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The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy

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To read more about heart disease and cholesterol, check out this eBook on the Diet–Heart Myth.

It’s hard to overstate the impact that cardiovascular disease (CVD) has in the U.S.. Consider the following:

  • Cardiovascular disease affects 65 million Americans.
  • Close to one million Americans have a heart attack each year.
  • In the U.S., one person dies every 39 seconds of cardiovascular disease.
  • 1 of 3 deaths that occurs in the U.S. is caused by cardiovascular disease.
  • 1 in 3 Americans have metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance.
  • The total cost of cardiovascular disease in 2008 was estimated at $300 billion.

To put that last statistic in perspective, the World Health Organization has estimated that ending world hunger would cost approximately $195 billion. One might argue that the $300 billion we spend on treating cardiovascular disease in the U.S. is a necessary expenditure; however, a recent study which looked at the relationship between heart disease and lifestyle suggested that 90% of CVD is caused by modifiable diet and lifestyle factors. (1)

Unfortunately, cardiovascular disease is one of the most misdiagnosed and mistreated conditions in medicine. We’ve learned a tremendous amount about what causes heart disease over the past decade, but the medical establishment is still operating on outdated science from 40-50 years ago.

In this 4-part series, I’m going to debunk 3 common myths about heart disease:

  1. Eating cholesterol and saturated fat raises cholesterol levels in the blood.
  2. High cholesterol in the blood is the cause of heart disease.
  3. Statins save lives in healthy people without heart disease.

In the fourth and final article in the series, I’ll discuss strategies for naturally protecting yourself against heart disease and improving your heart health.

Myth #1: Eating Cholesterol and Saturated Fat Raises Cholesterol Levels in the Blood.

Most of us grew up being told that foods like red meat, eggs and bacon raise our cholesterol levels. This idea is so deeply ingrained in our cultural psyche that few people even question it. But is it really true?

The diet-heart hypothesis—which holds that eating cholesterol and saturated fat raises cholesterol in our blood—originated with studies in both animals and humans more than half a century ago. However, more recent (and higher quality) evidence doesn’t support it.

Cholesterol and saturated fat: dietary enemies or innocent victims of bad science?Tweet This

On any given day, we have between 1,100 and 1,700 milligrams of cholesterol in our body. 25% of that comes from our diet, and 75% is produced inside of our bodies by the liver. Much of the cholesterol that’s found in food can’t be absorbed by our bodies, and most of the cholesterol in our gut was first synthesized in body cells and ended up in the gut via the liver and gall bladder. The body tightly regulates the amount of cholesterol in the blood by controlling internal production; when cholesterol intake in the diet goes down, the body makes more. When cholesterol intake in the diet goes up, the body makes less.

This explains why well-designed cholesterol feeding studies (where they feed volunteers 2-4 eggs a day and measure their cholesterol) show that dietary cholesterol has very little impact on blood cholesterol levels in about 75% of the population. The remaining 25% of the population are referred to as “hyper-responders”. In this group, dietary cholesterol does modestly increase both LDL (“bad cholesterol” and HDL (“good cholesterol”), but it does not affect the ratio of LDL to HDL or increase the risk of heart disease. (2)

In other words, eating cholesterol isn’t going to give you a heart attack. You can ditch the egg-white omelettes and start eating yolks again. That’s a good thing, since all of the 13 essential nutrients eggs contain are found in the yolk. Egg yolks are an especially good source of choline, a B-vitamin that plays important roles in everything from neurotransmitter production to detoxification to maintenance of healthy cells. (3) Studies show that up to 90% of Americans don’t get enough choline, which can lead to fatigue, insomnia, poor kidney function, memory problems and nerve-muscle imbalances. (4)

What about saturated fat? It’s true that some studies show that saturated fat intake raises blood cholesterol levels. But these studies are almost always short-term, lasting only a few weeks. (5) Longer-term studies have not shown an association between saturated fat intake and blood cholesterol levels. In fact, of all of the long-term studies examining this issue, only one of them showed a clear association between saturated fat intake and cholesterol levels, and even that association was weak. (6)

Moreover, studies on low-carbohydrate diets (which tend to be high in saturated fat) suggest that they not only don’t raise blood cholesterol, they have several beneficial impacts on cardiovascular disease risk markers. For example, a meta-analysis of 17 low-carb diet trials covering 1,140 obese patients published in the journal Obesity Reviews found that low-carb diets neither increased nor decreased LDL cholesterol. However, they did find that low-carb diets were associated with significant decreases is body weight as well as improvements in several CV risk factors, including decreases in triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin and c-reactive protein, as well as an increase in HDL cholesterol. (7)

