Links: Go to episode page (with study links & resources) Subscribe to PREMIUM Receive our weekly newsletter More episodes on cholesterol & heart disease About This Episode: The Multiple Risk Factor Intervention Trial (MRFIT) was a groundbreaking clinical trial conducted in the 1970s and 1980s. Its main objective was to investigate the relationship between various risk factors and the incidence of heart disease. The study aimed to determine whether modifying risk factors, such as high blood pressure, high cholesterol levels, and smoking, could lead to a reduction in cardiovascular events. The trial spanned several years, with participants being followed up for a period of approximately six years to assess the incidence of cardiovascular events and mortality. The primary outcome measures included coronary heart disease (CHD) mortality and overall mortality. The MRFIT trial yielded several important findings that have significantly influenced our understanding of cardiovascular health and prevention strategies. In this episode we take a look at why this is such seminal research, as well as the contribution of one of the greatest researchers ever in the field, Jeramiah Stamler.

Explore the influential 1957 paper on dietary fats and blood cholesterol levels. Learn about the Keys Equation, which identifies the importance of the P:S ratio in the diet. Understand the impact of saturated and polyunsaturated fats on blood cholesterol levels. Discover the enduring nature of the Keys equation and the importance of reading published papers in nutrition science.

This is a Premium-exclusive episode, so here you'll only hear a preview. In order to listen to the full episode you’ll need to subscribe to Sigma Nutrition Premium. About This Episode: It has been clearly demonstrated that elevated LDL-cholesterol (LDL-C), or perhaps more specifically pro-atherogenic lipoproteins, is causal in atherosclerosis development in humans. One crucial concept within this is that the risk relates not only to the magnitude of elevated LDL-C, but the duration of exposure. Thus, the role of LDL-C in driving atherosclerosis is referred to as a “cumulative, integrated exposure over the lifecourse”. But, what exactly does this mean? In this episode, Danny discusses the cumulative exposure model of LDL-C in atherosclerosis, the evidence supporting it, and the implications of this for the “debates” that get raised in relation to LDL-C (or apoB-containing lipoproteins) and heart disease. Links: Subscribe to PREMIUM See more episodes on heart disease and lipids Receive the free Sigma email newsletter

Links: Resources and info for this episode Subscribe to PREMIUM Receive Danny's weekly email newsletter About This Episode: Losing at least 5% of one’s initial body weight is associated with improvements in glycaemic control, blood pressure, triglyceride levels, and other positive outcomes. Due to these reasons, it is typically recommended that individuals classified as overweight or obese should engage in effective weight loss interventions. However, despite the potential for clinically significant weight loss through these interventions, weight regain is a common occurrence. This can be attributed to a combination of low adherence to weight control strategies and compensatory physiological mechanisms that influence weight regain. Consequently, this may result in a cycle of losing and regaining weight over the long term, which is commonly referred to as “weight cycling.” There are concerns regarding the potential harm to health and increased risk of chronic diseases associated with weight cycling. Some mechanisms have been proposed, such as the loss of lean mass during weight loss periods that is not regained when weight is regained. However, the evidence supporting the harmful effects of weight cycling on health is incomplete and many unanswered questions remain. In this episode, we will examine the evidence published to date and draw evidence-based conclusions regarding the impact of weight cycling on long-term health.

Links: Episode Resources Subscribe to PREMIUM Receive our weekly newsletter About This Episode: There has been interest in, and debate about, how protein intake impacts metabolic health, particularly in relation to insulin resistance and type 2 diabetes risk. Recently, there has been interest in higher protein intakes as an intervention in diabetes, owing to a variety of potential mechanisms. For example, the satiety value of protein, the promotion of insulin secretion by protein, and imapcts on incretin hormones. However, others have warned against high protein intakes. With some going as far as to claim high, or even moderate, protein intakes can lead to insulin resistance or negatively effect beta-cell function. In this episode, we look at the research typically cited in support of such claims, and dig into the details. We consider the overall evidence in this area to answer the question ‘do high protein diets cause insulin resistance or increase diabetes risk?’.

Links: Go to episode page Subscribe to PREMIUM Receive our free weekly emails About This Episode: The management of type 2 diabetes has long been a challenge, but a new study conducted by researcher Mark Lyngbaek and his colleagues has the potential to add important considerations to the approach to treatment. Titled the “DOSE-EX” randomized clinical trial, their study uncovers the impact of exercise and weight loss on beta-cell function, a key factor in diabetes progression. DOSE-EX is a four-armed randomized trial involving 82 individuals with newly diagnosed type 2 diabetes. The participants were divided into four groups: standard care, calorie restriction, calorie restriction with exercise three times per week, and calorie restriction with exercise six times per week. Over a span of 16 weeks, the researchers assessed the effects of these interventions on beta-cell function using various indicators. The study’s findings are incredibly interesting, demonstrating that exercise in combination with diet-induced weight loss leads to a substantial improvement in glucose-stimulated beta-cell function. Importantly, the results indicate the importance of considering both: a) the exercise dose, and b) the methodology of assessing beta-cell function, when evaluating intervention effectiveness. In this episode, Dr. Lyngbaek will elucidate the implications of these findings for the management of type 2 diabetes. We will explore the potential of exercise as a therapeutic tool, its optimal dosage, and the considerations for integrating it into individualized treatment plans. About The Guest: Dr. Mark Lyngbæk is a physician, currently in an introduction position at the Department of Rheumatology and Internal Medicine 2 at Holbæk Hospital, and also a PhD student at the Centre for Physical Activity Research at Rigshospitalet. His research has looked at exercise, beta-cell function and type 2 diabetes. He is supported by a research grant from the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation (grant number NNF17SA0031406). The Centre for Physical Activity Research is supported by TrygFonden (grants ID 101390, ID 20045, and ID 125132).   Subscribe to PREMIUM

