Discover and read the best of Twitter Threads about #LMHR
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📍Big milestone!📍
The Nov/Dec @LipidJournal just dropped!
🚨Featuring the #LMHReditorial 🚨
via @nicknorwitz et al
It focuses on #LMHRs, both in consideration of their high #LDL and an urgent call for expanded #research.
Why is this important?... /1
doi.org/10.1016/j.jacl…
The Nov/Dec @LipidJournal just dropped!
🚨Featuring the #LMHReditorial 🚨
via @nicknorwitz et al
It focuses on #LMHRs, both in consideration of their high #LDL and an urgent call for expanded #research.
Why is this important?... /1
doi.org/10.1016/j.jacl…
2/ Certainly the biggest impact is bringing this phenotype well into the spotlight.
If you've been following my work from the beginning, you can appreciate just how much energy I've put toward putting this phenotype in front of Lipidologists.
If you've been following my work from the beginning, you can appreciate just how much energy I've put toward putting this phenotype in front of Lipidologists.
3/ But this is understandably a challenge given how much progress on this research has been accomplished outside typical channels ("Citizen Science").
-- Until now.
-- Until now.
🧵1/8 Here's an easy thread for reference on our current papers. 👇👇👇
🔖 Bookmark this!
We cover:
- High #LDL on #lowcarb/#keto
- Lean Mass Hyper-responders (#LMHR)
- The Lipid Energy Model (#LEM)
- And, ofc, our #LMHRstudy underway right now
🔖 Bookmark this!
We cover:
- High #LDL on #lowcarb/#keto
- Lean Mass Hyper-responders (#LMHR)
- The Lipid Energy Model (#LEM)
- And, ofc, our #LMHRstudy underway right now
2/8 The #LMHRpaper was our first describing the #LMHR phenotype
- #LDL #Cholesterol of 200 or higher
- #HDL #Cholesterol of 80 mg or higher
and
- #Triglycerides of 70 mg or lower
Which is actually common for lean, very folks on #lowcarb/#keto folks. doi.org/10.1093/cdn/nz…
- #LDL #Cholesterol of 200 or higher
- #HDL #Cholesterol of 80 mg or higher
and
- #Triglycerides of 70 mg or lower
Which is actually common for lean, very folks on #lowcarb/#keto folks. doi.org/10.1093/cdn/nz…
3/8 Our second paper brings a case report on a single #LMHR with extremely high #LDLc (~500 mg/dL) for 2.5 years, their eating patterns, and current CT angiography.
(⚠️Please note this is a single case report and should be considered anecdotal, ofc) doi.org/10.3389/fendo.…
(⚠️Please note this is a single case report and should be considered anecdotal, ofc) doi.org/10.3389/fendo.…
1/4) I want to unpack this quote from our #LMHR editorial
Operative word="CONSIDER"
LMHR are understudied, w/ nothing proven about 🫀 risk in this population
Thus all patients should consider available data IN THE CONTEXT of their n=1 medical situation
Operative word="CONSIDER"
LMHR are understudied, w/ nothing proven about 🫀 risk in this population
Thus all patients should consider available data IN THE CONTEXT of their n=1 medical situation
2/4) We are NOT making a blanket medical recommendation; we are doing the opposite!
We advocate that all parties - patient, doctors, and scientists - maintain an open mind on what is clearly on open, controversial, and critical issue
We advocate that all parties - patient, doctors, and scientists - maintain an open mind on what is clearly on open, controversial, and critical issue
3/4) This is not only the right thing to do, but it is the quickest way to progress
Open mindedness is a matter of reciprocity
Being dogmatic in either direction while data are outstanding, stalls progress
Open mindedness is a matter of reciprocity
Being dogmatic in either direction while data are outstanding, stalls progress
🚨New #LMHR Editorial in JCL!🚨
🙏Please RT🙏
- Cautious consideration for #LMHRs
- Calls for patient-centered approach
- Calls for more research on #LMHRs(!)
