Live Long and Well Discusses Dairy Fat and Coronary Calcium Scans with the Skeptical Cardiologist
In which I pontificate on precision individual heart disease risk assessment and the benefits of full-fat yogurt
I’ve become a fan of the podcast of Dr. Bobby Dubois which aims to help us “Live Long and Well.” Every week he presents (using a remarkably mellifluous and calming voice) a simple but evidence-based discussion of health-related topics. He’s not pushing supplements and he’s not serving click-bait.
Recently, he had me as a guest to discuss a couple of my favorite topics.
Here’s his introduction:
I used to believe full-fat dairy was a ticket to heart disease. Turns out… not so fast.
In my latest episode of Live Long and Well, I sat down with Dr. Anthony Pearson, a cardiologist known for his evidence-first, myth-busting approach. We dug into what really raises your risk for heart disease—and what might not be as dangerous as we've been told.
Dr. Pearson's story began with a croissant, some butter, and a disagreement with his wife. That moment launched his journey into nutritional science—and flipped his stance on dairy. He shared new data suggesting that fermented, full-fat dairy may actually lower cardiometabolic risk. (Yes, that means cheese and whole milk might not be the villains.). Read more here.
We also explored the risks of extreme keto diets, especially for those who see their LDL cholesterol shoot up. And we unpacked the role of the calcium heart scan—a $100, non-invasive test that can detect dangerous plaque in the arteries long before symptoms strike.
If you're confused about what matters most when it comes to preventing heart disease, this episode is for you. Dr. Pearson's perspective is grounded, scientific, and incredibly practical.
👉 Listen here: Episode 37 – We Can Reduce Our Risk of Heart Disease
Follow Dr. Pearson and his wonderful blog, The Skeptical Cardiologist.
Stay curious. Stay proactive. And yes, enjoy your butter—just be smart about it.
To living long and well,
Dr. Bobby
Take a listen. And let me know what you think in the comments along with any questions you might have about coronary calcium scans and saturated fat consumption.
Gravelly Yours,
-ACP
Thank you for sharing. A couple of comments from a fellow skeptic.
1. The vast majority of diet studies are observational and hugely subject to confounding. Even the RCTs are essentially impossible to blind - either the authors or the subjects. So IMO the entire body of research on diet and disease is questionable at best. To the extent that any of it might be valid, the Mediterranean Diet seems to have the most support. And this diet is pretty far from full-fat, or heavy on dairy, or "slathering in butter."
2. Athletic performance for most people benefits from reduced fat and higher carb intake. There are a lot of RCTs in this arena. So if you want to do something that actually has strong evidence of benefit - exercise - maybe keep the fat low. There are apparently some athletic outliers who thrive on high-fat diets. This is not me or most exercisers. Eating a bagel or a banana and going for a run, sure. An omelet or a plate of bacon or sausage, not so much.
3. CAC scores. Your friend and colleague, and brilliant analyst of research and clinical practice, John Mandrola, is not a fan, especially for asymptomatic people. He has addressed this topic several times over the years, and his argument is pretty solid.
https://www.sensible-med.com/p/coronary-artery-calcium-trial-fails
https://www.aafp.org/pubs/afp/issues/2019/1215/p734.html
We should all exercise, control weight and BP, minimize lipids, not smoke, and treat disease, regardless of our metabolic and health parameters. But personalized medicine with full-body scans and batteries of tests, continue to show no benefit in any study I have seen. Including CAC scores.
What am I getting wrong?
Many have an easier time giving up meat but eggs and dairy are tough. So it stands to reason that we'd hope for the saturated fats from dairy to somehow be immune to the same biochemical processes. Yet dairy consumption tends to cluster with other lifestyle habits that vary widely between individuals, making it hard to isolate the true cardiovascular impact of dairy through observational studies alone.