Dave Feldman Profile picture
Sep 21, 2020 12 tweets 5 min read Read on X
1/ #ListeningThread @drlipid on @PeterAttiaMD #Drive

I always enjoy when Attia and Dayspring talk lipids. Looking forward to this one...

peterattiamd.com/tomdayspring6/
2/ At about eight minutes in Dayspring discusses how there is new emerging data on various things in the last couple years, particularly triglycerides and how they have taken center stage in relation to atherogenicity of an ApoB particle.
3/ About 10m in @PeterAttiaMD brings up the importance in distinguishing the difference between what ApB and LDL-P — of course, if you followed me for a while, you know this is a distinction of crucial importance for me (see cholesterolcode.com/thoughts-regar… )
4/ So I have some thoughts around the discussion following the 15:45 mark, but it’s not super Twitter friendly and I want to just keep going. I’m a double back with the thread of its own at some point...
5/ Wow — at around 23m in @PeterAttiaMD describes a (what I assume is) a hyper-responder case. (Possibly a LMHR...?)

Dayspring answer is worth listening to verbatim.

I’m moving this podcast to a #MustListen status
6/ Full disclosure -- I had to pause the podcast to ruminate on these discussions, and now I need to take care of some business.

I'll restart this #ListeningThread later at my next bloc of convenience...
7/ At 35m in they are discussing the Vasa Vasorum.

@PeterAttiaMD differentiates the environments of the arterial lumen vs the VV with regard to insulin, glucose, sheer stress, etc. and why that should be considered a stronger suspect given potential risk of damage.
8/ At around 37m in they start talking HDL cholesterol, expanding on our drug targeting of this marker has it yielded positive effects, along with a brief mention on Mendelian randomization studies as well.
9/ Talk about timing. At about halfway through – around the 60 minute mark — @drlipid talks about OxLP_ApoB test and its value (particularly in the context of Lp(a))

cc: @OxPL_apoB and @siobhan_huggins
10/ Yes — the *same* assay that is the central focus of my just-completed experiment. (Data will be reported soon)

cholesterolcode.com/oxldl-replicat…
11/ At about 74m @drlipid points out that if one were only allowed to look at one metric to be cost effective, he would recommend LDL triglycerides (tho they concede that discreet assay isn’t commercially available). But I definitely agree that LDL-TG should be very meaningful.
12/ I'll concede the pharmacological topic isn't as interesting to me so I'll button up here.

Again, this podcast has definitely been very interesting for many reasons I've outlined above. (I don't think I'll re-cover the ground of ApoB vs LDL; see blog post for details on that)

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More from @realDaveFeldman

May 21, 2023
1/🧵 If Plaque #ApoB-48 > #ApoB-100

Quite a rabbit hole so far...

First, let me say that data on this has been a bit limited. But *IF* we do ultimately confirm there are more ApoB-48 (B48) than ApoB-100 (B100) in ASCVD plaque, it would be a very big deal.

Let's unpack... Image
2/ First, thanks to @TuckerGoodrich for pinging me on these pubs and pressing the discussion.

But also credit to @CaloriesProper on tweeting this a couple years ago (I missed it then)

To understand why this would be so important if true, some review...
3/ B48 and B100s are the major proteins on chylomicrons (CMs) and VLDLs, respectively.

CMs mostly carry lipids from the small intestine to the bloodstream (lipids consumed), VLDL mostly carry lipids from storage; predominantly from adipose stores.

See full linages here 👇 Image
Read 10 tweets
Apr 14, 2023
1/ Chat on Triglyceride rich #LDL

#Me: Why would triglyceride rich LDL particles be more atherogenic than triglyceride poor LDL particles?

#ChatGPT: Triglyceride-rich LDL (low-density lipoprotein) particles are more atherogenic (i.e., more likely to contribute to the… twitter.com/i/web/status/1…
2/

#Me: Couldn’t it also be possible that triglyceride rich LDL are ultimately the result of metabolic dysfunction and that better explains its association with atherosclerosis?

#ChatGPT: Yes, that is also a possibility. Triglyceride-rich LDL particles are often associated… twitter.com/i/web/status/1…
3/

#Me: Is it possible that almost the entire amount of atherogenesis associated with high triglyceride rich LDL is due to dysfunctional lipid metabolism and the diseases that result in these profiles rather than the LDL particles themselves?

#ChatGPT: Yes, it is possible that… twitter.com/i/web/status/1…
Read 4 tweets
Apr 13, 2023
1/🧵 I'm definitely a fan of both @DominicDAgosti2 and @DrRagnar (obviously), so I was excited to see them chatting about #lipids, #LMHRs, and Dom's consideration of increasing carbs to lower his #ApoB

If no one minds, I'd like to add some thoughts...

2/ First -- I'm extremely excited to share @DominicDAgosti2 may be the most notable N=1 I've waited for regarding #ResistanceTraining change & #LDL/#ApoB in a #ketogenetic context

Those who've followed me for a while know exactly what I'm talking about...
3/ When chatting with Dom in SD last year for dinner, he mentioned focusing less on maintaining such a sizable muscle mass as he typically does, and I predicted he'd likely see his LDL/ApoB as considerably higher with this change if still #keto. This podcast appears to confirm...
Read 10 tweets
Mar 24, 2023
🧵Followup on #salt comment last night:

Took 3 readings of my blood pressure this morning:
113/78
106/68
98/74
Average: 106/73

Context:
- Male, 49
- Moderate exercise
- Moderate-high stress career
- Supp 6-10g of salt daily when #keto* to relieve fatigue, cramping (for >5 yrs)
2/ So everyone on #keto should be like me and take copious amounts of #salt?

Well, sorry, but the answer appears to be:
👉 Your results may vary.... a lot.

On the little-to-no salt side, check out @KetoCarnivore's recent discussion on this
3/ Also check out this short video answer in a Q&A from Steve Phinney regarding salt intake research
Read 5 tweets
Mar 23, 2023
1/ #Metabolism, #lipids, and #ASCVD
#megathread🧵🧵🧵

Okay, I want to revisit and breakdown my position on this crucial topic and the challenges in communicating it.

⚠️ Get comfortable, as this could get long.

Ready? Let's go...
2/ First, it's worth reviewing why there's a high level of confidence low density lipoproteins (LDLs) drive atherosclerotic cardiovascular disease (ASCVD)

For an excellent, lay-person video, I recommend @NutritionMadeS3's from a couple years ago 👇

3/ Also in the name of arguably the most cited meta-analysis for the Lipid Hypothesis to date:

"Low-density Lipoproteins cause atherosclerotic cardiovascular disease"

This meta combines lines from genetic, observational, and interventional studies.

pubmed.ncbi.nlm.nih.gov/28444290/
Read 25 tweets
Mar 12, 2023
Maybe. I hope so.

Let me just say a major problem with the #diet and #nutrition space is just how many sides seek to oversimplify these things.

And as unpopular as it is to say it, I think there's way too much focus of folks having extremely quick success as though it's common.
I know it's well intentioned.

But I also know many people in my own family who have struggled their whole lives to lose weight and assume if they don't have this near instant drop to their goal weight like <fill in the blank success story> then they are doing it all wrong...
... I can't tell you how many times I point out truly new, record-setting successes with people I know personally -- but it's their own record, their own health journey.

But they often can't see it because they hear they "won't be hungry anymore on <fill in blank diet>"...
Read 5 tweets

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