AND we raised money from the LMHR community to make this *open access*.
Let's unpack... /1 authors.elsevier.com/a/1g22A6tb2E2O…
🙏Please RT🙏
- Cautious consideration for #LMHRs
- Calls for patient-centered approach
- Calls for more research on #LMHRs(!)
AND we raised money from the LMHR community to make this *open access*.
Let's unpack... /1 authors.elsevier.com/a/1g22A6tb2E2O…
2/ So why is this a big deal?
Two reasons:
For one, this editorial is the first of its kind to gather MDs and PhDs together to help develop a clinical position on the #LMHR phenotype and importance of expanding research around this phenomenon.
That's hard to understate!
Two reasons:
For one, this editorial is the first of its kind to gather MDs and PhDs together to help develop a clinical position on the #LMHR phenotype and importance of expanding research around this phenomenon.
That's hard to understate!
3/ Typically, there have been just two positions on the topic of high LDL on keto, particularly LMHRs.
- Conventional: LMHR *must* lower LDL/ApoB
- LH skeptic: LMHR can ignore LDL/ApoB
This editorial concludes those with high LDL-c/ApoB from keto "should consider" lowering.
- Conventional: LMHR *must* lower LDL/ApoB
- LH skeptic: LMHR can ignore LDL/ApoB
This editorial concludes those with high LDL-c/ApoB from keto "should consider" lowering.
🚨 NEW! Lean Mass Hyper-Responder Editorial🚨
👉 10 MD & PhD authors from 4 countries🌍coming together for 1st of it's kind Consensus Statement on #LMHR
👉 Published in official Journal of the National Lipid Association @LipidJournal
A thread 🧵👇
authors.elsevier.com/a/1g22A6tb2E2O…
👉 10 MD & PhD authors from 4 countries🌍coming together for 1st of it's kind Consensus Statement on #LMHR
👉 Published in official Journal of the National Lipid Association @LipidJournal
A thread 🧵👇
authors.elsevier.com/a/1g22A6tb2E2O…
2/ A bit of background to catch some of you up
Over the past 6 years a population of people has emerged who demonstrate ⬆️ LDL on a #ketogenic diet in the context of ⬇️TG +⬆️HDL
Phenotype was first observed by @realDaveFeldman and (historically) named Lean Mass Hyper-Responders
Over the past 6 years a population of people has emerged who demonstrate ⬆️ LDL on a #ketogenic diet in the context of ⬇️TG +⬆️HDL
Phenotype was first observed by @realDaveFeldman and (historically) named Lean Mass Hyper-Responders
3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers
Cohort Study
pubmed.ncbi.nlm.nih.gov/35106434/
Case Report
pubmed.ncbi.nlm.nih.gov/35498420/
Cholesterol drop protocol
pubmed.ncbi.nlm.nih.gov/35938774/
Lipid Energy Model
pubmed.ncbi.nlm.nih.gov/35629964/
Cohort Study
pubmed.ncbi.nlm.nih.gov/35106434/
Case Report
pubmed.ncbi.nlm.nih.gov/35498420/
Cholesterol drop protocol
pubmed.ncbi.nlm.nih.gov/35938774/
Lipid Energy Model
pubmed.ncbi.nlm.nih.gov/35629964/
1/ This is true, but for those who are interested deserves some unpacking. Short thread… Here we go…
Yes, insulin resistance is a stronger risk marker than elevated LDL-C. This can be quantified as lipoprotein insulin resistance (LP-IR).
Yes, insulin resistance is a stronger risk marker than elevated LDL-C. This can be quantified as lipoprotein insulin resistance (LP-IR).