Links: Subscribe to PREMIUM Episode page Receive Sigma emails About this Episode: We've just released a lengthy 'ask me anything' episode, where Dr. Alan Flanagan addressed specific listener questions, over on the Sigma Nutition Premium feed. In this episode, you'll hear one detailed answer from that AMA, in which Alan discusses the concept of "causal risk factors". This is a term that is regularly mentioned on the podcast, and has a very specific and important meaning. This episode will give you an in-depth understanding and comfort with the term, which will enhance your future understanding and learning. If you wish to hear the other 10 questions Alan answered, you can subscribe to Sigma Nutrition Premium here.

Links: Go to episode page (with resources) Receive Danny's weekly emails Twitter: @NutritionDanny Subscribe to PREMIUM About This Episode: In the UK, there is a threefold higher incidence of type 2 diabetes in UK African and Caribbean (AfC) communities, compared to the general population. And ethnic inequalities in type 2 diabetes treatment and outcomes have been documented. And so addressing these inequalities is an urgent healthcare priority in the UK. Differences in outcomes relate to physiological differences as well as pragmatic issues and structural barriers. Professor Louise Goff has done pioneering work in relation to both aspects. Prof. Goff’s research has highlighted ethnic differences in type 2 diabetes pathophysiology between those in UK African and Caribbean groups and white Europeans. This means that typical screening for diabetes may not be as useful for AfC communities, in addition to treatments not being as appropriate. In addition, there are noted differences in engagement with diabetes education services and self-management advice. This may be due to the fact that the delivery of information is not culturally relevant to those in AfC communities. And so diabetes structured education programs have been found to be less successful in people from minority ethnic groups. Prof. Goff has attempted to address this by developing a culturally tailored self-management education and support program for type 2 diabetes in black-British adults. This program, called the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) program, has initially been trialed with local Black African and Caribbean communities and healthcare providers in South London. In this episode, Prof. Goff discusses the ethnic differences in diabetes pathophysiology and the other factors underlying the inequalities in diabetes outcomes in black African and Caribbean communities. Go to episode page (with resources)

Links: Episode page (with links to resources) Receive Danny's weekly emails Subscribe to PREMIUM About This Episode: The topic of whether hunger and satiety are affected by the time of day has generated considerable interest within the nutrition research community. Researchers have been particularly intrigued by the potential influence of circadian rhythms on caloric intake throughout the day. Initially, a number of studies proposed that consuming high energy intakes in the morning could lead to significantly greater weight loss compared to evening consumption. And while much attention was placed on the hypothesis that differences in expenditure were the cause, more recent research has called that into doubt. And so, it is crucial to consider the possibility that other factors may be contributing to the outcomes observed in the intervention trials. In recent years, a series of papers has suggested an alternative explanation; the impact of time-of-day energy intake on appetite and hunger. In this episode, Alan and Danny take a look at the current evidence related to this connection between time-of-day, appetite, and energy intake. And then, from that, what does this mean for how calorie distribution may affect dietary intake, body composition and health.

Links: Join notification list for book pre-orders Go to episode page (w/ resources) Subscribe to Sigma Nutrition Premium About This Episode: “Weight cutting” is a common practice in weight-class based sports. And typically, combat sport athletes have reported cutting the largest amounts of weight for competition. The concept of cutting weight is based on the assumption that a size advantage gives a performance advantage in combat sports. And by getting into a lower weight class than their “normal” weight, athletes can enjoy an advantage (or, more accurately, not be at a disadvantage). The decrease in weight from an athlete’s habitual weight to their weight-class limit typically has two phases: a chronic weight loss phase (gradual dieting to lose fat mass), and an acute weight loss phase (rapid declines in weight due to losses of water, glycogen and gut residue). To discuss the science, practical application and dangers of weight cutting strategies, performance dietitian Jordan Sullivan is on the podcast. Jordan has been the performance dietitian for several years to Israel Adesanya, Alexander Volkanovski, Leon Edwards, Dan Hooker, Kai Kara-France, and many other well-known names. And he is the co-author, along with Danny, of the new textbook ‘Making Weight: The Ultimate Science Based Guide to Cutting Weight for Combat Sports’.