If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (8) A Japanese prospective study that followed 58,000 men for an average of 14 years found no association between saturated fat intake and heart disease, and an inverse association between saturated fat and stroke (i.e. those who ate more saturated fat had a lower risk of stroke). (9)

That said, just as not everyone responds to dietary cholesterol in the same manner, there’s some variation in how individuals respond to dietary saturated fat. If we took ten people, fed them a diet high in saturated fat, and measured their cholesterol levels, we’d see a range of responses that averages out to no net increase or decrease. (If dietary saturated fat does increase your total or LDL cholesterol, the more important question is whether that’s a problem. I’ll address that in the next article in this series.)

Another strike against the diet-heart hypothesis is that many of its original proponents haven’t believed it for at least two decades. In a letter to the New England Journal of Medicine in 1991, Ancel Keys, the founder of the diet-heart hypothesis said (10):

Dietary cholesterol has an important effect on the cholesterol level in the blood of chickens and rabbits, but many controlled experiments have shown that dietary cholesterol has a limited effect in humans. Adding cholesterol to a cholesterol-free diet raises the blood level in humans, but when added to an unrestricted diet, it has a minimal effect.

In a 2004 editorial in the Journal of American College of Cardiology, Sylvan Lee Weinberg, former president of the American College of Cardiology and outspoken proponent of the diet-heart hypothesis, said (11):

The low-fat, high-carbohydrate diet… may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type 2 diabetes, and metabolic syndromes. This diet can no longer be defended by appeal to the authority of prestigious medical organizations.

We’ve now established that eating cholesterol and saturated fat does not increase cholesterol levels in the blood for most people. In the next article, I’ll debunk the myth that high cholesterol in the blood is the cause of heart disease.

Research Spotlight: Health Coaching and Heart Health

Behavioral Counseling Dose-Dependently Improves Blood Lipid Levels

Oxidized low-density lipoprotein (LDL) cholesterol plays a critical role in the development of cardiovascular disease (CVD). High circulating levels of LDL cholesterol increase the likelihood that LDL may become oxidized, contributing to CVD pathogenesis. Diet and lifestyle changes have been found to reduce LDL cholesterol, but many patients have trouble sustaining nutrition and lifestyle changes over the long term. Behavioral counseling may help patients at risk for CVD maintain a healthy diet and lifestyle behaviors, and thus support improved long-term health outcomes. A 2019 study sought to examine the combined effects of behavioral counseling and healthy lifestyle changes on LDL cholesterol levels in adults with prehypertension and stage 1 hypertension, who are at an elevated risk of CVD.

Study Summary

  • Seven hundred fifty-six adults with prehypertension and stage 1 hypertension were randomized to one of three groups:
    • Advice-Only Group: Participants were given information about nutrition and lifestyle approaches for improving CVD risk factors, including dietary sodium restriction, weight loss, exercise, and a “healthy diet.”
    • Established Lifestyle Intervention Group: Participants were educated about healthy diet and lifestyle changes and provided with behavioral counseling.
    • Established + Dietary Approaches to Stop Hypertension (DASH) Lifestyle Intervention Group: Participants were instructed about healthy diet and lifestyle changes, behavioral counseling, and the DASH diet.
  • Subjects in the “Established Lifestyle Intervention” and “Established + DASH Lifestyle Intervention” groups experienced significant reductions in LDL cholesterol, triglycerides, and total cholesterol after six months compared to the “Advice-Only” group.
  • For every 10 sessions of behavioral counseling, LDL cholesterol decreased by 6.2 mg/dL.
  • The relationship between the number of behavioral counseling sessions attended and reductions in LDL cholesterol and triglycerides was mediated by a decrease in waist circumference, suggesting that the combination of behavioral counseling and lifestyle changes reduces visceral adiposity.

Key Findings

A combination of healthy lifestyle changes and behavioral counseling can reduce LDL cholesterol in individuals with hypertension and may thus reduce their future risk of CVD. Attending more behavioral counseling sessions appears to lead to more significant improvements in CVD risk factors. Frequent health coaching sessions, combined with the administration of nutrition, exercise, sleep, and stress reduction advice, may be a valuable model for improving long-term health in people with CVD risk factors.

Reference: Dose-dependent effects of lifestyle interventions on blood lipid levels: Results from the PREMIER trial.

