Carrie: Welcome to the Smarter Science of Slim. This is Carrie Brown and Jonathan Bailor.
Jonathan: And I was scolded last podcast for talking too much so I am not going to talk abor talking too much so I am not going to talk s much during this podcast, Carrie.
Carrie: Ha ha, oh dear, well, if they want any science at all you are going to have to say something because they won’t be getting any science out of me.
Jonathan: Well, today we are going to talk about cholesterol and how eating fat will not hurt cholesterol. Last week we talked about how eating fat will not make us fat. The week before that we talked about how eating fat doesn’t make us any less healthy. Carrie, you have a personal story about cholesterol and eating fat, what happened there?
Carrie: I do, but before we do that, I wanted to completely railroad this episode for about 30 seconds because you know a few episodes back I was all exited because I bought a 12.5 pound weight which turned out to be too weenie for me and I had to go back and get a 20 pound weight and so I wanted to share my little exercise update. And let people know that it is interesting what happens because I’ve been doing these arm exercises with my 20 pounds weight…
Jonathan: Your eccentric exercises…
Carrie: My eccentric exercises with this 20 pound weight… What I’m noticing is that it is not necessarily my arms that are changing. It’s my middle that is changing which is kind of… it’s really cool, but I just wanted to point that out because I want people to understand that they will get the results that they want but they might not get them in the order in which they think they will. So they may find their body changing in ways that aren’t quite what they expected first.
Jonathan: And Carrie you are not just doing arm exercises, right? You are doing eccentric exercise for your legs, for your back, for your chest and for your arms.
Carrie: Right. But remember, because I didn’t by my weight until… so I have just kind of added the arm thing but I have noticed now a decrease in what’s happening around my middle since I added the arm exercises and the one thing that I remember you saying to me once, when I just didn’t understand any of this, you send to me… I said: “How can you exercise your legs and make your arms stronger?”, because there was that study that did that, and you said to me that it was like when a diabetic injects insulin, they only inject it in their leg but the effects of that is felt throughout the body and this is a similar kind of thing. So I think that what is going on here is that adding the extra exercise of my shoulders and my arms is actually causing changing other parts of my body as well.
Jonathan: Causing a bit of a hormonal change that is causing more of a global change. And yeah folks, I cannot wait until we get into talking about how we exercise smarter – that is coming up in a few podcasts but what Carrie is describing is such a profound… the way exercise can be helpful is not in terms of burning calories but in terms of changing our hormonal balance and it’s awesome that you are experiencing that, Carrie, because this very small dose of a very potent form of exercise is having these macro, whole-body changes which is awesome.
Carrie: Right, and I, because I’m catching the impatient disease from you, Jonathan, I couldn’t wait until we got to the exercise bit to give my little exercise update, so there we go.
Jonathan: That’s fair and for folks that don’t want to wait, obviously you can go to the website and there is a bunch of free information on eccentric exercise, you can also of course read the book, and the gist of it is: It’s not about exercising for longer periods of time or even exercising more frequently, it’s about using more resistance while you exercise. Things like weight training, things like interval training. A bunch of free resources up on the website. But, what we eat, especially if we carry excess weight – take this to the bank – it’s ninety percent of it. Please do not see exercise as the panic exit. It’s not. Exercise cannot undo what an inSANE diet does. We *have* to take care of the eating first and fortunately we can do this very easily because we can enjoy things like fat, we can enjoy all sorts of food. We just want to steer away from starches and sweets, we can eat as much as we want as long as we don’t eat those things and we can do that while losing weight, while benefitting our heart and while not hurting, and in fact helping, our cholesterol. And that’s what I want to focus on this week because that is one of the primary objections you will hear when you start reintroducing whole foods that contain fat into your diet. People are going to say: “Well, isn’t that going to hurt your cholesterol?” and especially seafood – I talk about seafood really being in a class of its own – non-starchy vegetables, organ meat and seafood are the SANEst substances in the world. And organ meats and seafood have a lot of cholesterol in them. So if you are like “if I eat cholesterol, I’m going to screw my cholesterol” you are not going to want to go SANE, but we are going to take care of that in this episode.
Carrie: So here is my cholesterol story.
Jonathan: Tell us your cholesterol story.
