create a short-term energy deficit, do they also influence our hunger levels? And what about long-term exercise training? Could it modify our appetite in ways that help us better control our weight? Recent research suggests that exercise may indeed play a role in appetite regulation. Could exercise modify the subjective and homeostatic mediators of appetite in ways that enhance our feelings of fullness after a meal? One of the most fascinating aspects of this research is the variability in responses between individuals. Why do some people experience changes in appetite and energy intake after exercise, while others don’t? Could factors like adiposity, sex, or habitual physical activity levels play a role? In this episode, Dr. James Dorling of the University of Glasgow helps us delve into the evidence surrounding how factors like adiposity, sex, and habitual physical activity modulate our responses to exercise in terms of appetite, energy intake, and appetite-related hormone responses. About The Guest: Dr. James Dorling is a lecturer in Human Nutrition at the University of Glasgow. Dr. Dorling’s research is broadly focused on three areas: (1) the impact of nutrition and physical activity interventions on obesity-related endpoints and biomarkers of aging; (2) the regulators of appetite and eating behaviours; and (3) the changes in appetite and eating behaviours in response to health interventions. During his PhD, he studied the effects of acute exercise and obesity-related single nucleotide polymorphisms on appetite and appetite-related hormones. Following this, Dr. Dorling joined Pennington Biomedical Research Center where he worked as a postdoctoral researcher. His postdoctoral research principally focussed on the influence of calorie restriction and physical activity on weight, markers of aging, and eating behaviours.

In a world flooded with claims, advice, and recommendations on how to extend our lifespan, the buzz around various diet approaches, supplement regimens, and lifestyle hacks is deafening. But amidst the noise, one must pause to ponder: Are these claims rooted in science? And perhaps more crucially, are we even asking the right questions or pursuing the correct goals in our quest for longevity? Join us in our upcoming podcast episode as Danny delves into these intriguing questions. Rather than getting lost in the sea of trends and fads, Danny offers his insights on the essential inquiries we should be making. Discover how to shift our focus towards the core factors that genuinely enhance our chances of leading longer, healthier lives. Don’t miss out on this thought-provoking exploration into the science and philosophy behind longevity. Links: Subscribe to Premium Go to SigmaNutrition.com  

Acronyms & Terminology: NHS - National Health Service (UK) CAMHS eating disorder unit - Child & Adolescent Mental Health Service Tier 4 Services - CAMHS services are organized through a tiered system. Tier 4 is the highest on the hierarchy and relates to highly specialized or inpatient services. NG Feed - nasogastric (NG) tubes MDT decision - multidisciplinary team (MDT) decision-making CBT-E - Enhanced Cognitive Behaviour Therapy - a “transdiagnostic” treatment for all forms of eating disorder including anorexia nervosa, bulimia nervosa, binge eating disorder and other similar states​. ARFID - Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which people avoid eating certain foods, or restrict their diets to the point it ultimately results in nutritional deficiencies. SSCM - Specialist Supportive Clinical Management (SSCM) is a psychotherapy comprising a clinical management focus addressing anorexia nervosa (AN) symptoms and a supportive therapy component. Links: Subscribe to Premium Go to episode page About This Episode: When exploring the landscape of eating disorder treatment and research, several crucial topics emerge, each shedding light on different aspects of this complex field. Firstly, the practice of nasogastric feeding under restraint raises ethical questions and considerations. How do healthcare professionals navigate the balance between ensuring adequate nutrition and respecting the autonomy and dignity of patients? What are the potential implications and risks associated with this practice? Progress in understanding and treating eating disorders has evolved significantly over the years, yet challenges persist in translating research findings into effective clinical practice. How can advancements in genetics, neurobiology, and psychology inform more personalized and holistic treatment approaches? What barriers hinder the implementation of evidence-based practices within healthcare settings? An essential aspect of eating disorder treatment is understanding what “recovery” truly means. Beyond weight restoration, what factors contribute to a meaningful and sustainable recovery journey? How can healthcare professionals support individuals in achieving their unique goals and aspirations for recovery? Improving services and introducing better treatment options requires a nuanced understanding of the complexities inherent in eating disorders. How can healthcare systems prioritize patient-centered care and tailor interventions to meet the diverse needs of individuals affected by eating disorders? What strategies can be employed to address systemic challenges and foster positive change within healthcare settings? In addressing these questions and navigating the complexities of eating disorder treatment and research, expertise and insights from seasoned professionals are invaluable. In this episode Helen West, an Advanced Specialist Eating Disorders Dietitian with over 12 years of clinical experience, discusses her experience and understanding of these areas. With her extensive background and expertise, Helen offers valuable perspectives in tackling these critical topics within the realm of eating disorder treatment and research.