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546 Comments

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  1. Those old diet advice, ridiculous low fat and high carb doesnt works, its already proven! You guys must talk with body builders about what they think about that.
    If you want lean mass you-ll need some fats and saturated ones, dont be silly.

  2. but why is it that when i stopped eating cheese and red meat my cholesterol went down? did not change anything else in my diet or physical activity?

      • I am 70 years old and have stopped taking Cholesterol drugs and feel much better for not taking these drugs. I have found that they have done more harm to my body than good. I have started with a LCHF diet set by Prof. Tim Noakes and am experiencing wonderful health bennifits. I feel like a new man

        • My husband was advised to get on statins and his total cholesterol is 197. His ldl is a little high. He isn’t doing it. He has stopped eating a lot of cheese and pastas and not over eating at all. He gets his new numbers told to him this week after trying to lower the number for the last 3 months. Personally I don’t think his number needed to be lowered but the overall health of the way he is eating now is very good in my opinion so worth it for overall health. My cholesterol on the other hand isn’t as good of numbers at like 240ish. My hdl is good but my triglycerides screw this number up. The ldl isn’t very bad at all. I imagine it is from coca cola. But not sure.

        • Good on you Peter, I am 68 in May of this year, and am eating LCHF, I just keep putting on fat around my middle, on grains and carbs, low fat medium protein, so switching to fat instead of carbs, and losing waistline. I did LCHF before and went down to a 37 inch waist, a short spell on HCLF, has me back around 40 inch waist, and about 5kg heavier, because I have a high cholesterol, I will eat more mono fats like olive and avocado, but will still eat the fat on my meat, and eggs with yolks, only time will tell, because science seems very mixed up. Someone said most Drs’ and Scientists go with the lo fat way but maybe that is because they get ostracized if they do anything outside of the AM A guidelines. Cheers

    • It depends on the cheese and the preparation of the red meat. Some cheese actually has sugar in it and depending on your preparation of the red meat also. I’m not sure entirely because I don’t have any idea what your exact diet is, but if you were eAting a diet of cheese and red meat concurrently with carbohydrates then yes it will lead to an elevated cholesterol reading. For a LCHF diet to work you generally have to keep carbs around 20-50 grams a day. Other wise when you consume both there will definitely be a rise. The reason being is that glucose is the main source of energy in our body and the body reaches for that first . When you have an excess of glucose which comes from carbs, that will get stored. Anyhow, so when you keep carbs at 50 g, the body will need more energy and utilize the second source of energy which is fatty acids. Saturated fats is one type of fat amongst many and when metabolized becomes fatty acids. Because the body needs energy due to shortage of the glucose it will use the “sat fat” therefore it won’t accumulate and cause CVD nor can it be used for synthesizing cholesterol.

      So I think there might be something else in your diet that might be causing the increase in your diet. At the same time like the article says you could be a part of the 25% who is sensitive to sat fat and cholesterol synthesis.

  3. I totally understand what you are sayin but I still need your advice. I cut sugar and refined carbs, lost 11 kilos in 28 days and felt great. I had v little fat though, eating avocado in one piece of toast daily, usually Burgen bread, and then other stuff like salad and greet yoghurt and a usual tea, usual meats. Then a friend to,d me to eat more fats, and thing went haywire. I ate the cheese, the full milk, the creams on fruit and my weights gone nuts, and chol, high in the family anyway, skyrocketed. I’m on statins but why? Overboard in high fat? Listening to the wrong info? And weight back on.

    • Go back to what you were doing before. You were apparently getting enough fats and the right amounts that way. I cant seem to eat dairy foods like that as they clog my arteries. Yeasty too. Turn to sugar and not the same. on the other hand if I eat too much meat I get too many androgens and greasy with hair loss. I can eat burgers with the bun. I can eat a small baked potato with like a pork chop. Even a roll with it. But if I try to eat the creamy stuff you mentioned I get tired, my arms get tight from not clearing the stuff as its sticking to me, and fat. Also rashes around mouth with excema from dairy.