Carrie: Bear in mind that this was before I met Jonathan, but it is still relevant. And here is why: I read Taubes and I started eating a lot of protein and less starches, so that was all good. But my protein intake went up massively and I’ve got to tell you, a lot of that protein was bacon and sausages and cheese, I was eating a lot of cheese, so there was a lot of fat being consumed and, maybe more importantly because cholesterol always seems to be linked to animal fat, 95 percent of the fat I was eating was animal fat. In the four months after I started eating like this my cholesterol went down 100 points.
Jonathan: In how many months?
Carrie: Four months.
Jonathan: Wow! We’ll talk about it’s not about lowering our cholesterol necessarily, but that is a powerful anecdote.
Carrie: I wasn’t trying to do that. I have an annual check with my numbers. I started to do this about four months before and when I went to get my numbers my cholesterol, which historically had been like “oh, we are going to put you on statin” and I was like “no, you’re not”, and it was like 280, somewhere around there, it was super high and then I changed my diet and was eating a lot of animal fat and a lot of protein… minus 100 points right there.
Jonathan: Amazing. How many medications would you have had to be on to potentially do that pharmaceutically where as you could just do it through food and enjoy yourself – and have no negative side effects. When you go on one drug, you have to go on another drug because the side effect of that…
Carrie: Have you ever read the contraindications that come with a box of statins? Frankly I’d rather be killed by everything else than the things you get from taking these pills.
Jonathan: It’s not only physical things but they are not showing mental… like dementia and Alzheimer’s and even just short term mental problems. Statins may play a role if we have exhausted all diet and exercise options but to go on statins before going SANE and performing higher quality exercise is not something I personally would recommend.
Carrie: And let’s face it: You don’t want to deal with a Carrie that’s even madder than the one you have to deal with now!
Jonathan: Absolutely. Definitely cholesterol is a hot topic so I really want to give you the science, hopefully in an accessible way, in this episode. And let’s start with some established institutions because we hear “lower your cholesterol… blah, blah, blah…” from these established institutions but we don’t actually hear the other side from plenty of other very established institutions, for example let’s look at this quote from the American Diabetes Association: “Although low-fat, high-carbohydrate diets are recommended in an effort to reduce the risk of coronary artery disease the results of short term studies have shown that these diets can lead to an increased risk of coronary artery disease” and let’s do one other quick quote here. Remember a few episodes back and we talked about how a gentleman by the name of Ansel Keys really started this whole fear of fat and then tying fat to cholesterol. While Keys was doing his research the Federal Register, which is the official log of the federal government, was on record the true scientific data at that time which was, I’m quoting directly here: “The role of cholesterol in heart disease has *not* been established. A causal relationship between blood cholesterol levels and these diseases has not been proven. The advisability of making extensive changes in the nature of dietary fat intake of the people of this country has not been demonstrated.” Oops!
Jonathan: I mean, that’s pretty cut and dry and the data is just not there, Carrie. We are going to talk about it in detail but there never was and still is not… there is just no proof that high *total* cholesterol causes cardiovascular issues. What we will see is the *ratio* of our various forms of cholesterol to one another may have some bearing but *total* cholesterol is completely irrelevant. Saying that total cholesterol is indicative of heart disease propensity is a bit like saying eye colour is related to intelligence…
Carrie: It’s not?!
Jonathan: Ha ha.
Carrie: It this not why I am so smart? Because I have green eyes?
Jonathan: Ha ha, it’s not. In fact Dr Gordon in the American Journal of Medicine tells us that total cholesterol per se is not a risk factor for coronary heart disease at all and in fact Dr Ravnskov, who we talked about in the last episode, analysed 26 randomised and controlled trials which were designed to lower total cholesterol and therefore theoretically the risk of cardiovascular disease. So he looked at these studies in which there was a treatment group, so in the treatment group people ate less food that contained fat and/or took cholesterol-lowering drugs like statins and the control group, the group that didn’t really do anything, they didn’t take cholesterol-lowering drugs, they didn’t eat any less food that contained fat. Now across the 26 independent studies that had this setup the individuals who took cholesterol-lowering medication or ate less food containing fat had a *higher* incidence of just total death rate and the incidence of fatal heart attacks was equal across the groups. So *more* people in the group of people that tried to lower their cholesterol ended up dying and there was no difference in heart attack rates. And the researchers concluded: “Lowering serum cholesterol concentration does not reduce mortality and is unlikely to prevent coronary heart disease.”
