Thread by @EAllen0417

This will be a livetweet of Bart Kay's youtube vid about Statins, CVD, LDL and Saturated Fat linked below. Scary title: Statins might KILL YOU!

I immediately imagine a response vid titled: Water might KILL YOU!! (and is more likely to than Statins)

The video was brought to my attention by @professionaldog and so this is all his fault. Feel free to send complaints to him.

@professionaldog Meta discussion of the topic identifies it as "really, really important." Agreed. It is important. First slide title "Cholesterol -- Good or Bad" shows a chol molecule. This is to show how sciency he is. He notes you've heard about it. Wow! This is deep.

@professionaldog He elides his title by stating that cholesterol is neither "good" nor "bad." Wow. So true. A molecule can't have an intentional stance. The philosophy is deep with this guy. "Vested financial interests" alluded to obliquely, probably gonna get more of that later, we'll see.

@professionaldog "Whole bunch of genes that encode for its transcription … " not sure he knows of what he speaks here. Genes encode for their own transcription. Nucleic acids are not cholesterol. What I think he means is that genes can code for enzymes that can make cholesterol in the liver.

@professionaldog States that the genes to make cholesterol are there for a reason. I like that. It serves very useful purposes. Indeed, it's useful for stabilizing cell membranes. He says without cholesterol in your body you will die very very quickly. I know of no literature on this.

@professionaldog The reality is that people tolerate an LDL cholesterol level of zero without any adverse effects up to and including not dying. So he ignores this fact. This article was in print when he uploaded this vid. sciencedirect.com/science/articl…

@professionaldog States the idea that we can have too much cholesterol only applies to people with FH. Low carbists are all over the map on FH. Sometimes they are saying that FH people over 65 have same mortality as normal, and sometimes they are saying that people with FH are at high risk.

@professionaldog He ignores MR, GWAS and polygenic score studies showing the risk associated with elevated LDL is linear. Not single genes, multiple genes, with varying effects, that graph nicely with effect on LDL.
jlr.org/content/51/11/…
sciencedirect.com/science/articl…
academic.oup.com/ije/article/44…

@professionaldog Honestly this is exhausting. I'm 2 minutes and 56 seconds into his video and the true things he says are silly and obvious, everything else so far is provably false. I hope the rate of stupidity slows or this thread will be interminable.

@professionaldog Points out that people with FH don't live long lives. Says this unironically. Says people without FH have a blood cholesterol level that is exactly what it should be. Waiting to see how he squares this circle.

@professionaldog Says cholesterol is an alcohol and not a fat. Not sure he's had a full biochem course. Cholesterol is not a fatty acid, but it is a lipid, a member of the sterol class (hence the name). It's only an alcohol by O chem nomenclature. Hope the Wikipedia link on his browser works.

@professionaldog He says "it's not a fat, just a form of alcohol." He is clearly targeting a lay audience and this is just nonsense. Wow. So bad.

@professionaldog States confidently that dietary intake makes no real difference to serum cholesterol levels. In a sense this is correct. SFA is by far the most important component of the Keys equation, once serum chol is above a certain level. vorga.org/17-5-281.full.…

@professionaldog At this point I am going to take a break from this incessant Gish gallop of falsehood. But may resume later in the day.

@professionaldog Resuming. Some basic cholesterol biology discussion of lipoproteins as ferrying agents. This is all accurate as far as it goes. We have another veiled reference to "financial interests" but this section isn't horrible until he states that diet has no effect on lipoproteins.

@professionaldog Again, diet has a massive effect on cholesterol that is established by an equation and hundreds of metabolic ward experiments that continue up to now. Most recently @KevinH_PhD showed that low carb diets raise LDL and ApoB.

@professionaldog @KevinH_PhD Then we get to a staggering lie. "If you could meaningfully effect your cholesterol by what you eat then you wouldn't need a drug to do it." This is like saying if you could afford a car, you wouldn't need a loan to do it.

@professionaldog @KevinH_PhD The diet that lowers cholesterol is well established. It's a low fat, plant-based diet high in fiber and low in saturated fat and cholesterol. Multiple studies have established this going back a century. cambridge.org/core/journals/…

@professionaldog @KevinH_PhD Next slide has a great title: "Lipoprotiens" (sic)

Yep. This guy's a stickler. He reviewed his slides and presented from this slide and didn't even catch that … lots of noise about this slide to act like he knows what he's talking about.