    • Hi,
      Loads of people avoid dairy. I know that when I eat it I notice it through my sinus and feel clogged up. I would stick to the variety of fats you were having before like the avocado, olive oils, organic butter, coconut oil, nuts, seeds and flax oils as these are all ‘clean’. Diary is processed and it you previously avoided it you may have built up a bit of an intolerance. not to mention the sugars that can be included. Save the dairy for special occasions but remember that full cream is the best.
      I have my own blog http://www.journeythatislife.wordpress.com as well as a clean Facebook page http://www.facebook.com/cleantreats1 which you might find helpful!

      but if you are only eating fats then remember this is your furl source so an increase wont hurt. just reduce your fats in meals when you are carbs! 😀

      • I can drink milk direct from the cows but not milk from the shops . I can eat real butter sparingly but not the margarine, What ever they add to the produced food does not agree with me frsh is best of every thing but all in moderation.

    • Did you eat the high fat while eating the same amount of carbs? One piece of toast typically has 24g of carbs and for this type of diet you have to decrease the amount of carbs to 50g or less in order to eat above the RDA recommendations and not have increased cholesterol levels. I think your friend might have left out that vital part. Also make sure that the cholesterol readings could be high sometimes for eating sat fat from what I’ve heard as long as long as it’s the HDL cholesterol levels being higher than then LDL ones. But since you gained the weight back I’m not sure if that’s the case here

    • I personally would avoid any of the processed meats and dairy.

      Stick to the meat to get your fat.

  4. Karina, if you have read this article you should already know it. Still if you want to know more, I have compiled lot of resources like articles and videos on my blog http://yrusick.wordpress.com/ for anybody to review. From what I have understood there is no correlation of Saturated Fats with Cholesterol or Cholesterol with heart disease. If anything, they are good for you. Google Gary Taubes, Sally Fallon, Donald Miller, Mary Enig, Robert Lustig, William Davies, Michael Pollan, Weston Price Foundation – to name a few – and get more answers.

  5. I want to know about saturated fat and cholesterol intake. Is that true that saturated fat raises cholesterol higher than cholesterol intake does? If yes, could anyone explain to me?

  6. Excellent article Chris. I am from India and the edible oil industry created this misconception that Coconut oil is bad, cholesterol is bad. A south Indian population which predominantly consumed coconut oil, turned toward sunflower oil. With atrocious amount of omega-6, the health of the people got affected. The same is with cholesterol.

    • Very true and the same has happened in other parts of the world like Philippines and other nations of south east Asia. It has been seen that when people like Japanese emigrate to USA they get all the diseases of North America which were unheard of in their native land. Not only that, when people in big cities like Tokyo gravitate towards Standard American Diet (SAD) then they get similar diseases in their own lands. It is also true of western countries like France which had low heart disease despite high fat/dairy consumption but it began to change with the advent of SAD there.

  7. I wonder if some of the cholesterol / CHD contradictions could be addressed by looking at some of the numerous other factors that determine our overall health; nutritional insufficiencies (esp. vitamin C and B12), systemic pH and adrenal health, for instance. Inflammation occurs in an acidic environment, damages blood vessels walls, which call for cholesterol to form plaque to provide protection. I don’t think we can focus on one system function and try to juggle one aspect and get a result that we can actually draw conclusions from. Our metabolism is very complex, and I don’t think the above approach takes that into account.

  8. OK let me drop the bomb, hdl is good cholesterol. Lsl is not bad but rather neutral cholesterol. Vldl is the bad cholesterol. You can eat any type of natural food and live healthy and long. Processed meat, including a steak from a corn fed cow is toxic. Margerine is toxic, as is regular butter. The ONLY butter you should be eating is grass fed such as Kerry gold. The human body cannot store fat without insulin, therefore by removing sugars, starches and unnatural carbs from your diet (vegetables are fine) your body has no choice but to lose weight. Exercise is important as it builds muscle mass and breaks down insulin resistance. Alcohol is bad for you as it spikes insulin just like sugar. Follow those rules and you’ll be fine. If its been made or has an ingredients list on the packet don’t eat it. Eat only real natural foods as nature intended. All I have posted is well researched and verifiable.

    • Sugar is good for you. If there is not enough sugar in the blood, the body will release adrenaline to break down proteins into glucose.

      Almost all sugars are 50/50 glucose/fructose.

      Sugar in Fruits are entirely fructose; which the body can not even use, it must convert it to glucose.

      Also, do more research on resistant starches and what it does for the bacteria in the lower intestine. The body craves insulin spikes at certain times also.

      Completely wrong on that front.

      • The sugar in fruit is not entirely fructose. The sugar profile of fruit is comparable to that of table sugar(which is 50/50): 20-60 percent fructose, and the rest sucrose with trace amounts of glucose.