Carrie: So why put yourself through the misery of eating low-fat food if you are going to have the same propensity to die?
Jonathan: And it’s really unfortunate, Carrie, because similar to what we talked about calories there was just this fundamental biology which has been lost. Remember, humans stayed slim and avoided diabetes long before we even knew what a calorie was, let alone counted them. That is because our body automatically regulates functions such as energy balance. The body also regulates cholesterol levels, meaning that if we never ate cholesterol our body would just up-regulate the production of cholesterol and if we eat a lot of cholesterol our body makes less cholesterol. Again, our body is always trying to stay in homeostasis, so this idea that if we eat more cholesterol bad things is going to happen, no, our body is just going to help compensate for that.
Carrie: Because our bodies are awesome.
Jonathan: They are awesome. They are designed to keep us healthy and we seem to have potentially lost sight of that because there is a much bigger market in thinking that we are broken and that we need to take a bunch of medicine to fix us, whereas in reality if we just avoid things that break us in the first place we can stay healthy pretty easily.
Carrie: And our bodies are pretty incredible when it comes to recovering from the damage we have inadvertently done by listening to all of this bad marketing, bad science, whatever you want to call it.
Jonathan: So Carrie, let’s step through this piece by piece by piece, because listener listening may be having conversations with their physicians after learning this information, maybe you can hand your physician a copy of the book, a copy of some of Gary Taubes’ work because the research is there, it is just that not all of us have heard it, including primary care physicians in many cases. So for foods that contain fat and cholesterol to be killers, three points have to be proven. This is very simple logic. Point number one: Eating natural foods that contains fat leads to risky levels of cholesterol. OK. Second point is that these levels of cholesterol cause cardiovascular disease and then the third point is that the diet outlined by the government’s guidelines AKA low-fat, low-protein, high-carbohydrate diet improves these cholesterol levels. It is a fact that none of these things have ever been proven. It has never been proven that eating natural foods that contains fat leads to risky levels of cholesterol. It may lead to higher total cholesterol but we will get to why that is not necessarily risky in a second. It has never been proven that these levels of cholesterol cause cardiovascular disease, a significant proportion of people who suffer from cardiovascular disease have very low levels of cholesterol. And finally it has definitely not been proven, in fact the opposite has been proven, in the sense of that the government’s high-starch, low-fat, low-protein diet improves cholesterol levels – absolutely not proven.
Carrie: That is amazing. Why don’t we know this? Don’t get me started.
Jonathan: We will talk about the big business of bad health; actually we are going to talk about it in the next couple of podcasts. But let’s get back to a little bit of direct quotes from the researchers here. Dr German from the University of California very eloquently and succinctly summarises the state of cholesterol research with the quote: “The approach of many main stream investigators has been narrowly focused to produce and evaluate evidence and support of the hypothesis that dietary satiated fat elevates LDL cholesterol and thus the risk of coronary artery disease. The evidence is *not* strong and overall dietary intervention by lowering satiated fat intake does *not* lower the incidence of non-fatal artery disease nor does such dietary intervention lower coronary disease or total mortality.” Again we get into this scenario like we did a couple of podcasts back where researchers are trying to prove this right because they get their funding from the government that told us it was right in the first place – and even when they’re trying to prove it right they still can’t. They still can’t prove that this is true because it is not!
Carrie: Oh oh – he’s going to start banging on the table in a minute. I can tell… he’s getting all excited.
Jonathan: Ha ha, in fact Carrie, I am getting excited because SANE foods that contain fat have never been proven to lead to risky levels of cholesterol. In fact studies have shown the opposite. They have shown that the high-starch, low-fat, low-protein diet promoted by the government’s guidelines has been proven to worsen the type of cholesterol that has been shown to decrease the risk of heart disease, HDL cholesterol. And let’s pop up, just real quick here because this is where the confusion comes up, we shouldn’t just be talking about cholesterol. We need to talk about the different types of cholesterol. There is quite a few, let’s just simplify it here and say that there are two major ones: There is LDL, which is low density lipoprotein and HDL, which is high density lipoprotein. Traditionally HDL is thought of as the ‘good’ cholesterol and that is backed by science, LDL is thought of as the ‘bad’ cholesterol and that is not necessarily supported by science. There is a difference in particle size of LDL but that’s a complexity that we will not get into in this podcast. We have to have cholesterol because if we don’t we cannot produce new cells, we cannot produce hormones. Even if we never ate any of it our liver or our intestines would produce it. So we don’t just want to talk about cholesterol, we want to talk about the ratio of LDL/HDL and then when it comes to predicting heart health the American Heart Association, the International Diabetes Federation and the World Health Organization – so this isn’t some fringe group, this is about as big as they get – they all agree that low HDL cholesterol, not high LDL cholesterol, is what matters.