@professionaldog @KevinH_PhD States that a lipoprotein holds the sphere of a particle together and "encodes for it." Again, I wonder if this guy knows how genes are turned into proteins. Proteins don't "encode" in normal cell activities. Then again, he doesn't even notice when protein is misspelled.

@professionaldog @KevinH_PhD More blather about a scientific conspiracy … seriously how can anyone imagine that low carbism isn't a conspiracy theory when they hear them repeatedly refer to a conspiracy between the general scientific consensus and "financial interests."

@professionaldog @KevinH_PhD He has no axe to grind "in terms of financially," he's just here to explain the science. Yeah sure, no axe to grind "in terms of financially." patreon.com/Bart_Kay

@professionaldog @KevinH_PhD We are 15 minutes into the video that is 67 minutes long and he hasn't presented the results of a single scientific study and has made numerous basic errors unworthy of a high school student. I am going to skip to any part where he says anything worth refuting.

@professionaldog @KevinH_PhD Slide title: "Atheroclerosis" (sic)

Wow. He's an expert. He's obviously a very careful researcher.

Weirdly, he pronounces an "s" between the first o and the c.

@professionaldog @KevinH_PhD He makes a claim that if a clot forms from ASCVD and it goes to the lungs it will cause a "problem." This is wrong. The lungs have plenty of oxygen. Pulmonary embolism comes from the venous circulation and has only a small relation to ASCVD.

@professionaldog @KevinH_PhD Weirdly, the JUPITER trial did show less PE in the group treated with statins. How sure am I he won't mention this in the rest of the video? Very sure. nejm.org/doi/full/10.10…

@professionaldog @KevinH_PhD He states that when heart tissue dies do to an MI, it's not a good thing. Yay!! Oh, wait, then he starts talking about how veins don't form plaque. This is one of the dumbest low carbist talking points. Veins don't form plaque UNLESS they are put in to do an artery's job.

@professionaldog @KevinH_PhD Then, of course they do. Which means that it is blood flow characteristics combined with blood lipids that creates ASCVD. He's right that blood pressure effects ASCVD development. …ovascularultrasound.biomedcentral.com/articles/10.11…

@professionaldog @KevinH_PhD Now we get the low carbist nonsense about "oxidized" LDL being the cause of disease. Just so we're clear. All ApoB containing molecules are atherogenic. Some are worse than others. This article explains it well.
onlinelibrary.wiley.com/doi/full/10.11…

@professionaldog @KevinH_PhD We are almost halfway through the video now and he hasn't even mentioned statins in a video that's ostensibly about statins. This guy is filibustering sciency sounding stuff to try to accrue credibility from laypeople. He will then spew fact-free low carb conspiracy nonsense.

@professionaldog @KevinH_PhD Side note; I love how the vowel in "it" has migrated to somewhere between a schwa sound and a breathed "u" sound in the eastern Pacific.

@professionaldog @KevinH_PhD He shows a section of an aorta and struggles to remember the name, calls it "the main artery that comes out of the top of your heart." Says it has "atherosclerotic legions." Sorry, this is pathetic.

@professionaldog @KevinH_PhD He doesn't even understand circulation. Again uses a wildly incorrect description of how embolism works, suggesting that an embolism from the aorta could cause a heart attack. He should re-read Harvey. ncbi.nlm.nih.gov/pmc/articles/P…

@professionaldog @KevinH_PhD The coronaries arise from the aortic sinuses.

Anything breaking off from the interior of the aorta won't make it back to the aortic sinuses since it will be lodged in capillaries in some other tissue. It can't even get to the lungs. 🤔

@professionaldog @KevinH_PhD He agrees that LDL is associated with atherosclerosis (good) and then claims this is a spurious correlation and not causative. "Firefighters go where there are fires."

@professionaldog @KevinH_PhD You can be sure he won't bring this up. academic.oup.com/eurheartj/arti…

@professionaldog @KevinH_PhD He then goes into the breakdown of the content of plaque. States very little fat. No source given, but quotes mg per total weight, which includes water. This study shows that in unstable plaque 40-50% of the volume is lipids, 13% in stable. heart.bmj.com/content/69/5/3…

@professionaldog @KevinH_PhD Brief aside. Dunking on low carbist conspiracy theory enthusiasts is so easy anyone can do it. Simply read actual articles about the topics they misspell after you have corrected the misspelling.