        Low blood sugar triggers all sorts of metabolic responses, the two relevant ones being lipolysis and proteolysis. Neither of these things is bad in the general case when you aren’t actually starved of fat or protein. We have the processes specifically to meet our bodies energy requirements, they do not signal some kind of detriment to health in the presence of sufficient protein and fat intake.

        • Ok fine, so i had a brain fart about the fruit sugar. What i really meant was they dont hav glucose; what the body primarily uses. They just hav fructose and table sugar, that is all. (2 things loathed by modern nutrition.)

          These aren’t necessarily the specific processes let alone general things i was referring to, but Ok great so these processes are not “bad” to you.

          Why rely on the body and give it more stress to do anything, such as any protein synthesis, when u can jus eat something? The “general case”. Lol. I understand the average person in America has abundant stores and isnt lacking in fAt etc, but its not like these features werent a ‘Paleolithic’ sign of deficiency in its average person. Did an ancestral person always have access to “sufficient” fat and protein? how often did they even have access, exactly? Why start with americans as a base? Why not someone else elsewhere, or jus a modern normal person of health? What is anything about amerika thats normal?

          Not to mention paleolithic people prolly had more sugars in their diet than what ‘Paleo’ tends to prescribe.

          Bad is relative. Always has been (philosophically. In general). What isn’t bad, doesn’t mean is optimal. And none of this even considers its only as far as our current science knows about anything of these “processes”.

      • your body’s gasoline is sugar, your body turns everything into sugar so it can run, if you give your body sugar your body is gonna store the extra sugar it doesn’t need turning it into fat, but if you give your body protein… like meat or veggies your body is gonna work extra hard to extract that gasoline (sugar) your body needs, burning extra sugars in your body to survive

      • dont give ppl the wrong info or else there’s gonna be a heart attack mayhem like there’s a measles mayhem now (not vacc your kids)

        • camila.. If you don’t ingest liquid you will die Quickly..If you don.t eat Fat you will soon die (a few months). If you don’t eat protein you will last a little longer, but you will die. If you don’t eat carbs, you will not die. this is proven. Our bodies cannot make certain ESFA’s, if we don’t get protein then the body will eat itself, If we don’t get carbs, the body can make them from protein and/or Fatty acids,and can use ketones to run most things with ease. I have nothing against any way of eating, just get sick of the preaching that goes on, especially as you are on a LCHF site. If you don’t agree go to the site that suits your type of eating, end of story. Cheers.

  9. This is very interesting. I was only yesterday told I have raised cholesterol. Strange thing is I should be a model for a low cholesterol lifestyle. I am a reasonably fit, 120ib, 42 year old, female vegetarian. I already follow all the advise on the diet sheet I was sent, eat nuts and soya, no meat etc, I don’t eat fish, that’s about it.

    • Saffron,

      It may be hereditary or genetic, and not have anything to do with lifestyle. Conversely, perhaps taking fish oil if you don’t want to eat fish might help?

      I am one of those people that is seeing the “myth” described here actually WORK…so I am rather at a loss too with these things. The low saturated fat, low cholesterol, high fiber diet is working for my fiance, very well, in fact. (I’ve added his numbers in previous comments below.)

      He does get a lot of fish and avocado, which is part of the good cholesterol, which is another thing that helps lower the bad. What does your good cholesterol look like?

      • You can get a vegetarian source of dha/oil – through microalgae supplements. Contrary to popular belief, fish itself is NOT high in DHA – it comes from the algae they consume 😉

    • Alot of how cholesterol is transported has to do with the amount of protein in the blood. Because cholesterol is a waxy type substance it doesn’t mix with water thus protein is necessary to coat the cholesterol substance so it can then become transportable throughout the body.

      • Vegetarianism does not mean inadequate protein. I’ve been pescetarian for 9 years and, though I do eat fish about 1-2x/weekly, I’m vegetarian most of the time. I get protein from regular consumption of legumes, soy products, and nuts. Yet my cholesterol is also higher than it “should” be.

  10. My fiance has been battling cholesterol recently, and used a low cholesterol/high fiber diet plus starting a workout routine, practicing portion control, and using “My Fitness Pal” on the Iphone to maintain a daily caloric limit. Basically, everything the newer articles (including this one) are saying is a myth, now. The following are his results, without any medication:

    2/26/14: 36 year old Male Patient, 190 lbs

    Chol T = 311mg/dL
    Trig = 166/dL
    HDL = 46mg/dL
    LDL = 232mg/dL

    5/19/14: 37 year old Male Patient, 160 lbs

    Chol T = 243mg/dL
    Trig = 95/dL
    HDL = 38mg/dL
    LDL = 186mg/dL

    10/27/14: 37 year old Male Patient, 160 lbs

    LDL = 168mg/dL.