Carrie: And the science backs it up?
Jonathan: And the science backs it up completely. So if low HDL cholesterol is the major problem, then why are we talking about lowering cholesterol levels? Lowering HDL cholesterol is terrible for your health.
Carrie: Because if we didn’t we couldn’t prescribe everybody statins and make a bunch of money, Jonathan, get with the program.
Jonathan: That’s absolutely fair and the point here is that, again it’s still a pretty crude measurement, but when we want to talk about relative risk of heart disease in terms of cholesterol we have to look at the ratio of HDL/LDL and I have a chart here which kinds of look like a battleship grid where you have got HDL going up the vertical axis and the level of HDL running across the horizontal axis and the point is that if you have a high level of HDL, it really doesn’t matter what your level of LDL is, because that HDL is going to take care of you. That is really what matters. If you can get your HDL high enough your level of LDL doesn’t really matter so if that is the case… So, one: total cholesterol is irrelevant. If someone says their cholesterol is 185 their risk of heart disease could either be huge if they have incredibly low for example if they had HDL level of 25 and then LDL level of 160, they would have a very high risk of heart disease because of that ratio, the low HDL, but if they had for example a HDL of 85 mg/dL and their LDL was a 100 then they have an incredible low risk of heart disease. So even if you are like: “Oh my total cholesterol is 185” it doesn’t tell you anything. Similarly if your total cholesterol is 245, again you could either be on the right track or the completely wrong track depending on that ratio.
Carrie: That is awesome.
Jonathan: We’re about increased HDL cholesterol rather than decreasing LDL cholesterol. High HDL cholesterol protects us from heart problems more than dropping our LDL levels ever could. So, heart healthy – and folks, burn this into your brain because you will see things like heart healthy on starch and sweets in the store “it’s heart healthy, it lowers cholesterol” – heart healthy is not about lowering total cholesterol. It’s about raising HDL cholesterol and those inSANE starches, they do lower total cholesterol because starch lowers both HDL and LDL, saturated fats, the thing we have heard so much about, that is going to raise your total cholesterol because it raises both HDL and LDL whereas unsaturated fats, the fats we find in plants and seafood and lean meats, they raise our HDL by lowering our LDL so those are like the best for us. Saturated fats are neutral and things like starches, the very things we have been told are heart healthy, are not because they drop the HDL which is the most important thing – we actually want to raise that.
Carrie: Well, and I just want to say that if some of you are out there and going “wow, I’ll never remember that – that was too much information. I’ve got my LDLs and my HDLs…” – here is the thing: Eat SANE and you don’t have to worry about it because it will all take care of itself. That’s what I do. Anymore I don’t think about cholesterol or HDL or LDL, you know when I go and have my check up I get my numbers, but that is once a year. Between that I don’t even think about it anymore. I eat SANE. It’s all good.
Jonathan: It’s all good and there is a wealth of evidence to support this and again, if you want to be heart healthy you want to raise your HDL levels and the way you do that is by eating more whole foods that contain fat and less starches and sweets. And again there is a wealth of evidence to support this. For example Dr Menzek from Maastricht University he tell us that “[..] there is a wealth of evidence that increasing the concentration of HDL cholesterol through diet will lower the risk of coronary artery disease” and Dr Després from Laval University tells us that “[..] low HDL cholesterol increase coronary artery disease risk. Programs resulting in an increase in HDL levels could decrease the incidence of heart disease.” So any diet that causes us to lower our HDL, regardless of what it does to our LDL, is doing more harm than good and if we replace SANE sources of fat with inSANE sources of starch we will drop our HDL cholesterol. Yes, we will also drop our LDL cholesterol but who cares, the cart has already left the stable, our cholesterol is worse off and that is why Dr Mozzafarian at Harvard University wrote: “Focussing on the effects of total and saturated fat on total and low density lipoprotein [LDL cholesterol] may have failed to reduce coronary heart disease risk and inadvertently worsened insulin resistance and weight gain.” and Dr Garr in the Journal of the American Medical Association (JAMA) follows up with: “High carbohydrate diets caused persistent deterioration of glycemic control and the accentuation of hyperinsulinemia [which is basically just the things we talked about earlier about the pre-diabetes and poor insulin regulation] as well as increased very low lipodensity protein [which is the bad form of cholesterol]” but again this is what we have been told to do because when we eat starches and sweets we lower our total cholesterol but why would we ever want to do that? And this isn’t even new data. Lowering HDL cholesterol has been known for decades to destroy our health.
