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Gil Carvalho MD PhD🌈🇵🇸 Profile picture
@NutritionMadeS3
Aug 10, 2020 • 6 tweets • 2 min read • Read on X
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Some stunning facts about the microbiome

(including how it can help you lose weight and fight inflammation, cancer, diabetes)

(short thread)

full video:
1) we're more microbial than human

we're effectively supra-organisms, and may have more bacterial than human cells

only 1% of the genes we carry are human. the other 99% are in our microbiome (bugs in out gut). ALL of those genes can impact our health

nature.com/articles/nrmic…
2) we can digest fiber

Fiber isn't excreted unchanged as we used to think. It (esp. soluble fraction) is digested by the microbiome, which produces short-chain fatty acids (SCFAs) - butyrate, acetate, propionate

SCFAs feed our gut wall and help prevent disease
3) SCFAs regulate hormone balance and appetite/weight

Direct administration of SCFA precursors induces the gut wall to secrete hormones that signal satiety and prevent weight gain

gut.bmj.com/content/64/11/…
4) SCFAs can prevent/ameliorate disease

SCFAs have been implicated in reducing inflammation and preventing colon cancer

cell.com/cell/fulltext/…
5) fiber can improve glucose control

RCT data showed improved glucose parameters in diabetics on a high fiber, whole grain-rich diet

“high-fiber diet promoted growth of SCFA-producing organisms (...) and correlated with improved blood-glucose”

science.sciencemag.org/content/359/63…

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More from @NutritionMadeS3

Gil Carvalho MD PhD🌈🇵🇸 Profile picture
Sep 29, 2024
fascinating new mendelian randomization study quantifies risk associated with triglyceride-rich lipoproteins (VLDLs etc) & their remnants

concludes ~4x more atherogenic particle for particle than LDL particles (maybe even more)

interesting implications
jacc.org/doi/abs/10.101…
this indicates that 2 populations with the same ApoB level would have different risk depending on what type of ApoB particles are elevated (LDLs? VLDLs? both?)

some contrary views presented by Sniderman:
sciencedirect.com/science/articl…
"does this mean LDL doesnt matter?"

NO. the study shows all these ApoB particles are atherogenic but points to TG-rich lipoproteins as being even more so *particle for particle*. most people have many more LDLs so the risk attributable to those will still predominate
Read 6 tweets
Gil Carvalho MD PhD🌈🇵🇸 Profile picture
Jan 10, 2024
“Are eggs good or bad?”

A fascinating recent study looked at this perennial question.

HT @TheBhupiThakur


🧵🔽sciencedirect.com/science/articl…
Re: heart disease in particular, we can find heterogeneity in the literature. Some studies point to a signal of risk for eggs, others find no stat sig effect.

One of the main differences between science and Social Media content is how they deal with heterogeneity.
Social Media feeds you polarization. One FB forum argues eggs are poison, and shows you only the studies reporting risk.

Another argues eggs are a perfect, risk-free superfood, and shows you only favorable studies.
Read 18 tweets
Gil Carvalho MD PhD🌈🇵🇸 Profile picture
Oct 11, 2023
The Twinkie diet

In 2010, a nutrition Professor set up an experiment

he ate 1800 cals/day mainly from ultraprocessed sweets, Doritos, sugary cereal and Oreos
edition.cnn.com/2010/HEALTH/11…
over 2 months, he lost 27lbs. his BMI came down to the normal range

his LDL-C dropped 20%. his triglycerides, 39%

his anecdote illustrates a couple points:

▶️we can lose weight on almost any type of food, as long as we cut calories enough
▶️ some foods make it easier to cut calories. calorically concentrated junk food makes it easier to overconsume calories, so for most people they're not ideal. most people won't achieve the precise control on a day to day basis that the Prof exercised in his experiment
Read 6 tweets
Gil Carvalho MD PhD🌈🇵🇸 Profile picture
Jan 30, 2023
Once you understand HDL-cholesterol is not causally protective, it's straightforward to see why some of the popular ratios can be misleading

quick 🧵 using TC/HDL-c as example
to make the math easier let´say my HDL-c is 40mg/dL and my total cholesterol (TC) is 200

That’s a TC/HDL-c ratio of 5
Hypothetically, if my HDL-c doubles (and everything else stays constant), my HDL-c is now 80 and my TC is 240 (remember, TC is the sum of all serum cholesterol including HDL-c)

Now my ratio is 3
Read 5 tweets
Gil Carvalho MD PhD🌈🇵🇸 Profile picture
Jul 6, 2022
Does high ApoB still raise risk if I´m “metabolically healthy”?

The evidence indicates it DOES.

(thread)
The idea that cholesterol level is completely irrelevant has largely subsided.

As the public is exposed to more scientific evidence, it has become increasingly obvious that blanket denial is not realistic.

So a more nuanced idea emerged.

“it´s about context”
According to this idea, high cholesterol/apoB increases risk in “sick” people (e.g. insulin-resistant/obese/diabetic) but is harmless for the insulin-sensitive & lean
Read 12 tweets
Gil Carvalho MD PhD🌈🇵🇸 Profile picture
May 27, 2022
"low cholesterol correlates with higher all-cause mortality so having high cholesterol is protective"

a misunderstanding that refuses to die

we know with a very high degree of certainty that this idea is *wrong*

3 lines of evidence:
1) lowering cholesterol via randomized clinical trials or genetically determined shows, if anything, *lower* total mortality

this comfortably supersedes the associational U-curve
ncbi.nlm.nih.gov/pmc/articles/P…
thelancet.com/action/showPdf…
academic.oup.com/ije/article/44…
thelancet.com/journals/lanhl…
2) even the authors of some of the U curve studies have alerted (in no uncertain terms) against concluding causality from those associations

bmj.com/content/371/bm…
bmj.com/content/371/bm…
Read 7 tweets

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