1/ 😁Thread -- About Me -- 5 year update😁

It's been a busy 24 hours since @joerogan's podcast dropped where @CarnivoreMD discussed our work (mega thx, Paul!). There's been a surge of new followers, so I figured it was high time to do an update for those just tuning in...
2/ I'm a senior software engineer and systems architect having developed a variety of platforms over my career.

Five years ago next month I saw my cholesterol levels skyrocket on a ketogenic diet and was extremely interested as to the mechanisms behind it...
3/ I began learning everything I could about Lipidology and the system that moves #cholesterol around in our body. To my surprise, it has many structural things in common with a network (a very advanced one, mind you), but soon I was manipulating my own lipid levels easily.
4/ In fact, the first major data I was gathering in 2017 revolved around the Inversion Pattern where (unintuitively), I demonstrated the three day average of dietary fat would inversely impact LDL-C levels when fat-adapted.
5/ Long story short, this has ultimately led to development of what I call the #LipidEnergyModel which might help to explain this phenomenon of higher cholesterol when fat adapted, particularly if metabolically healthy.
6/ I recently presented this to @Stanford in the following talk, though it does get a little technical:

And to be sure, it's a work in progress. We're putting together the paper right now.
7/ If pressed for time, you might want to check out this five minute, highly simplified version:
8/ The #LipidEnergyModel led to recognition of a common "triad" of (1) high #LDL Cholesterol (LDL-C), (2) high #HDL Cholesterol (HDL-C), and (3) low Triglycerides (TG)

This pattern doesn't apply to everyone low carb, but it does seem proportionally more likely where healthy
9/ Conversely, there's a pattern that is nearly the opposite known as "Atherogenic Dyslipidemia" with low HDL-C, high TG, high proportion of "small dense" LDL particles.

It associates with high cardiovascular disease risk and all cause mortality.
10/ You'll hear me talk about these two lipid profiles a lot because I think they are fundamental to our understanding of disease and how it impact lipid levels.
11/ Over time I recognized the spectrum of this triad would have one group at the far end of it, which I observationally called "Lean Mass Hyper-responders" (LMHRs) LDL≥200, HDL≥80, and TG≤70

This pattern crosses all genders, ethnicity and ages
12/ And actually, this group tends to have some of the lowest cardiovascular risk markers overall, save the one of interest with LDL.

It's worth pointing out that we don't know how much or little these risk factors interact as this is very uncharted territory
13/ Those with the triad, and particularly LMHRs, are understandably concerned about having higher total and LDL cholesterol. The vast majority of lipid professionals, cardio associations, etc recommend against this, full stop
14/ While I often say I'm "cautiously optimistic" with regard to this triad as it relates to risk given the specific context of fat adaption, I'm being very explicit that it's an unknown. There are definitely bad reasons for high LDL and the two are not mutually exclusive.
15/ Moreover, I strongly advise everyone reading this to check out articles making the case for lowering LDL, don't just look at the skeptic's position.

My colleague, @DrNadolsky penned a good one at my request here: cholesterolcode.com/guest-post-the…
16/ Here's my own presentation from last year at Keto Salt Lake regarding cholesterol and risk:
17/ All that said, while @DrNadolsky and I have differing hypotheses regarding risk in this context, we're thankfully teaming up with @DrRagnar to test it directly with a LMHR study.

Here's the pitch video -- although note it has changed from 5 years to 1
18/ You can help us make this study a realty by showing your support here: citizensciencefoundation.org/campaigns/lean…
19/ Lastly, I have to add a big shout out to my good friend and collaborator, @siobhan_huggins, who both helps manage the CC site and specializes in the vastly complex, yet often lipid-related #ImmuneSystem.

One of her best articles to date: cholesterolcode.com/lipoprotein-po…
20/ Feel free to visit the blog to learn more about our work: cholesterolcode.com

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More from @DaveKeto

29 Sep
1/ Thread -- Let's Get the Data

Many medical professionals (like my good friend and colleague, @DrNadolsky) feel strongly that #LowCarb-ers may be acting very recklessly by allowing their #LDL #Cholesterol to be much higher than the guidelines allow.

2/ And this may well be the case.

Certainly if "diet induced" high LDL is the equivalent to genetically high LDL, such as those with #FamilialHypercholesterolemia (FH), then there should be likewise rapidly progressing #atherosclerosis.
3/ "The sine qua non of FH is severe elevation of total and LDL cholesterol levels." jaoa.org/article.aspx?a…

Often heterozygous FH is considered where LDL is 190 to 500 mg/dL, with homozygous being above 500.
Read 14 tweets
25 Sep
1/ So allow me to get engineer-y for a moment -- I was really happy with how the structure of this debate played out.

To recap:

- We worked out having 5 minutes uninterrupted from each for opening statements to the featured questions...

2/ - After that, we moved into the "unstructured, conversational" portion of the debate on that question.

Since I said I'd give a polite warning whenever either participant ran over 5m, it seemed both took around 5m each in a back-and-forth during this phase...
3/ To be sure, both participants might have the other interject for clarifications or to make a point briefly, but it was almost never abused.

And my general rule was to give the one being interrupted some extra time to complete their point. And overall, this worked very well.
Read 6 tweets
23 Sep

(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?
Read 15 tweets
21 Sep
1/ #ListeningThread @drlipid on @PeterAttiaMD #Drive

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

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… )
Read 12 tweets
20 Sep
The Five Stages of Emotion with Methodical N=1 Experiments:

Stage 1: Excitement at the Idea

You realize with just X days of intensive effort and Y blood draws, you'll get some extremely valuable data.
Stage 2: Focused Beginning

You hit the ground running -- checklists, clocks, scheduling with cooking and phlebotomists!
Stage 3: Dread at the End

This experiment is taking fooooooorever. Why do you even do these things? Every day seems to get exponentially longer.

And are those few hickups you had going to ruin everything anyway?
Read 5 tweets
17 Sep
1/ Thread -- Avoiding the #MisstatementLoop

Taking the interest in understanding another's position and where they are coming from is key to having a productive conversation / debate.

But what if someone is persistently misrepresenting your position - even if unintentional? Image
2/ Of course, the most obvious example of this with clear malice is the Straw Man fallacy (which I won't go into here).

Yet what about where someone restates your position in a way that's not too far off, save some critical flaws that you assume are a simple misunderstanding?
3/ What happens next reveals the problem.

You find you're spending a lot of time attempting to clarify your position in a good faith effort to correct the misunderstanding -- but it isn't working. The other party either isn't getting your original point with repeated attempts...
Read 6 tweets

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