Carrie: So the take away is: Eat more bacon…
Jonathan: That is NOT the take away! I would say the take away is that if you want to enjoy bacon as part of a SANE, balanced breakfast – this is the official Smarter Science of Slim – that would be fine but we don’t want to swing the pendulum in the other direction. But of course, yes, you can enjoy bacon.
Carrie: That was my point.
Jonathan: Yes, you can enjoy it. But just to drive home, folks, this is an area that I feel passionate about because high cholesterol runs in my family so I have had extensive conversations with my parents as I am interested in their health and they have been taught the conventional wisdom which is just patently wrong. So, again this isn’t new information, in the February 1989 issue of the Diabetes Care Journal put out by the American Diabetes Association, again not some fringe, extremist group, they did a study comparing the government’s diet, high-starch, low-fat, low-protein, with a more SANE way of eating. The study concluded: “The LDL [bad cholesterol] was significantly increased. High density lipoprotein [HDL – good cholesterol] was significantly decreased after consumption of the 60 percent carbohydrate diet.” Then comparable results, and Carrie this will hit home for you, were found with the equally imbalanced UK dietary guidelines and in the words of the University of Glasgow researcher Arafhosseini responded with: “Following the UK guidelines resulted in changes more likely to favour an increased risk of coronary heart disease.” So it’s not new information.
Carrie: And you know, that just reminded me when you said University of Glasgow, I think I’m right that the rate of heart disease and all that bad stuff in Scotland is really, really high and you know what it is? It’s all that porridge. It’s all that oatmeal. That is not heart healthy at all as it turns out. If they ate more haggis and less oatmeal they would all be a lot healthier.
Jonathan: Folks this is just why it is so clear. You just go and repeat what Carrie said to someone and here is what they will say to you: “But oatmeal has been shown… it says on the box that it lowers total cholesterol” and it does, but remember that doesn’t matter because lowering HDL which is worse, that does more harm than lowering LDL does good. And even saturated fats, which Carrie is so fond about, even saturated fat about which so much has been said – every other week there is a study about saturated fats – here is what the American Heart Association and this is crazy, because these are the same people that accept hundreds of thousands of dollars from food manufacturers to put ‘heart healthy’ labels on their high-starch, low-fat products. These same people have said – I’m quoting directly from the American Heart Association…
Carrie: He is waving his arms again.
Jonathan: Here it is, here it is, the American Heart Association: “No adequately designed randomised controlled study in the general population has shown that increasing saturated fat intake significantly decreases coronary heart disease mortality.” Translating: There is *no* data *at all* that supports that if you eat the foods that they get money to tell you to eat is heart healthy. There is no data to support that.
Carrie: I’m going to come in with a black eye tomorrow because Jonathan inadvertently whacked me in the face while was waving his arms around getting p’ed off about fat.
Jonathan: False, false, false.
Carrie: I have to say, my boss actually said to me the other day about breakfast. He normally eats breakfast in the office and he likes porridge because he is also British. Oatmeal. So I said to him “you don’t want to eat that”. And he said “I don’t” and I said “No”. “Well, what do I want to eat?” and I said “You want to eat bacon and eggs” and he looked at me like I had lost my mind but he did eat bacon and eggs.
