Discover and read the best of Twitter Threads about #LMHR

Most recents (20)

1/ 🚨New N=1 Experiment: #IsItSaturatedFat🚨

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. Image
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.
Read 6 tweets
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... 🧵 Image
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👇
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.
Read 7 tweets
🚨 #LeanMassHyperResponder lowers LDL 🚨

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… Image
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:…
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 Image
Read 19 tweets
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?
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)

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.
Read 5 tweets
Thread! Can you be #LMHR and not "lean?!"

1/ This ??? has come up before, can you be LMHR and not actually lean. Here is a good case!

Individual meets all criteria for LMHR, but BMI 27. So, by the formal definition, the answer is simply, "yes." But let's discuss the nuance... Image
2/ First, let's again redefine what an LMHR is: >=200mg/dl LDL, >=80mg/dL HDL, >= 70mg/dl TG. That's it. BMI is not part of the definition. The term, "LMHR" is historic based on the general pattern that persons who have this profile TEND to be lean and/or athletic, but ...
3/ That's not a hard and fast rule. So, one could fairly argue the term isn't perfectly descriptive, re "LEAN". This is nothing special -- it's just language. I could come up with any number of examples of imperfect terms, Syndrome X, Aplastic anemia, etc. And it well may be...
Read 7 tweets
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
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.
Read 4 tweets
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...…

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
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
Read 9 tweets
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!…
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
Read 22 tweets
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...
2/ ... Hence the importance of the #LMHRstudy (still recruiting, btw -- see 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...
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...
Read 6 tweets
📊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 (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...
Poll (3/4)

When did you first hear of the Lean Mass Hyper-responder profile?
Read 5 tweets
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.…
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."…
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...
Read 5 tweets
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…
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...
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...
Read 10 tweets
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.
Read 12 tweets
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
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
Read 24 tweets
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…
Read 8 tweets
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
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.…
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

Read 4 tweets
1/ There really has been a sea change I've noticed lately with regard to both the #LipidTriad and the #LMHR phenotype.

I'm not going to call anyone out, but I will say there are many who I had several spirited discussions in the past few years...
2/ ...who considered high LDL = "high" risk, full stop...

... but are now expressing #LMHRs may actually be at "low" risk of cardiovascular disease (in spite of having LDL in the 95% of the pop), just that they "could be better" if they have these LDL levels lower than they are.
3/ It's worth emphasizing their position hasn't changed with regard to higher LDL = *more risk* of CVD. Thus, it would still be better for #LMHRs to have lower LDL, all else being equal.

But the magnitude of difference in the assumed risk has changed for many.
Read 6 tweets
1/ Okay, this seems to keep coming up. People who are clearly very fat adapted (like, say, very athletic #LMHR #Carnivores), but who have lower ketones -- specifically, BHB (beta hydroxybutyrate) at perhaps 0.2 to 1.0

And they say, "Hey! Why aren't I in ketosis?"

Let's unpack..
2/ Do we commonly see the athletes who are healthy on a mixed or even carb-centric diet with low levels of blood glucose? Yes, we do.

In fact, it's when we see high levels of fasting glucose in the blood *in spite* of being athletic that we start to worry, of course...
3/ ... We don't see an athlete with low glucose and assume they are not using as much of it as the couch potato with high glucose. Rather, it's likely the other way around.

In other words, accumulation in the bloodstream isn't a clear indication of use, it can mean the opposite!
Read 9 tweets
1/ Thread

Commenting on @kevinnbass article regarding our #LMHR Measurement Project via <— Please continue to donate!
2/ “... I am musing a bit offline about what exactly his LHMR study would show even if atherosclerosis did not progress in his subjects much.

Because we already know that other factors besides LDL also modify risk.”

This is a very important stopping point, right at the start...
3/ The vast majority of LMHRs who approach us at the site or groups explain their doctor is extremely concerned — regardless of their other risk factors that might be optimal. And this is understandable given existing medical opinion regarding LDL.
Read 10 tweets
1/ I want to take a minute to give special recognition to @DrNadolsky.

Like me, he's very interested in #LMHRs, hence the CSF project we're working on with @DrRagnar

Unlike me, he hypothesizes a different outcome. But that's a feature, not a bug...
2/ The thing he and I certainly have no problem doing right now is making these hypotheses public before the data is in. If the data shows a clear advancement in rapidly progressing atherosclerosis, my opinion will change with it. If the data shows little to none, his will change
3/ This might sound like a no-brainer, but I find some in every community will have hypotheses that are effectively unfalsifiable. This is why the #LMHR phenotype is truly a unique opportunity in science, with all CVD markers low save the one of interest.
Read 5 tweets

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