    I can’t remember the rest of these from this occasion and I don’t have the sheet in front of me, but I can also say that the HDL is higher (it went back up after Fiance started adding Avacado into his diet very regularly on his tunafish on whole grain!) I believe it was 50+. Trigs were normal.

    So I will tell you that for some reason, the old advice IS working for my fiance. I am starting to wonder about cholesterol because these new articles are quite the contrary to the experience we are having. I don’t get it. The first 2 sets of numbers are directly off of his reports, and number don’t lie. So I’m a little worried when I keep reading these new “myth” articles.

    • I’d also like to note that this topic is very serious in our family and I am passionate about helping him as his father has had a few open heart surgeries, and is diabetic. He has been plagued with these life-threatening issues for most of his adult life and I don’t want to see the same happen to my fiance, so I have been actively contributing & insisting on a better lifestyle for him. My mother was also diabetic, and passed away 8/14 from heart failure, which also killed her brother; their father also had a pacemaker. We have a lot of familial heart problems and I am trying to make this stop with our generation if possible!

      • I agree that the weight loss was a contributing factor, however he had normal levels before starting the high fat low carb diet previously, at the higher weight.

        He also is continuing to lower levels despite having stopped losing weight.

    • His HDL fell from 46 (already low) to 38mg/dl (too low!). This is dangerous.

      You mention it rose again, after adding healthy fats. You may consider lowering Carbs, as this will help the weight loss and improve LDL/HDL ratios.

      • If he loses any more weight he will disappear. 😉 He doesn’t need to lose weight now. He’s maintaining.

      • https://www.youtube.com/watch?v=egqf7k5Lzhk&index=1&list=PLCC2CA9893F2503B5

        I started with 1 whole raw egg, shell and all, wash, rinse , toss in blender with banana and ice, makes a great shake, can add most anything for super flavor, ice cream, ice yougurt, Vanallia is favorite of mine, and coconut, makes it nearly a candy with all the nutrients of the calcium in the shell to the membrane, (collagen) to the densly packed D3, omega’s and b’s not to mention the protein’s and The Essencials !!! all in the egg,
        week 1 = 1 shake for breakfast 1 at bedtime,
        week 2= add a 2nd egg in am and 1 at bed time
        in a month add 2nd egg at bedtime,
        from their adjust up to what makes you FEEL Your best! and im not kidding !

    • Stephanie, your experiences and take are the most valuable for this debate. I would like to direct you to my blog where I have compiled lot of resources: http://yrusick.wordpress.com/. There under Educational Videos look for a 7 minute video of Gary Taubes about Cholesterol. Start from there and go further to other videos like one by Dr. Donald Miller. In a nutshell, you need to develop your own understanding by educating yourself. From my understanding, I can tell you that you should simply forget about Cholesterol. All these numbers virtually mean nothing as these are set against the backdrop of artificially selected “normal numbers” and there too they don’t get the numbers right when e.g. they don’t distinguish between VLDL and LDL.

  11. I am a care provider for a program that is subsidized by the USDA, which requires that we serve milk for breakfast and lunch. We choose to serve grass-fed, glass-bottled, non-homogenized Jersey whole milk. We recently lost our monthly $1,000 USDA food reimbursement for doing so (the USDA requires that we serve all children over 24 months 1% or FAT-FREE! milk). It would be fine to serve low-fat Nesquik chocolate milk with 17g of added sugar – if that gives any insight into the logic… Any links to research/articles on the benefits of whole vs. skim milk would be GREATLY appreciated. We will share those with families. Thanks!

  12. A friend and I switched to a low-carb diet about 3 months ago. Recently they had a blood test, and their LDL numbers increased and their HDL numbers decreased – high enough that the doctor started talking about statins. Didn’t expect that based on everything I’ve read.

    They’ve since abandoned the low-carb diet, although I’m sticking to it hoping that they’re just the exception – but I’m going to schedule a blood test for myself in the next month also. Any idea why their blood results could change so much for the worse?

    • I waited until my weight loss stabilized before getting my blood work done and saw my HDL go really high, while my LDL went down. I also went through Private MD labs for my NMR lipoprofile and hs-CRP.