2/ in the largest prospective trial to date (WHS, median follow-up was 21.4 years. N=28 024 women aged >45 years). LP-IR had an adjusted hazards ratio of 6.4 for coronary disease, as compared to 4.3 for obesity 3.9 for smoking and only 1.3 for LDL-C.
jamanetwork.com/journals/jamac…
jamanetwork.com/journals/jamac…
3/ in other words, there was ~ 540% increase in coronary disease risk with insulin resistance but only ~30-40% for LDL-C. Furthermore, there was likely an interaction between terms as the association didn’t hold for large LDL but was driven by small LDL, which is associated w/ IR
1/ Medical Case
👉53y M, #LMHR w LDL 394, HDL 111, TG 40 for 4y on #keto diet
👉BMI 21.6
👉Prior to keto LDL was 98 mg/dl
👉CCTA shows no plaque, CAD-RADS = 0
👉Parents both lived to >80y w/o cardiac events Family hx of neurodegenerative diseases, including 2x of 👉Parkinson’s
👉53y M, #LMHR w LDL 394, HDL 111, TG 40 for 4y on #keto diet
👉BMI 21.6
👉Prior to keto LDL was 98 mg/dl
👉CCTA shows no plaque, CAD-RADS = 0
👉Parents both lived to >80y w/o cardiac events Family hx of neurodegenerative diseases, including 2x of 👉Parkinson’s
2/ Patient doesn’t want to abandon diet because it makes them “feel my best.”
You’ll notice, there’s no poll associated with this case. Medicine isn’t a democracy and not all medical opinions on Twitter are equally informed. However, I wanted to share this case ...
You’ll notice, there’s no poll associated with this case. Medicine isn’t a democracy and not all medical opinions on Twitter are equally informed. However, I wanted to share this case ...
3/ ...as a juxtaposition to the extremism I’m seeing ON BOTH SIDES: LDL/ApoB is benign v. lower is better (period). Neither is the case. A bit of nuance…
With respect to “LDL/ApoB is benign,” all things being equal, the data don’t support this view. It’s a risk factor...
With respect to “LDL/ApoB is benign,” all things being equal, the data don’t support this view. It’s a risk factor...
1/ Yes, the topic of a "hyper-response" with high #LDL #Cholesterol (LDLc) on #keto has been coming up a lot this summer, particularly for #LMHRs -- and that's a good thing. More discussion and research desired!
I'll try to unpack the key differences in 3 standing hypotheses...
I'll try to unpack the key differences in 3 standing hypotheses...
2/ Conventional: higher LDLc "hyper-response" (HR) mainly due to higher consumption of saturated fat (SF)
@DrNadolsky hypothesis: HR due to higher SF, but also genetics
Me: HR affected by many things, but generally more influenced by Lipid Energy Model (LEM) than SF or genetics
@DrNadolsky hypothesis: HR due to higher SF, but also genetics
Me: HR affected by many things, but generally more influenced by Lipid Energy Model (LEM) than SF or genetics
3/ Starting with a few key influences we all agree on...
These things likely have a significant detectable increase on LDL compared to reverse:
1) Swapping unsaturated fat with SF
2) Reducing fiber
3) Less resistance training
These things likely have a significant detectable increase on LDL compared to reverse:
1) Swapping unsaturated fat with SF
2) Reducing fiber
3) Less resistance training
If I went #vegan #keto for 3 weeks, do you think I’d still be #LMHR? @realDaveFeldman @siobhan_huggins @drscottyk @AlbertSyMD
1/ Okay, I'm putting a bow on this. And, short answer is... yes, the 37% have it. You can be on a 0 cholesterol #vegan #ketogenic diet and be #LMHR. Now for a debrief with some reflections. @realDaveFeldman @AlbertSyMD @siobhan_huggins @drscottyk ...
2/ First and foremost, what did my diet look like?
Vegan and w/o no coconut to maintain low sat fat % <15% total fat. These are data from a day of soy protein, 1/4c tahini, 1lb eggplant, 100g broccoli, 6 Tbsp EVOO, 4 Tbsp avo oil, 2 oz ea macadamia and pecans, 200g asparagus
Vegan and w/o no coconut to maintain low sat fat % <15% total fat. These are data from a day of soy protein, 1/4c tahini, 1lb eggplant, 100g broccoli, 6 Tbsp EVOO, 4 Tbsp avo oil, 2 oz ea macadamia and pecans, 200g asparagus
1/ 🚨New N=1 Experiment: #IsItSaturatedFat🚨
🙏retweet🙏
Yes, I'm doing a new N=1 -- and it's going to be a biggie!
