1/ Interesting thread by @mak_sysepi regarding a recent study on HDL-C with a massive sampling -- 15.8 million! academic.oup.com/ije/advance-ar…

Note this tracks my favorite metric, All Cause Mortality.

(Hat tip @DrNadolsky)
2/ If you already follow my work, you've known for some time that I value looking to HDL-C alongside triglycerides. In particular, I like to compare the "low carb lipid triad" to atherogenic dyslipidemia. HDL-C is a very important part of each...
3/ The paper we're working on for the Lipid Energy Model focuses on studies that demonstrate HDL-C going up and down as it relates to metabolism, both in a health and diseased state.

It's worth noting a very common association of high HDL is alcoholism.
4/ So if I'm reading this right, we can combine the 3-4 and 5-7 days a week drinkers to all three groupings:
Low HDL-C: 10.9%
Med HDL-C: 12.8%
High HDL-C: 14.8%

Certainly it's reasonable to consider some amount of the high HDL-C hazard ratio could be impacted by alcohol use...
5/ Even so, it's still doing substantially better where compared to low HDL-C.

That said, I sure would love to further stratify by low TG given the total volume we have to work with in this data.

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More from @DaveKeto

9 Feb
A paper combining Triglycerides/HDL-C and All Cause Mortality with dialysis patients --

This deserves a #ReadingThread... (at least between my calls and meetings today)...
"In fact, traditional CV [cardiovascular] risk factors, such as hypercholesterolemia and obesity, have not been found to be reliable predictors of mortality risk in these patients..."
"... as previous studies have shown these factors are paradoxically associated with better survival in the hemodialysis population."
Read 15 tweets
7 Feb
1/ There really has been a sea change I've noticed lately with regard to both the #LipidTriad and the #LMHR phenotype.

I'm not going to call anyone out, but I will say there are many who I had several spirited discussions in the past few years...
2/ ...who considered high LDL = "high" risk, full stop...

... but are now expressing #LMHRs may actually be at "low" risk of cardiovascular disease (in spite of having LDL in the 95% of the pop), just that they "could be better" if they have these LDL levels lower than they are.
3/ It's worth emphasizing their position hasn't changed with regard to higher LDL = *more risk* of CVD. Thus, it would still be better for #LMHRs to have lower LDL, all else being equal.

But the magnitude of difference in the assumed risk has changed for many.
Read 6 tweets
6 Feb
Ah — looks like I have a podcast for my walk today...

... I may be adding comments to this thread as I listen...

@FoodLiesOrg @TuckerGoodrich @drcateshanahan
Had to run minute 23 Tucker brings up that there are some amount of these PUFAs that are necessary and obligate to the body, but the quantity is typically much higher in the modern diet due to heavy use of seed oils...
... I bring this up because I do think @TuckerGoodrich is often portrayed by others as though he’s against any amount of PUFA in the diet. As always, I’m #ProNuance. ;)
Read 5 tweets
2 Feb
Really enjoying this latest podcast on @PeterAttiaMD’s #Drive so far.

Now up to the part where Dr Yassine is discussing GLUT1 regulation with the brain... (about 22m in)...
Hmmm...

“... the brain is not efficient at using fat as a source of ATP.”
“... nevertheless when the brain goes through crises and cannot utilize glucose, we have a mechanism to extract ATP from fat. But the result is a price tag, the result is oxidative stress.”

Please visit this around minute 24 to get the full context.
Read 5 tweets
23 Jan
1/ So I did my 3D body scan this morning (and no, not posting pictures or sharing absolute numbers).

This will have been 5 days since isocaloric carb swapping in low-ish carb for keto.

Waist +0.9"
Stomach +1.2"
Hip +0.4"

Wow... in 5 days? This was pretty unexpected...
2/ Just a reminder-- this is the most controlled experiment between phases I've had to date. Replicated sleep and exercise timing and patterns, even water quantity and consumption window.

Given this shorter time span for the phase, I wasn't expecting much difference to emerge...
3/ Although, to be sure, both my wife and I noticed I was putting on more weight in the midsection even before the scan. I'm holding at around 199.6 for two days in a row, so while I gained around 2.5lbs initially, it seems to have leveled off.
Read 8 tweets
21 Jan
1/ Well... this is awkward...

I'm gaining weight on my "bonus" carb-swap phase in spite of it being isocaloric and everything else being nearly identical (exercise, sleep, supplements, even liquid consumption) w/ prior keto phases.

And I'm gaining it pretty fast, actually...
2/ And actually, the "low carb" phase is technically slightly lower in calories than the keto phase.

And this experiment is as controlled as I get
- Fixed eating times with fixed meals (9am/2pm/7pm)
- Fixed exercise (walking) with same route and time (~3pm)
- Comparable sleep
3/ Sure -- like many reading this, I'd assume this is in large part glycogen and water gain. But I'll concede this is impressively fast given I'm at maintenance level of calories -- which was literally just demonstrated in the run-up phases before this one.
Read 4 tweets

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