Dave Feldman Profile picture
Sep 23, 2020 15 tweets 4 min read Read on X
1/ 🦠🦠 #COVID19 / #CORONAVIRUS SURVEY 🦠🦠

(Note-- this is the sixth time I'm posting this exact same survey, each 5 weeks apart. Links at the end of this thread, but don't compare until you've completed this first, ofc.)

Answer as honestly as possible.

Here we go... Image
2/ Generally speaking, do you feel *your government* is under-reacting, overreacting, or acting appropriately in response to this pandemic?
3/ Generally speaking, do you feel *the media* is under-reacting, overreacting, or acting appropriately in response to this pandemic?
4/ Generally speaking, do you feel *private citizens* are under-reacting, overreacting, or acting appropriately in response to this pandemic?
5/ What do you predict will be the true fatality rate (percent of those who will die) of this infection once we have stronger testing to find all who are both symptomatic and non-symptomatic?
6/ What number of deaths worldwide do you predict will result from this pandemic?
7/ How soon do you predict we'll have a vaccine for #covid19 approved and widely available to the public?
8/ How many people do you personally know who have been confirmed to have #covid19? (Blood test verified)
9/ Do you consider yourself at high risk if you are infected with #covid19?
10/ [NON-MEDICAL PROFESSIONALS ONLY]

All medical professionals click "(🚫 Doesn't apply to me)"

Are you concerned about your local hospital being able to treat you or your family should they get infected?
11/ [MEDICAL PROFESSIONALS ONLY]

All non-medical professionals click "(🚫 Doesn't apply to me)"

How concerned are you about your hospital or clinic having capacity to meet patient intake for ICU?
12/ How concerned are you for your financial wellbeing in 12 months?
13/ How concerned are you for the financial wellbeing of your country in 12 months?
14/ Thanks for contributing and making it this far!

You can find the original surveys posted exactly 5 weeks apart starting here:

April 1:

May 6:

June 10:

July 15:

• • •

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More from @realDaveFeldman

May 8
🧵 #KetoCTAUpdate thread

I have lots to share today on our recent Keto-CTA paper (#LMHRstudy).

Let's unpack:
⏳ Background & study overview
🤼 #MiHeart match analysis
📊 Initial findings
⚠️ Controversy & missteps
💡 New discoveries
📀 #OpenData release
✅ Next steps
2/ ⏳A brief background, study overview

(For those just tuning in...)

This research started 10 years ago with my work on #lowcarb/#keto, identifying "Lean Mass Hyper-Responders" (#LMHR) with this lipid triad:

+⏫#LDL #cholesterol ≥200 mg/dL
+⬆️#HDL #cholesterol ≥ 80 mg/dL
+⬇️#triglycerides ≤70 mg/dL

(See the original article here: cholesterolcode.com/are-you-a-lean…)

After trying (and failing) to get conventional researchers interested, I started the Citizen Science Foundation (@realCSF) – a 501(c)(3) Public Research Charity.

💰We crowdfunded a study budget for #LMHR and near-#LMHR individuals with this triad. It took a lot of work, but the community stepped up to make this happen.

📝 We recruited 100 participants who traveled to Lundquist Institute to undergo a high-resolution heart scan called a CT angiogram (#CTA).

A year later (visit 2), they returned for a second #CTA, allowing Lundquist to compare the scans and track plaque progression.

When Lundquist shared the aggregate data of the first set of scans after they were completed, I was excited, but we needed more data to make comparisons.Image
3/ 🤼#MiHeart Match Analysis
-- Semi-Quantitative --

Component #1:
🔬The semi-quantitative match with Miami Heart showed nearly identical plaque levels with our Keto-CTA cohort
---

Following the initial baseline scans, Lundquist was then able to conduct a matched analysis with participants from another study, known as Miami Heart (#MiHeart). Eighty of our participants were matched with individuals from this other study based on age, sex, ethnicity, and shared low CVD risk factors.

They were compared with a semi-quantitative analysis. Semi-quantitative readings involve a cardiologist visually evaluating and scoring plaque buildup at key locations in the coronary arteries.

So what were the results?

In short, our participants, with an average LDL cholesterol of 272 mg/dL over 4.7 years, showed no statistically significant difference in plaque levels compared to the Miami Heart cohort (average LDL cholesterol: 123 mg/dL).

You can read our published paper for this analysis here: jacc.org/doi/10.1016/j.…Image
Read 11 tweets
Apr 14
🧵 My thoughts on the Baseline Piece of the Puzzle
-- That everyone keeps missing... 1/10

A week ago today the longitudinal paper for our KETO-CTA study dropped (jacc.org/doi/10.1016/j.…) and there's been a lot of positive feedback, but also critiques worth discussing. I'd like to zero in on the topic of NCPV and PAV change.

First and foremost, I’m looking to be respectful of lead author Dr. Adrian Soto-Mota (@AdrianSotoMota) and Principal Investigator Dr. Matthew Budoff (@BudoffMd) regarding the complexity and relevance the heterogeneity of the cohort with regard to our findings. The coming paper expanding on this for both classification and clinical use is already under submission for review.

However, waiting for the publication of the new paper seems very untenable given how long these things take and interest in discussing the overall change in NCPV and PAV for the KETO-CTA study.

This can be challenging on my end as I want to represent this study effectively. And that’s difficult right now when I not as versed to delve deeper into both the heterogeneity relevance statistics like Dr. Soto-Mota or the issues with looking to changes in NCPV or PAV at low baseline levels like Dr. Budoff.

However, here’s what I can speak to…

I can speak to my own personal challenges in looking to the change of NCPV and PAV overall and why this hasn’t made sense to me. Not from a standpoint of discouragement, such as — this makes the study look bad. No, I mean it actually doesn’t fit any model I’m aware of save present plaque being predictive of future plaque change.

Let me unpack what I’m talking about…

Our baseline scans from the study showed this was a low risk population. Again, if looking at this from a population level.

But then, we were able to do a match analysis with Miami Heart. Matching up age, sex, ethnicity and risk factors quite tightly, but with our cohort having an average LDL-C of 272 mg/dL, and the matched Miami Heart cohort having average LDL-C of 123 mg/dL. And what did we find? They were nearly identical. In fact, for the semi-quantitative data ours was trending slightly better. jacc.org/doi/10.1016/j.…Image
2/10 - Moreover, while unpublished, I was cleared to present a preliminary quantitative match analysis with Miami Heart last year at a conference. These would make use of Cleerly scan data for both our cohort and Miami Heart. So it had both overall plaque volume and non calcified plaque volume (NCPV).Image
3/10 - But even better, there was a subgroup analysis that excluded those taking cholesterol lowering medication on Miami Heart to match again with ours... Image
Read 10 tweets
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

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