My good friend and colleague, @DrNadolsky completed his recent #MakingLMHR experiment concluding the added 2 sticks of butter as the reason for his LDL increase.
🙏retweet🙏
Yes, I'm doing a new N=1 -- and it's going to be a biggie!
My good friend and colleague, @DrNadolsky completed his recent #MakingLMHR experiment concluding the added 2 sticks of butter as the reason for his LDL increase.
2/ He's already conceded he's left out all the context on aiming for #LMHR profile, the relevance of RER, and the #LEM (so no need for people to keep pinging me on the IG video). I've chatted with him privately and we'll leave it at that. 👍
3/ However -- this actually affords us a huge new opportunity.
@DrNadolsky's claim isn't just his own, it's just about everyone else's outside the low carb community.
Simply stated: high #LDL #cholesterol seen in #LMHRs is predominantly due to high consumption of saturated fat.
@DrNadolsky's claim isn't just his own, it's just about everyone else's outside the low carb community.
Simply stated: high #LDL #cholesterol seen in #LMHRs is predominantly due to high consumption of saturated fat.
1/ I want to give huge props to @DrNadolsky for doing this #MakingLMHR experiment!
Yes, I know some of my followers may be blocked -- so I'm including an image as well.
If you're interested in how this experiment came about -- read on... 🧵
Yes, I know some of my followers may be blocked -- so I'm including an image as well.
If you're interested in how this experiment came about -- read on... 🧵
2/ We've had an ongoing debate on how much (or little) #saturated fat consumption is responsible for high #LDL #cholesterol levels we typically see for #LMHRs.
Whereas I (we) believe #LEM to have greater relevance overall.
Which led to the experiment👇
Whereas I (we) believe #LEM to have greater relevance overall.
Which led to the experiment👇
3/ Could @DrNadolsky emulate the #LMHR phenotype while *not* being fat adapted? (or at least, to get his #LDL #cholesterol that high?)
He consumed two sticks of butter a day to test this! 🧈🧈
Yes, the experiment went more toward my prediction, so alas, I won't be flying there.
He consumed two sticks of butter a day to test this! 🧈🧈
Yes, the experiment went more toward my prediction, so alas, I won't be flying there.
🚨 #LeanMassHyperResponder lowers LDL 🚨
#LEM #LMHR
1/ First off, this thread is long with lots of nuance.
But here’s the bottom line:
👉 I dropped my #LDL by over 400 mg/dL
👉 Previously ~500
👉 Now it is under 100
(Yes, you read that correctly)
Here’s how I did it…
#LEM #LMHR
1/ First off, this thread is long with lots of nuance.
But here’s the bottom line:
👉 I dropped my #LDL by over 400 mg/dL
👉 Previously ~500
👉 Now it is under 100
(Yes, you read that correctly)
Here’s how I did it…
2/ The method was quite simple:
Add in some carbs.
This shouldn’t be a news flash for anyone following our work on the Lipid Energy Model
We published on this intervention with the #LMHRpaper case series here: doi.org/10.1093/cdn/nz…
Add in some carbs.
This shouldn’t be a news flash for anyone following our work on the Lipid Energy Model
We published on this intervention with the #LMHRpaper case series here: doi.org/10.1093/cdn/nz…
3/ I’m an example of an LMHR that eats a relatively low saturated fat diet at baseline. Even when >80% of my fat intake is MUFA/PUFA, my LDL can run >500. Thus, it’s not simply the sat fat. Even when fiber intake has been >30g with net carbs <30g, my LDL can easily run >350
1/5 This is BIG & I've really been looking forward to it. @DrNadolsky will be looking to see if he can reach a #LMHR phenotype while not being low carb or keto (or at a minimum, increase LDL-C to 200)
In short, can high consumption of saturated fat w/o being fat-adapted = #LMHR?
