Discover and read the best of Twitter Threads about #lccholesterolchallenge
Most recents (7)
1/ Interesting timing, @LDLSkeptic -- @siobhan_huggins and I are coauthoring a post that lays out the "lipoprotein-centric" vs "lipid profile-centric" schools of thought.
But since this has come up a lot in the last 24 hours, I'll do a twitter thread on the overview...
But since this has come up a lot in the last 24 hours, I'll do a twitter thread on the overview...
2/ Almost everyone takes the "lipoprotein-centric" view of risk. That is to say, most believe there's a particular lipoprotein metric to watch for. The troublemaker, as it were.
For conventional medicine, that's all ApoB-containing lipoproteins (remnants and LDL, of course)...
For conventional medicine, that's all ApoB-containing lipoproteins (remnants and LDL, of course)...
3/ For many in the low carb space it's a subset of LDL. Specifically, the "small dense" particles, rather than the "large buoyant" particles with the latter generally considered safe.
Also, and related, many point to oxidized LDL (oxLDL) or glycated LDL as the true troublemaker.
Also, and related, many point to oxidized LDL (oxLDL) or glycated LDL as the true troublemaker.
1/ Retweeting for balance from my good friend and colleague, @DrNadolsky
To be sure, I agree large LDL particles can be participants in atherogenesis.
The real question is whether they are independently initiating and/or accelerating atherosclerosis (regardless of context).
To be sure, I agree large LDL particles can be participants in atherogenesis.
The real question is whether they are independently initiating and/or accelerating atherosclerosis (regardless of context).
2/ Existing medical consensus is that yes, regardless of context, more LDL=more risk of CVD, full stop.
Myself, I believe context does indeed matter. Which is why I suspect we haven’t yet gotten a study to meet the #LCCholesterolChallenge
cholesterolcode.com/lccholesterolc…
Myself, I believe context does indeed matter. Which is why I suspect we haven’t yet gotten a study to meet the #LCCholesterolChallenge
cholesterolcode.com/lccholesterolc…
3/ In short, I think the context of why we get particular lipid patterns (such as atherogenic dyslipidemia) helps to expose the underlying root cause of atherogenesis.
I often refer to this as “lipid profile centric” thinking vs “lipoprotein centric” thinking.
I often refer to this as “lipid profile centric” thinking vs “lipoprotein centric” thinking.
@OhhiyoGarmen @kevinnbass I agree ApoB-containing lipoproteins have a "role in atherosclerosis". This often gets conflated with serum levels of LDL-C (dose-dependent), but the distinction is important because they are not identical. One isn't a matching proxy for the other, even where correlative...
@OhhiyoGarmen @kevinnbass ... If high LDL-C were always atherogenic, then there'd be no metabolic or lipid profile at a population level with high LDL-C, yet low atherosclerosis. This is why I initiated the #LCCholesterolChallenge to help find any studies with high LDL, high HDL, low TG = high CVD.
@OhhiyoGarmen @kevinnbass To date, I haven't had anyone submit a study that meets this criteria. All studies I've been able to locate that stratify high LDL-C + high HDL-C + low TG show low CVD.
1/ I consider #HDL extremely relevant, yes. It’s one of the existing five criteria for metabolic syndrome and one of the three for atherogenic dyslipidemia. ncbi.nlm.nih.gov/pmc/articles/P…
2/ It’s one of my three target markers for the #LCCholesterolChallenge (which is about to turn two years old next week). cholesterolcode.com/lccholesterolc…
I haven’t yet found any study that stratifies ⬆️LDL+⬆️HDL+⬇️TG showing ⬆️cardiovascular disease as of yet, but I’ve found the opposite
I haven’t yet found any study that stratifies ⬆️LDL+⬆️HDL+⬇️TG showing ⬆️cardiovascular disease as of yet, but I’ve found the opposite
3/ See studies linked in this LMHR article - cholesterolcode.com/cholesterol-en…
And I don’t have it handy as I’m on my phone, but we see this likewise stratification of the triad in the 4S trial...
And I don’t have it handy as I’m on my phone, but we see this likewise stratification of the triad in the 4S trial...
@AviBittMD @Jevan @RocknRolloff As you know, I don't quickly jump to hit the Causality Proven Button anyway. ;)
But that said, when something is shown to associate with greater ACM in every context found at a stepwise dose dependent level, I consider that compelling. The key is to look for every context...
But that said, when something is shown to associate with greater ACM in every context found at a stepwise dose dependent level, I consider that compelling. The key is to look for every context...
@AviBittMD @Jevan @RocknRolloff Hence my interest in [high LDL + high HDL + low TG] (Low carb lipid triad).
@AviBittMD @Jevan @RocknRolloff Thus far, the #LCCholesterolChallenge hasn't been met yet and I haven't put out the #LDLBounty. But maybe you, @AviBittMD, will be the one to collect. ;)
cholesterolcode.com/lccholesterolc…
cholesterolcode.com/lccholesterolc…
1/ Today marks my 18 month-aversary since beginning the #LCCholesterolChallenge cholesterolcode.com/lccholesterolc… and exactly a year ago adding #LDLBounty to meet the challenge. To date, I've only found studies showing the opposite -> High LDL+High HDL+Low TG = Low cardiovascular disease..
2/ The reason I say "best study" in the challenge instead of "any study" is that I thought it may well be possible there were tens if not hundreds of studies that might meet the definition. Again, I've only found the opposite, like this one: ncbi.nlm.nih.gov/pubmed/27166203
3/ The colored overlays are mine, to emphasize this "triad" of high LDL, high HDL, and low triglycerides... 
1/ The anniversary of the #LDLBounty will be in a couple weeks. I'm still seeking to gather non-drug/non-gene studies showing a triad of high LDL+high HDL+low triglycerides=high cardiovascular disease. Thus far, I've only seen studies showing the opposite.
2/ This is extremely relevant to #keto/#lchf given this triad of rising LDL, rising HDL, and dropping triglycerides is a very common outcome. Of course, if you follow my work, you know I consider this more likely due to being powered by fat (metabolic) than disease (pathologic)
3/ After six months with no submissions, and on the anniversary of the original #LCCholesterolChallenge, I brought the finder's fee up higher to $1,000 with a $3,000 budget.