Carrie: Let me just add one thing here, Carrie, so a couple of things I would recommend as part of that breakfast: Some non-starchy vegetables, so not just bacon and eggs. And then for individuals who may be tempted to overdo it with bacon, because I know there are some individuals who could just eat bacon like potato chips and they just can’t stop, ham is also a wonderful breakfast meat and gives you a lot of the same kind of flavour. So another is pork product, another good option, all are good. The point here is that fat does not… there is no data that shows that fat harms your cholesterol. In fact what the data does show is exactly the opposite. That certain fats, unsaturated fats such as specifically omega-3 fatty acids, we’ll talk about some good sources for those in a second, those fats not only do they raise your HDL which we talked about is wonderful they also lower your LDL. It is a fact that if you want to improve your ratio of LDL/HDL cholesterol the best way to do that is to increase your consumption of poly-unsaturated omega-3 fatty acids. And those are most easily found in seafood, things like flax seeds or chia seeds and you know what – those are fats. So the studies show us, don’t take my word for it, take Harvard University which says “Limiting unsaturated fats [what I just talked about] which is usually done by increasing carbohydrates is detrimental. Low-fat, high-carbohydrate diets provide a higher glycemic load, aggravate hyperinsulinemia [that is insulin regulation] and may thus increase the risk of diabetes and coronary artery disease.” Sadly we have been told to do exactly the opposite of what science has shown. We have been told to take whole food natural sources of fat to replace them with starches and sweets. This pretty much wraps up the government’s involvement in this whole role and the short version is that, basically the government told us the exact opposite of what we should be doing and that’s really, really unfortunate but kind of makes sense if you look at what has happened to our country from when the exact moment the government got involved in health our health has gotten worse. So it’s gotten precipitously worse the more involved they have got. It was fine before they got involved but then, sadly, big business jumped on the band wagon because producing starch- and sweetener-rich products that is just a whole industry, it’s a trillion dollar plus industry and once we get into that we are going to see the full picture of what we are up against and then we will also have a full picture of how we solve it. Fortunately the solution is quite simple: Just eat food.
Carrie: Well, you and I are going to have to sit at opposite ends of the studio because we are both going to end up with black eyes with all the arm waving that is going to go on during that podcast!
Jonathan: I love it. So coming up next, folks, big business’ role in this inSANE scenario we find ourselves in today and Carrie, do you have any closing remarks about our cholesterol conversation?
Carrie: Other than I really want to say “eat more bacon” but I’m scared you will slap me, so… ha ha… I’m just going to say: Keep it simple, people. Understand the science that Jonathan told you, but don’t try to think about that. If you eat SANE the cholesterol will take care of itself.
Jonathan: Yeah, exactly, and the reason I stress the science is again because we have had this beaten into our heads. It’s time to stop taking people’s words for things, because that is what we did with the government, we just “OK” “Eat more starches and sweets!” “OK – based on what though?” “We have no data or actually we have data but is shows the opposite, but just take our words for it because we are experts”. So that’s why I want to provide the science but yes, enjoy bacon but also ensure that you are enjoying some non-starchy vegetables with that. Make sure you are getting your protein. And next week it’s all about big business causing big people.
– How smarter exerciser triggers a hormonal response that leads to whole-body fat loss
– How going SANE is at least 90% of long term health and fitness
– Why you do not have to fear SANE foods that contain cholesterol such as nutrient dense meats, seafood, eggs, etc.
– How Carrie dropped her cholesterol 100 points while eating more food containing cholesterol
– The myriad side-effects of statins
– How there is no and never was any proof that high total cholesterol leads to disease
– How healthy cholesterol is about high HDL cholesterol, not low total cholesterol
– How 26 studies showing that interventions designed to lower total cholesterol lead to a higher total death rate than doing nothing
– How the body automatically regulates our cholesterol levels
– How to talk with your physician about your cholesterol
– How eating natural foods containing fat does not lead to risky levels of cholesterol
– How high levels of cholesterol do not cause cardiovascular disease
– How the diet outlined by government’s guidelines worsens cholesterol
– How eating a high-starch diet is one of the worst diets to eat in terms of cholesterol health
– How the difference between HDL and LDL cholesterol matters immensely
– How cholesterol is required or we die
– How lowering our HDL is one of the worst things we could do for our health
– How “heart healthy” starch *does* lower total cholesterol, but that’s at best irrelevant, and at worst horrible for your health
(Total Cholesterol in Parenthesis)
– How inSANE starch lowers good cholesterol
– How all natural fats raise good cholesterol
– How any diet that causes us to lower our HDL is doing more harm than good…and how that’s what the government’s low-fat-high-starch-low-protein diet does