In short, can high consumption of saturated fat w/o being fat-adapted = #LMHR?
2/5 There's a bit of back-and-forth that originated this experiment which you can read about here 👇
And yes, this could literally result in my flying to him to confirm results directly with advanced bloodwork & RER (Respiratory Exchange Ratio)
And yes, this could literally result in my flying to him to confirm results directly with advanced bloodwork & RER (Respiratory Exchange Ratio)
3/5 But more importantly, this gets to a very common assumption regarding #LMHRs -- that their phenotype can be mostly explained by higher consumption of saturated fat.
Design a VLC diet that is low in fiber with the goal toward reaching a low respiratory exchange ratio on a cohort of lean, fit athletes (but no other exercise confounding like resistance training or diet confounding like meds/sups, etc).
I’d likewise bet big majority = #LMHRs
I’d likewise bet big majority = #LMHRs
Full disclosure - @DrNadolsky and I took to some of this discussion via direct texting. However, it did lead me to a good question that I decided to turn into a poll out of curiosity...
1/2 Another great prop bet @DrNadolsky and I were discussing:
He proposed he could emulate the #LMHR phenotype by consuming a lot of butter and coconut oil while not keto and fat-adapted (thus, high RER). I'd predict the opposite.
He proposed he could emulate the #LMHR phenotype by consuming a lot of butter and coconut oil while not keto and fat-adapted (thus, high RER). I'd predict the opposite.
WOW! >300 retweets in first 24 hours!
1/ Now for a thread from the first author on the #LEM Paper:
👉What it IS
👉What it ISN'T
👉👉and What's NEXT...
doi.org/10.3390/metabo…
Read on... @realDaveFeldman
1/ Now for a thread from the first author on the #LEM Paper:
👉What it IS
👉What it ISN'T
👉👉and What's NEXT...
doi.org/10.3390/metabo…
Read on... @realDaveFeldman
2/ What it IS:
We provide the first description of the long-awaited #LEM hypothesis, a model that attempts to explain:
(i) the inverse association between BMI and LDL-C on #lowcarb diets
(ii) the #LMHR phenotype, in which lean people on low carb exhibit very ⬆️LDL-C⬆️HDL-C⬇️TG
We provide the first description of the long-awaited #LEM hypothesis, a model that attempts to explain:
(i) the inverse association between BMI and LDL-C on #lowcarb diets
(ii) the #LMHR phenotype, in which lean people on low carb exhibit very ⬆️LDL-C⬆️HDL-C⬇️TG
3/ These phenomena, presently, have no complete competing explanation:
If effect were purely genetic, the🧬s would need 2explain:
>how macronutrient change can alter, not just LDL-C, but HDL-C+TG as part of a triad
>correlation between BMI and lipid changes
That's a tall order
If effect were purely genetic, the🧬s would need 2explain:
>how macronutrient change can alter, not just LDL-C, but HDL-C+TG as part of a triad
>correlation between BMI and lipid changes
That's a tall order
We know Twitter has the potential to confuse messaging around sensitive topics, including those of our research on #LMHR Therefore, I want to play 20Q with you about our papers! All answers can be found in the manuscripts! Begin!
doi.org/10.3389/fendo.…
pubmed.ncbi.nlm.nih.gov/35106434/
doi.org/10.3389/fendo.…
pubmed.ncbi.nlm.nih.gov/35106434/
Question 1: The definition of a lean mass hyper responder is
Question 2: If you suffer from type 2 diabetes, you're at elevated risk of exhibiting increases in LDL-C on a ketogenic diet because you're metabolically unhealthy
1/ Always honored to have your added opinions, @Lpa_Doc and I'll again mention I'm a tremendous fan of your work (and the #OxPL assay, btw)
The #LMHR phenotype is potentially providing a new window of investigation into lipid metabolism, but its high LDL risk level is unclear...