@professionaldog @KevinH_PhD Alert: I have made a mistake. The Hall study mentioned above only showed elevated LDL, not ApoB. However, since ~90% of ApoB is LDL, it's not a bad bet that ApoB went up, and the linked study suggested low carb diets do raise ApoB. sciencedirect.com/science/articl…

@professionaldog @KevinH_PhD The mechanism by which ASCVD causes thrombosis is usually cholesterol crystallization creating instability in the endothelial layer and attracting platelets. Cholesterol, like any other chemical, crystallizes at higher concentrations more easily. sciencedirect.com/science/articl…

@professionaldog @KevinH_PhD He calls plaque lesions "legions" again. Is this a common pronunciation that I'm unaware of?

@professionaldog @KevinH_PhD Definitely into Brandolini's law territory here.

@professionaldog @KevinH_PhD Finally a study. He uses a slide from Felton showing how much cholesterol is present in unstable plaque. So … cholesterol plaque is mostly cholesterol once you get rid of the water. Good to know. Read the article, more fat is present in worse plaques. ahajournals.org/doi/full/10.11…

@professionaldog @KevinH_PhD We're more than halfway through here … not a statin mentioned and no statin studies reviewed. I am anticipating a giant load of falsehoods all at the end.

@professionaldog @KevinH_PhD He admits he's a lifelong advocate of low carb diets. Interesting childhood that must have been. Describes omega sixes as "pro-inflammatory" without any citation. We've really only had one citation so far in the whole talk.

@professionaldog @KevinH_PhD Finally another study. He loves the Siri-Tarino MA. Of course he does. The Siri-Tarino MA is to low carbism what the Q'uran is to Islam. I've dealt with ST and Krauss at length elsewhere. It's faulty and ignores MW experiments.

@professionaldog @KevinH_PhD Kay "suggests" that eating more SFA is cardioprotective. Citation not given. Says more studies need to be done, but umm, why should more studies need to be done if you already know that? He advises people that coconut oil is healthiest fat … without any studies?

@professionaldog @KevinH_PhD Another low carbist tactic is to focus on admission cholesterol levels. This is inaccurate as severe physiological disruptions like sepsis, strokes, heart attacks and trauma acutely drop cholesterol. I was taught this in school and residency. ncbi.nlm.nih.gov/pmc/articles/P…

@professionaldog @KevinH_PhD We're three quarters of the way through the talk and still not a single mention of statins, no reference to statin trials and nothing about how statins cause or prevent disease. This guy is the Duane Gish of low carbism.

@professionaldog @KevinH_PhD Finally, with only 17 mins left in the video we get a slide about statins and it's correctly spelled and even has facts on it. He then claims that the package insert on statins doesn't claim reduction in risk for heart disease. But of course it does. From package insert.

@professionaldog @KevinH_PhD Says that everyone knows they don't have that indication, while of course they do. Lying brazenly and confidently might be the most successful business model in the world.

@professionaldog @KevinH_PhD Ridiculous slide only meant to intimidate the lay public showing terpenoid synthesis. He's doing this precisely to seem more sciency. Since only people who can't spell "protein" or "atherosclerosis" are listening at this point, it probably works.

@professionaldog @KevinH_PhD He reiterates all the things he said at the beginning and finally brings up the MA from Ray in Archives from 2010. One study that showed a .91 risk associated with statins in ACM. Agreed this wasn't significant, but other studies have shown a significant effect around 10% on ACM.

@professionaldog @KevinH_PhD Here are some:
jamanetwork.com/journals/jamai…
journals.sagepub.com/doi/abs/10.117…
nejm.org/doi/full/10.10…

@professionaldog @KevinH_PhD Bart is certainly not "steel-manning" the position of medicine on this. Fundamentally, though, even if we take all his statements as true, he makes no effort to suggest that they can kill, since the only study he references shows a non-significant reduction in mortality.

@professionaldog @KevinH_PhD I really don't have the energy to continue on with this gent. Anyone else who wants to take on his positions, just look them up. He will be wrong.