      I find it interesting that your friend saw the drop in HDL on a high fat low carb diet. What were some of the foods he was eating and avoiding?

      I avoid breads, grain, pasta, refined sugar, vegetable oil, and soy. I eat healthy fats like olive oil, MCT oil, coconut oil, grassfed butter, avocados, nuts, whole fat cheese and a little whole fat milk, leafy lettuce, kale, spinach, cucumbers, berries, broccoli, grass fed beef, bacon, cage free eggs, wild salmon. I make my own salad dressing with evoo and apple cider vinegar and even eat the occasional carb now and again. I also eat dark chocolate 70-85%.

      What kind of exercise does your friend do? I try to walk a brisk pace every day 10 minutes at a minimum.

      Don’t over-consume meat. It’s better to eat more vegetables with a little meat. Too much will put stress on the liver.

    • My fiance has been battling cholesterol recently, and used a low cholesterol/high fiber diet plus starting a workout routine, practicing portion control, and using “My Fitness Pal” on the Iphone to maintain a daily caloric limit. Basically, everything the newer articles (including this one) are saying is a myth, now. The following are his results, without any medication:

      2/26/14: 36 year old Male Patient, 190 lbs

      Chol T = 311mg/dL
      Trig = 166/dL
      HDL = 46mg/dL
      LDL = 232mg/dL

      5/19/14: 37 year old Male Patient, 160 lbs

      Chol T = 243mg/dL
      Trig = 95/dL
      HDL = 38mg/dL
      LDL = 186mg/dL

      10/27/14: 37 year old Male Patient, 160 lbs

      LDL = 168mg/dL.

      I can’t remember the rest of these from this occasion and I don’t have the sheet in front of me, but I can also say that the HDL is higher (it went back up after Fiance started adding Avacado into his diet very regularly on his tunafish on whole grain!) I believe it was 50+. Trigs were normal.

      So I will tell you that for some reason, the old advice IS working for my fiance. I am starting to wonder about cholesterol because these new articles are quite the contrary to the experience we are having. I don’t get it. The first 2 sets of numbers are directly off of his reports, and number don’t lie. So I’m a little worried when I keep reading these new “myth” articles.

  13. Hi, John, I saw that you backlink to previous articles in this excellent series. Can you edit the earlier articles and forward-link to the next article? Saves time examining the overview page.

    Thank you for these excellent articles!

  14. since everybody is different, I decided to see how my own body reacts to lowering dietary cholesterol. I held dietary cholesterol to less than 250mg per day for a month then did a before and after comparison of blood cholesterol. the results:

    before: total=225, HDL=34, LDL=148, trig.=213
    after: total=153, HDL=25, LDL=94, trig.=174

    note HGL decreased, which is the surprise here. prior to the experiment, I had no dietary restrictions, and am borderline obese (6′, 205lb). It is an easy experiment to do, and yields individually relevant results.

    • all levels of Lipid profile decreased it is good but HDL level of 25 is alarming. how about continuing with this diet and start taking NIACIN tablets. I am not expert feel taking Niacin will increase HDL level consult your physician
      khanna

      • Indeed, I would view and HDL level of 25 as alarming.Niacin might effect your HDL level some but would add exercise to the mix.

    • Wouldn’t adding the healthy cholesterol back in (olive oil, fatty fish like salmon, avocados) bring that HDL back up too?

  15. Chris, what about the Esselstyn study (also ones by Ornish and others) showing striking reversal of heart disease in patients who ate *very* low fat vegan diets?

    • When the first Statins (HMG Reductase Inhibitors) came out I signed up for an experimental protocol researching dietary fat, etc. and cholesterol levels. My family has high cholesterol levels genetically (fortunately with high HDL levels) and I wanted to try dietary intervention to see what the result would be. I went on a strict low fat low cholesterol diet where I had to write everything down that I ate from a list for an extended period of time. I was shocked by the results as when I was rechecked my cholesterol had gone from 265 to 335…on the low fat diet. I asked the M.D. in charge of the study what is going on…he just laughed and said the result was not surprising as in his opinion dietary intervention in westerners was only effective in about 15 percent of the people in the study. As he put it, if your liver (where cholesterol is made) doesn’t see it coming down the pipe (dietary intake) it up regulates the gene to make more…and visa versa. Having said that, I did go on statins (10mg/day) and continued to exercise more regular and my numbers have improved immensely over the years (1988 to the present). My last total cholesterol was 196 with my HDLs being 102. I have kept an excel spreadsheet of all my medical testing data since that imd and can graph any long term trends.