The #LMHR phenotype is potentially providing a new window of investigation into lipid metabolism, but its high LDL risk level is unclear...
2/ ... Hence the importance of the #LMHRstudy (still recruiting, btw -- see LMHRstudy.com for details)
In the mean time, we regularly and often emphasize everyone should work with their doctor and understand the guidelines recommend against high cholesterol...
In the mean time, we regularly and often emphasize everyone should work with their doctor and understand the guidelines recommend against high cholesterol...
3/ ... There are many like this pt who are in the unusual position of having a severe medical condition that appears to be uniquely resolved through a very carb restricted diet.
With respect, the patient didn't immediately refuse any form of treatment...
With respect, the patient didn't immediately refuse any form of treatment...
📊Polls ahead of #KetoSaltLake
Poll (1/4)
Lean Mass Hyper-responders (#LMHRs) are defined by:
+⬆️#LDL #Cholesterol at 190mg (5.17mm) or higher,
+⬆️#HDL-C 80 (2.07) or higher &
+⬇️#Triglycerides of 70 (0.79) or lower
In your opinion, cardio risk level of this profile is likely
Poll (1/4)
Lean Mass Hyper-responders (#LMHRs) are defined by:
+⬆️#LDL #Cholesterol at 190mg (5.17mm) or higher,
+⬆️#HDL-C 80 (2.07) or higher &
+⬇️#Triglycerides of 70 (0.79) or lower
In your opinion, cardio risk level of this profile is likely
Poll (2/4)
Many demonstrating the #LMHR phenotype (but not all) consume a diet...
High in animal protein
High in red meat
High in saturated fat
In your opinion, if we were to further stratify the #LMHR population to those with the above diet, their cardio risk level would be...
Many demonstrating the #LMHR phenotype (but not all) consume a diet...
High in animal protein
High in red meat
High in saturated fat
In your opinion, if we were to further stratify the #LMHR population to those with the above diet, their cardio risk level would be...
Poll (3/4)
When did you first hear of the Lean Mass Hyper-responder profile?
When did you first hear of the Lean Mass Hyper-responder profile?
1/ A very busy time
But in this late moment of calm before the weekend, I'm finding myself truly humbled that our #LMHRpaper is finalized and has crossing so many interested eyes.
I hope many will agree with us this phenomenon is well worth researching.
cholesterolcode.com/our-paper-on-l…
But in this late moment of calm before the weekend, I'm finding myself truly humbled that our #LMHRpaper is finalized and has crossing so many interested eyes.
I hope many will agree with us this phenomenon is well worth researching.
cholesterolcode.com/our-paper-on-l…
2/ Via @nicknorwitz: "... this paper has stimulated vigorous discussion, risen to the top of its journal for all time reads, and is among the top 15 trending papers across all American Society of Nutrition associated journals for the year 2021." nutrition.org/15-trending-nu…
3/ There's quite a bit more work in the pipeline from the many great collaborators I have the honor to be working with. We're passionately working on a #LipidEnergyModel paper, the #LMHRstudy (currently underway), and a couple other projects I can't announce just yet...
1/ Wow!
Interesting study about HDL-raising & LDL-lowering medications, CETP & PCSK9 inhibitors, w 1 finding that caught me off guard
Will reveal later in thread 2encourage ppl 2read in context, bc study revealed both good and bad
#CVD #Alzheimers
nature.com/articles/s4146…
Interesting study about HDL-raising & LDL-lowering medications, CETP & PCSK9 inhibitors, w 1 finding that caught me off guard
Will reveal later in thread 2encourage ppl 2read in context, bc study revealed both good and bad
#CVD #Alzheimers
nature.com/articles/s4146…
2/ Study used Mendelian randomization 2assess possible effects of SPECIFIC pharmacological CETP or PCSK9 lowering on risk
Useful for assessing whether the failures of CETP inhibitors are more likely due to off-target or on-target effects and for directing future development...