      • You know what also (besides statins) downregulates HMG-CoA-reductase? Glucagon. And what upregulates it? Insulin.

        So what about low carb instead of statins???

        You should slap your doctor in the face with a stale baguette, for not telling you this…

  16. Chris, what about saturated fat and ED. I have read that a paleo type diet that uses commercial meat can increase saturated fat and very rapidly create ED symptoms in men.

    Can you comment on this please?

  17. I have read this entire page and now my question that I hope will be answered is this: I like carbs and feel way better when I eat them. I am actually referring to the refined carbs. Since this is my preference can I lower my intake of meats to allow for the carbs I seem to need so much more than meat(I can feel it) and will not eating as much meat but still eating carbs help my cholesterol go down some? Someone on here said that it is the combining of them that is the oxidizing bad effect so….I am just wondering if anyone knows this to help me. Thanx

    • @Lu, there is a million articles out there running folks from one side of the ship to the other. Most are crap! As a research scientist for some 40 and as someone who also had the job of reviewing a lot of papers that other folks wanted to publish in peer reviewed journals, I can say that a lot of junk work slips through the cracks. I won’t even mention charlatans who publish in non peer reviewed journals as in “The Journal of What’s Happening now”, where their buddies can schill for the masses with the buy my magic, organic, all natural, non-global warming, etc. pill or regimen and rake it in. They are selling “eternal life through chemistry” and would make a medicine man selling hadicol or 666 from the back of a conestoga wagon in the old west blush.

      Read and think logically. Many carbs and cereal grains are recent addition to mans diet when he gave up hunter gathering and picking up nuts and berries. This was only some 20,000 years or so ago. Before that it was chasing down a wildebeast for days until it collapsed and perhaps not eating for several days. Nobody rang a bell for breakfast, the same for lunch. Knowing this and knowing that in humans, the genome doesn’t change quickly at all, we have been sold a bill of good with eat…eat…eat…vegans good, meat eaters bad. So much junk science out there…tis very frustrating for a researcher to see.

  18. I feel bad when I see the confusion in the minds of people because two camps are being set up, 1. low fat, plant diet 2. high fat, paleo.

    But, very few people resort to common sense to resolve the issue.

    We humans are omnivorous animals. We eat plants & meat! It’s as simple as that. For a healthy lifestyle, you need to EAT both! Sorry, Ornish & low fat, plant camp, but you cannot disregard the natural human anatomy.

    It is possible to get very “fit” on a strict Ornish diet, but that is mainly coming from the “strictness” of avoiding the obvious bad processed foods and sugars. However, this camp targeting meat intake and even natural fat intake as dangerous just doesn’t make sense, as the human body was built to get nutrients from ALL THESE SOURCES to increase our chances of survival in the wild (back in the days).

    Any diet which isn’t BALANCING intake from all the key sources i.e. plant, meat & fat is a skewed diet, which will lead to other problems for the body.

    Key operating words when it comes to food is BALANCE & VARIETY. We were hunter-gatherers. We hunted our meats and gathered our plants and fruits. Continue to do that in a balanced way, along with exercise, and you would live at your optimum. This is common sense.

    • Alas, science is not common sense. The latter is often wrong (and also at times right); the only way to find out is by careful open-minded studies. If meat is so essential to our health, then one would expect, for instance, Adventist vegans to be unhealthy, or the Okinawan elders, or the Ornish patients. Do you know of studies showing that one does poorly on a (truly, as in 10% of calories) low-fat plant-based diet?

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<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/comment-page-5/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='5306' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='Heartburn/GERD' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=Heartburn%2FGERD' /> </div> </form> </div>
[gravityform id="9" title="false" description="false" field_values='popup_name=Gut Health']
<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/comment-page-5/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='5306' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='Gut Health' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=Gut+Health' /> </div> </form> </div>
[gravityform id="9" title="false" description="false" field_values='popup_name=Food Additives']
<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/comment-page-5/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='5306' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='Food Additives' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=Food+Additives' /> </div> </form> </div>
[gravityform id="9" title="false" description="false" field_values='popup_name=Diet-Heart Myth']
<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/comment-page-5/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='5306' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='Diet-Heart Myth' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=Diet-Heart+Myth' /> </div> </form> </div>
[gravityform id="9" title="false" description="false" field_values='popup_name=B12']
<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/comment-page-5/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='5306' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='B12' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=B12' /> </div> </form> </div>
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