Useful for assessing whether the failures of CETP inhibitors are more likely due to off-target or on-target effects and for directing future development...
3/ Some positive things:
👉MR analysis suggests CEPT inhibition could be useful4reducing coronary hard disease risk (OR=0.95) risk & thus further drug development may be warranted
👉CEPTi anacetrapib&evacetrapib most closely
reflected the on-target association of lower CETP...
👉MR analysis suggests CEPT inhibition could be useful4reducing coronary hard disease risk (OR=0.95) risk & thus further drug development may be warranted
👉CEPTi anacetrapib&evacetrapib most closely
reflected the on-target association of lower CETP...
1/ Time for another monster thread aimed at adding a bit of nuance to Twitter. This one is about Lean Mass Hyper-Responders, HDL, and it's topic might surprise you: Is ⬆️HDL-C in #LMHR bad? Read on to have thoughts provoked...
2/ Something I have intentionally yet to point out (but plan to include in upcoming writings) regards the potential adverse effects of high HDL-C in #LMHR? What?! High HDL is bad? Well, based on the epidemiology, yes. Multiple studies...
3/ including Copenhagen City Heart and CANHEART, report a U-shaped mortality curve whereby very low or very high HDL levels are associated with increased mortality. The most striking example is the blue line, which is all-cause mortality in CANHEART.
1/ It's been quite a week on Twitter regarding #lowcarb and LDL
I have been on the fence about weighing in, not wanting to add to the dog pile, but decided 2drop my thoughts in this thread
If u don't have time to READ THE WHOLE THING IN CONEXT, ignore& consider me🪰 on the wall
I have been on the fence about weighing in, not wanting to add to the dog pile, but decided 2drop my thoughts in this thread
If u don't have time to READ THE WHOLE THING IN CONEXT, ignore& consider me🪰 on the wall
2/ I'll first address @deirdre_tobias analysis of LDL and all cause mortality. With the caveats that I'm not an epidemiologist &hope to have more insightful questions when time passes and the dust settles, I am not in disagreement w/ the main results: high LDL associated with ACM
3/ That's actually old news, isn't it?Not so say that the analysis doesn't bring something to the table, but on a population level v high LDL levels (will get to low LDL in a minute) are generally undesirable. Thus, all things being =, a conservative gambler would pick low-is LDL
1/ As a #LMHR and close colleague of @DaveKeto I feel compelled to jump in here and clarify my own stance on LDLp and ASCVD risk because I feel that our positions are usually misrepresented by others. Here we go…
2/ To cut to the chase, outside the low-carb lipid triad of high LDL and High HDL and low TG, I would absolutely personally consider elevated LDLp an issue. Where I to have high LDL and atherogenic dyslipidemia I would both take an LDL lowering med and, more importantly IMO…
3/ change my lifestyle to improve the atherogenic dyslipedmia. Personally I do have concerns about longterm safety use of statins specifically and would preference Zetia/PCSK9i. But that’s besides the point. I won’t speak for @DaveKeto but for my part the LMHR phenomenon & LEM…
1/ Reminder: "Lean Mass Hyper-responder" is literally defined as a combination of LDL ≥ 200, HDL ≥ 80, and Triglycerides ≤ 70.
In other words -- by definition -- #LMHRs are not hypertriglyceridemic (high triglycerides). They are the opposite. (See CholesterolCode.com/lmhr)
In other words -- by definition -- #LMHRs are not hypertriglyceridemic (high triglycerides). They are the opposite. (See CholesterolCode.com/lmhr)
2/ For example, in the first of this case series a woman is identified as hypertriglyceridemic (triglycerides of 1109). This is if 15 fold higher than the TG max cap of #LMHR.
lipidjournal.com/article/S1933-…
lipidjournal.com/article/S1933-…
3/ Moreover, we actually addressed this particular case of hypertriglyceridemia in our Letter to the Editor of this very case series. In fact, it's how we set up the question on what to consider when triglycerides are low instead
